Working With the Bottom 1% of the Class

Dr. Dumbshit came in to work a weekend shift as a locum. It took me about 15 minutes to figure out Dr. Dumbshit was an accurate representation of his name.

I know that medicine is not an exact science. Being in the medical field gives me a behind the scenes perspective that the general public does not have. When most people complain about a doctor being an ass, a dumbshit, or a sanctimonious piece of crap - I usually just nod and smile, thinking the whole time, "Yeah, okay. Sure, that's your perception." But oh let me tell you - I would agree 110% with them on this one. I think that he may have opened up every medical journal and textbook in sight and said, "Ah...nah....they're not right. I'll do it the opposite way."

EMS brought us 2 victims from an SUV rollover. The 16 year old girl had been sleeping in the backseat and was partially ejected out the side window. Her upper body was in the rig, and her legs were trapped under it as it came to rest on it's side. Luckily, it landed in a ditch so there was a little "give" room under her legs. She still ended up with an obviously deformed left thigh.

Dr. Dumbshit and I prepared for her arrival in Trauma 2. I put the blue handled Xray pad on the stretcher in anticipation of getting her off the backboard ASAP, and still providing a somehwhat stable environment for transfers to CT scan, etc.

"Why are you doing that? Get that thing off of there!" Dr. Dumbshit yelled. Yes, yelled. Our very first interaction and my first thought was 'he has a lump of coal up his ass that may already be turning into a diamond.'

"Um......I'm preparing the stretcher for our trauma patient. This is standard for when we get them off the backboard."

"They better not be on a backboard. There's no reason for it," he replied.

HELLO? Seriously? This was an unrestrained backseat passenger in a rollover crash who was partially ejected. If they didn't require immobilization then I'd eat my cousin's dirty underwear.

"Trauma Standards of Care indicate they should be immobilized. And they will be, because our EMS crew is excellent in the care they provide."

Just as ended my sentence, Medic 1 rolled in with our IMMOBILIZED and splinted patient. God love 'em.

Dr. Dumbshit stomped his foot and yelled, "WHY IS THIS PATIENT IMMOBILIZED? NOW I HAVE TO SCAN THEM!"

Sweet shit on a stick. Seriously, this man was on the verge of a breakdown. The spittle was flying and the veins were bulging on his forehead. I pulled Lucy to the side and told her to go find Dr. Q quickly. Unfortunately, Dr. Q was busy with the patient's mother who was in the other room.

As our patient was screaming in pain, Dr. Dumbshit decided to start his trauma survey focusing on her leg. Yes, he skipped A, B, C, D, E, F, and G and went right to her leg. He started poking and prodding and attempted to take the spider straps off of her. Medic 1 and I both reached down and refastened the straps immediately.

"Dr. Dumbshit, do you think you might want to start with the primary assessment?"

Damn it all, he was messing up our flow. Trauma's are meant to be run in a very particular order. When you follow that order, things flow smoothly. You don't miss anything that needs addressed first, and you don't focus on something that does not matter at that particular moment.

"Nurse Crazy Pants, I can see that her leg is probably broken, so why don't I just start with that? Hmmmmmmmmm?"

"Well Dr. Dumbshit, maybe you might want to start with Airway, Breathing, and Circulation since I think she might have a pneumo. Her breath sounds are decreased on the left and she's having some difficulty breathing." Then I whispered under my breath "stupid idiot."

"WHAT DID YOU SAY?" he yelled.

"I said 'Sure, I'll get it'" handing Medic 1 a needle for a possible decompression.

"Oh, well, OK. Sure, let's do that. Yeah. Maybe we need a stat Xray too."

"Coming through!" Our blessed radiology tech shouted and pushed into the room with his portable machine.

"Yep, I already put the order through for that Dr. Dumbshit," I replied.

