Tuesday, December 19, 2006

Behold, the Awesome Power of Human Stupidity

There are some days that I encounter patients whose actions, driven by an utter absence of common sense, cause me to leave a treatment room shaking my head in dismay and mumbling to myself.

I'm not talking about the basic run-of-the-mill honest mistakes here. These are not the "I thought I had shut off that circuit before cutting the wires" kind of crowd. These are the runner-ups for the Darwin Awards who tried very hard to kill themselves but failed through sheer incompetence, thus disqualifying themselves from glory. Their survival was not so much a matter of God mercifully wrapping His arms around these people. It would be more accurate to say that the Angel of Death simply rejected these people because his pals at the bar would never have believed the story- it would have just been too easy. Even the Angel of Death has his standards, you know.

But just when I think I have seen something that officially qualifies me for the "I Have Seen It All" Hall of Fame, someone else discovers a new and creative way to come this close to finishing himself/herself off, only to survive to tell the tale to his/her grandkids. And oh, yes: they do procreate.

In fact, I think that there is a lost race of human beings whose origins have vanished in the mists of time; a race whose progeny now walk among us, wearing our clothes, eating our food, and sending their children to our universities; and yet these homonids have not quite shed the self-immolating tendencies of their predecessors. This race might very well be the missing link between the Darwin Laureates who managed to extinguish themselves on their own merits, and the Robbie Knievels of today. (By the way: I know a guy who claims, proudly, to have been shot in the foot by the younger Mr. Knievel. But I digress...)

I call this lost race Homo hey-watch-thissicus.

The hallmark of the species is its absence of a state of being merely accident prone, which is more the manner of H. jerrylewisium. Rather, the defining characteristic of the race is its ability to operate in a realm of logic that defies the laws of physics, thermodynamics, organic chemistry, common sense, and fire codes. The three most commonly-observed subspecies (that is, those who wind up in Emergency Rooms across the nation more often than any others) are Homo jackassii, Homo webmedicus and Homo mindblowinglystupidiens.


H. jackassii are a subspecies who instinctively choose to do things, without giving due thought to the empiricals of physics, that invariably lead to great personal physical anquish and embarrassment. These are the numbskulls who sit in shopping carts and let their idiot friends push them down a steep hill with parked cars on either side. (I've met them- or more to the point, I've met their parents, who tend to be exceedingly embarrassed when I come out to explain to them why their stupid kid is in the ER this time.) Others of the species choose to car-surf (I've scraped acres of real estate out of their backsides). Still others try to jump their BMX bikes over a busy street during rush hour (not realizing that a mere human on a lightweight bike has inadequate mass to achieve either the velocity or the momentum to carry himself/herself aloft on a trajectory spanning the minimum fifty feet required to clear the cars on the opposite side of the street... and even on the exceedingly rare chance that they do make it to the other side, then landing on both wheels without sustaining a screamingly-painful testicular crush injury or vaginal contusion upon impact of the rider's perineal area with that teensy-weensy bicycle seat... yikes!). These yobbos end up with shattered feet, shattered ankles, shattered tibias/fibulas, shattered knees, shattered pelvises, internal injuries, shattered femurs, compression fractures of the spine, skull fractures, facial avulsions... And do they wear helmets? Nooooooooooooooo...

ERs across the country attest that the jackassii gene is not exclusive to either the X or Y chromosome.


The second subspecies, H. webmedicus is marked by a set of ideas and thought processes regarding illness and treatment that are completely divorced from reality and logic. These are the people who, sometimes without benefit of a high school diploma, consider themselves more medically-savvy than the folks who go to college for an entire frigging decade, since they can now "google" their symptoms and treat themselves with mail-order medications from the internet. Of course, by the time these people arrive at my ER, the damage has been done- often irrevocablly so.

One such H. webmedicus case immediately comes to mind. Her husband stated that she had "chronic chest congestion" (self-diagnosed) and decided to manage it herself; after all, she had read a number of internet articles on the disorder.

