No Stranger to Pain

It's no secret that August is a tough month for parents. No summer camp, no day camp, no activities. Just me and the missus versus three little indians climbing the walls waiting for someone to entertain them. I'm on vacation now which means that I'm actually conscious most of the time. We were up north for a few days near the Sea of Galilee. It was hot and humid and sticky but we found lot's of water based activities for the kids so that they had a great time. So did I actually. But it was a relief to be back home where we have "normal" weather - just hot.
This prelude explains why I've actually had time to blog. Here are a couple of cases that have been stewing in my overheated brain for a bit.


I had the privilege of being on call in the ICU on the day that the Chief decided that two patients should be woken up from anesthesia and weaned from the ventilator.
The first patient was a 50 something gentleman who fell off a ladder while painting his home in preparation for his son's wedding. He had a brain contusion and rib fractures which caused a pneumothorax thus necessitating the insertion of a chest drain. As I reviewed the chest film before waking him up I noticed that there were old rib fractures on the opposite side.

In an epiphany of free association, I recalled two of the greatest movies of all time: Rambo - First Blood Part II, and Hot Shots! part Deux. I remember a line that is uttered in both movies. It must be mentioned that the second movie is a parody of the first. In Rambo II, our intrepid hero is strapped to a device to be tortured by electric shocks. The device actually looks like an old bed frame from a 5th rate motel. So much for Hollywood production values. Rambo has his shirt ripped off, conveniently showcasing Stallone's muscular physique. The torturer sees the multiple scars that adorn Rambo's torso and says, "I see you're no stranger to pain". Rambo then just grunts a reply. In Hot Shots! the scene is recreated with Charlie Sheen as our intrepid hero. His reply to "I see you're no stranger to pain" is: "Yeah, I've been married...twice."

Anyhoo.

Ladder man was obviously no stranger to pain. I began the weaning process. At one point the patient was fully conscious and extubated. I informed him that he was in the ICU after falling off a ladder and enumerated his injuries. He said, "what are you talking about? I fell off a ladder two years ago!". Which explained the old rib fractures. He had absolutely no recall of his most recent fall. Attaining the full measure of sarcasm that I could muster, I suggested he sell his ladder. Unfortunately, the patient develped severe pneumonia necessitating reintubation and another week of mechanical ventilation. Needless to say, he missed his son's wedding.

The second patient was a young bedouin who was suffering from hydrogen sulfide intoxication. That's the gas that makes rotten eggs rotten, and flatulence, well, just stink. But is is also toxic in high concentrations. He was working in the sewer when he was overcome by the gas and lost consciousness. A fellow worker tried to drag him out but felt the effects himself and had to abandon his co-worker. A rescue team from the fire dept. finally extracted him after half an hour. In addition to the effects of the gas he had aspirated raw sewage into his lungs. This patient actually recovered quite quickly with treatment. When he awoke I told him where he was. He also had no recall of the events. It turned out that it was his first day on the job with a contractor. The contractor didn't tell him that the work was potentially dangerous. I told him that he should give thanks to the Almighty because he had come within a hair's breadth of giving up the ghost. I also suggested that he contact a lawyer. It felt good to sick the hounds of hell on a non-physician.

I just love giving good advice.