Luckily, the Xray revealed a minor pneumo. A little oxygen and she was good to go. We didn't have to intervene immediately with something more serious. Her IV lines were started by EMS in the field and fluids were infusing, so we didn't have to worry about that at the moment either. Her vitals were somewhat stable and we completed the rest of her trauma assessment. The splint was still on her leg and providing stabilization there. No increase in swelling noted, pulses palpable and strong. Cap refill brisk.

"OK, let's check her back." Dr. Dumbshit said as he threw off her straps faster than I could cross the room and started to roll her.

"STOP!" I yelled.

"Huh? What?" he said.

"Dr. Dumbshit, we need to do a log roll on her. Let me get 3 other people to help."

"Ah no, we can do it ourselves. She'll cooperate - won't ya Betty Lou?"

"No. You will not roll her without doing it right. Stop right now until I get additional staff." I pushed myself between him and the patient.

"All right, whatever Nurse Crazy Pants. Have it your way."

"Thank you," I replied. Stupid Idiot.

"What did you say?" Oops! did I say that part out loud?

"Um, I said um.... I'm stepping in it. You know - the blood on the floor."

"Harumph," he replied.

Dr. Dumbshit and I then had a professional disagreement about what to scan on her. He felt nothing. I felt maybe stem to stern related to her mechanism of injury. I won. Only because he got tired of me not backing down. But seriously, are we giving good trauma care here or are we just trying to protect the patient from unneeded radiation? Which takes precedence? I would think life saving interventions and the complete CT scan would help us there.

Upon her return from CT scan, Dr. Q made his way into the room. A brief update to him on the occurrences of the last 20 minutes enabled him to send Dr. Dumbshit to the fast track area of the ER while Dr. Q assumed care of the trauma patients.

Thank you blessed baby Jesus!

We ended up shipping the patient out to a larger facility to surgically repair her femur fracture. She did very well and after rehab was back to her normal self.

I never saw Dr. Dumbshit again.

Please Let Me Go

He lost his wife to cancer 4 months before, his precious Betty Sue to whom he had been married for 40 years. He began drinking the day of her funeral and hadn't stopped. One Sunday evening, he decided he had had enough and wanted to join Betty Sue. So he drove himself in front of a semi truck.

He was still alive.

He was still conscious.

The trauma team was ready, the flow went smooth. Our patient ended up with a left chest tube, lacerated spleen, a tear in his intestines, pelvic fracture, a femur fracture, bilateral forearm fractures, and a minor closed head injury. Before we intubated him for his emergent trip to OR1, he kept screaming "Let me die! Let me die!" He was sobbing and saying he wanted to be with Betty Sue.

His son arrived just before we were planning intubation. "Steve - tell them to let me die! I need to be with your mom. Please! Please!" His son was crying and shaking. "No Dad, I can't. I can't lose you too."

"Please Steve, please let me go," his dad replied.

"Damn it Dad! No! Stay with me! I need you here!" Steve yelled at him.

His Dad turned his head away from him and refused to speak again. He was crying the whole time. As our physician explained to the patient what we were going to do (intubate, OR, etc), he made no indication that he was listening. He just cried.

This man was 60 years old and had the potential of many more years of life. The stress of the situation could have been warping his view of what he wanted. The head injury could be doing it too. He wanted to die, but only to be with his deceased wife. What ethical road do we take here?

The gentleman ended up in ICU for 6 days. The entire time in ICU he was asking the nurses to let him go. Telling them he wanted to die. He had multiple consults with psych/mental health/social workers to no avail. He was still determined that he wanted to die. He refused to speak with his son or any other family members.

On day 7 he was transferred to the Surgical Trauma floor where he promptly coded 35 minutes after arrival. They worked on him for 40 minutes before they called time of death. Many of us have often wondered if he did something to assist his death since he was no longer under 1:1 observation. He was so determined to die.

This was one of the saddest cases I've been involved in. He had sunk so deep into his depression after the death of his wife that he couldn't even reach the edge of rational thought. How do you fight something like that? I think when someone has made a decision to commit suicide in a large manner (driving in front of a semi truck, shooting self in head, etc), there is no turning them back. He was intent on joining Betty Sue, and he eventually did.