"Well, that's all that you guys do, isn't it?" He concluded. (At that moment I fervently wished that slapping was considered a therapeutic intervention.)

Never mind the fact that MDs and RNs go through continuing years of education throughout our entire careers to understand the intricacies of a human body that even now remains insanely, humblingly complex to even the greatest minds among us. All we really do is just google the stuff anyway. Hmph.

Somehow, the woman managed to obtain Prednisone without a prescription. She then arbitrarily decided that 100mg daily should do the trick. We met about a month later when she arrived at my ER in full-blown Multiple Organ Dysfunction Syndrome (MODS). The boyfriend told me that she had discontinued the prednisone the other day without tapering off.

As it turns out, she lived- but she was so physically deestroyed that the rest of her life (such as it is) promises to be an ordeal of physical, emotional, and psychological agony. Her major organs are ruined, and she emerged from her ordeal a different person.


The final subspecies is characterized by sheer abject stupidity with regard to self-care. One shining example of H. mindblowinglystupidiens can best be described in the following recent encounter:

A young man came to my ER treatment room with a garbage bag over his lower leg. He was whisked back to me before being fully triaged. The triage nurse apologetically told me that when she saw how badly he was bleeding through his dressings, she made the decision to bring him straight to the available trauma room.

I said, "No worries. My other folks are stable. I can triage him."

Well, the guy was simply lolling back and forth in the wheelchair, deathly pale and clammy. The ER Techs and I gowned up and gloved up. We chair-lifted the guy from the wheelchair to the gurney and put him on the monitor. He was tachycardic (fast heart rate), tachypnic (fast breathing rate), and just not at all well. I removed the garbage bag that covered his leg and noted at least a pint in there. I began to move faster. His full-length wool sock was wringing wet with blood. There's another pint. Blood was pouring through the dressing. I figured that this guy had been bleeding for at least half an hour, since he drove himself to the ER.

I sloughed the sock off the foot and it fell into the bag with a wet slap. I then noticed the dressing: thick layers of tape covered the gauze below. The tape was wrapped completely around the patient's leg haphazardly, as if in haste. There was no way to find the end of the mess, so I had to cut the dressing off. I ordered one tech to hold up the leg, ordered another to get me a couple of pots of 4x4 gauze and Kerlix rolls, and whipped out my trauma shears.

As I began cutting carefully through the dressing, I asked the man to tell me what happened. He informed me that he had been seen in the ER yesterday because he was cutting down cardboard boxes with a fresh box knife and accidentally cut his leg while bracing a box against it. Honest mistake, I thought to myself. The automatic assumption is that the sutures failed, or an artery suddenly decided to "let go."

As I finished cutting, I told the two techs to get ready and I carefully peeled back a section of the dressing. A jet of bright red blood shot from under the dressing and painted the drape four feet away, Jackson Pollack style, before arcing straight up and narrowly missing the Tech holding the patient's leg. She, a new Tech on her first week in the ER, let out a startled yelp and jerked her head away reflexively. I clapped the dressing back over the leg, grabbed gobs of gauze from the other tech (a veteran of the ER who simply said "Hmph"), and calmly (I think) told him to get more Kerlix pronto.

I once again raised the old dressing, prepared for the "pumper" this time, and slapped new gauze moistened with sterile saline over a distinctly new and very deep wound just below the wound that was sutured last night.

"Where did you get the new cut?" I asked.

"I did it today," the guy moaned. "I was changing my dressing."

"You cut yourself again when you were changing your dressing?"

"Yes. Ohhhh," he moaned.

"Okay. How do you slice the heck out of your leg changing your dressing?"

"I didn't have any scissors. Ohhhhhhhh."


I ordered the rookie tech to hold pressure, ordered the veteran tech to continue wrapping the leg, and I stepped over to the meet the patient's gaze. I leaned over the man, directing his eyes toward mine.

"Please tell me you didn't use the box knife," I whispered. "Please."

"I used the box knife," he moaned. "Ohhhhhhhhhhhhh."

I stripped my gloves off and walked out of the room to get the MD, shaking my head in dismay and mumbling to myself.