GSW!

The Setting:

I work in a private community hospital. The “community” we serve is in a dangerous part of town. There is a fair amount of earned non-taxable income. This is slang for drug dealing and prostitution. Drug dealers have a vested neighborhood interest and that is they don’t want any other drug dealers in their neighborhood. I didn’t say it was a happy community. Interlopers here frequently get introduced to the business end of a gun.

I don't live in this community. When I moved into my neighborhood we got cookies!

My neighbor, Chris, has much better looking flower beds than me. Still, I haven’t shot him…..not yet.

Anyway people always want to hear about Gun Shot Wounds. We are wonderfully blessed to be located near Vanderbilt University. The chaps down at Vandy have a most excellent Trauma Center, but they don’t take it all. There is a screening process.

We get 2 kinds of GSW’s at Skyline: the quick and the dead. EMS takes GSW’s to the chest and abdomen to Vandy, if the patient is alive when they arrive. These are the serious but saveable patients. This is good for multiple reasons. Primarily they have the staff to take care of it. They also get state funding. My surgeons are a great bunch of guys. They would love to take out your appendix or gall bladder. They don’t do so well with exploded livers and spleens. They also like to get paid and dealers and hookers don’t get health and dental.

First the Dead:

The first type of GSW’s we get are the “not quick” - meaning dead. EMS is called to a volatile scene, they scoop, they run. They don’t take the patient to Vandy if the game is already over. A tragedy has occured. It’s a failure on multiple levels. Having no where else to go, EMS comes to the ER. There is usually nothing for us to do. The police come and take a lot of pictures. I’ll speak to family members where I never really know what to say.

The family is ushered into the “Quiet Room”, every ER has one. This is where we break the news. I have some standard phrases I have honed over the years. There is a real art to this and we even practiced this in residency. “Your son is dead”, “I am sorry for your loss”, “This is as bad as it can ever get”. Sometimes everyone is real quiet, sometimes not. I go back to the bedside and help the nurses with the body if I can. There is a lot of gravity in this situation. Someone will inevitably try to crack a joke just to break the tension. This is an ER coping mechanism, not disrespect. I am sure we have all developed some deep psyche repression issues because of this, but it comes with the territory. Thick skin or at least the semblance of it.

And then there are the quick:

The quick are extremity shots and I can’t begin to explain what a non-event this has become. We get a call “GSW to the arm” and it’s really no big deal. If the arm is not blown off and no major bones, arteries or nerves are broken, the patient gets discharged. This summer alone, I have personally taken care of different patients with GSW’s to the arm, leg, both legs, in leg/out butt, in arm/out shoulder, etc. All of these patients were discharged. These people have been shot! Frequently they are out of the ER in less than 90 minutes.

Ironically every single patient has the exact same history.

Me: What happened?
Patient: I got shot.
Me: Who shot you?
Patient: Some dude.
Me: What were you doing?
Patient: Minding my own business.

“Some dude” has major issues with people minding their own business, he has shot over 20 patients this year. That’s the bad news. The good news is that Dude has pretty lousy aim.

I have seen several patients who have been shot multiple times and they are fine. Can you believe their luck? With my luck, someone could accidentally drop a bullet in a fireplace, it explode, bounce off 5 different things and hit me right between the eyes.

We saw a "Dude" this week who had been shot in both arms. How does that happen!? How can a bullet travel through both arms and miss everything between? No kidding, I have seen TWO patients in my career who got shot in their freaking head and the bullet glanced off the skull and the patient got away with minor injuries and a hell of a headache. These guys should drop whatever they are doing and immediately move to Vegas.

So anyway, One of the purposes of this blog is to try to give helpful ER insider tips. Here is this months entry.

Don’t get shot.

Eight Dollar Beer Rant

One draft beer at a Titans game is going to set you back eight bucks!

Actually, I don't have a problem with that. ER doctors and nurses hate drunk people. There is no way to sugar coat it. It's just that simple. Let me start with the guy who had "two beers”, every drunk patient I have ever cared for has only had “two beers”. Mr. Two Beers climbed a utility pole in an attempt to turn a city street light so that it would shine more directly on his lawn so he could cut his grass at night. Funny right?

Not so funny when he was electrocuted and fell 20 feet.

How about the young lady who was in Nashville celebrating her bachelorette party on the eve of her wedding; she didn’t have to pay for her drinks that night and everyone was buying. The ladies made it to see me that night in the ER. A night of fun ended up with me on the phone with this young girls parents telling them she had stopped breathing and was now on life support. Party over.

How about the fraternity pledge who passed out drinking, regained consciousness and then was required to participate in one more “brotherhood building” event consisting of dropping shots of whiskey into mugs of beer and drinking the entire thing. He passed out again but this time didn’t wake up.

Alcohol is the drug involved in more accident deaths than all the others combined. More than cocaine and heroin by far. Marijuana doesn't even make the list. The beauty is that not only is alcohol legal, it is marketed more than any other drug in the world.

Where is the FDA?
The FDA sends out frequent warnings about drugs that may cause you harm. Pediatric cold medicines and vomiting medicines recently made the list. You can't buy them over the counter and I can't prescribe them to you if you are under six. So tell junior he better just learn to love the taste of boogers. A certain arthritis medicine, later deemed unsafe, triggered a class action law suit. From reading their advertisements, I am not sure if Viagra is going to make me have sex or cause me to have a heart attack. Look at the lawyer speak heaped on drug company commercials. When is the last time you heard a declaimer on Budwiser commercial? Viagra should be so lucky.

Don't drink? Well you're not safe either. Overwhelmingly the number of fatal car accidents in the United States are alcohol related. Domestic violence, alcohol related. Child abuse, alcohol related. Assaults, alcohol related. My unofficial estimate is that alcohol cost our health care system in the hundreds of millions of dollars.

Now, I’m not a pariah either. I enjoy a nice glass of wine with dinner or sharing a beer with a friend. But what I am saying is that alcohol is a mind altering depressant and must be treated as such. I’m not proposing a new era of prohibition, but the ideas of prohibition were not misguided. Like all medications there should be strict regulations on its distribution. Abuse of this medication cannot be tolerated. Not only should you have to have a license to sell alcohol it should also be required for individuals to have a license to buy and consume alcohol.

Primarily our parents, high school principles and college presidents should completely crack down on underage drinking. It is absurd that one can purchase a six pack of beer for less than ten dollars. Our DUI laws are advertised as strict but how common is it for someone to get 2 DUI’s? Public intoxication is considered a misdemeanor and maybe gets a citation. How can we all be offended by the evil tobacco and let alcohol have a free pass? Where are our class action lawyers when we need them? Our law enforcement in Tennessee should take this crime much more seriously. It’s also time for our insurance companies to consider alcoholism as dangerous a diagnosis as cancer.

So next time you are at a Titans or Predators game and have to fork over eight dollars for a beer, you should think in a more intelligent world this price is about right.