With neighbors like these...

Who needs enemies?

The Egyptians, don't ya just love 'em? The majestic pyramids, the flowing nile, the inspiring mass demonstrations for freedom. Can't get enough of 'em. The Egyptian border army just loves to send us work in the form of multiple trauma victims.

Sudanese and Eritreans fleeing the horror in their own countries, seeking asylum, hazard the long trek to less than open arms here in Israel. This unwelcome is preferable to the treatment in Egypt,  where en route they are robbed, beaten, raped and killed. Those, like my most recent patient, manage to get to the border only to be shredded by machine gun fire. Those wonderful Egyptians, sometimes they wait for the hapless victim to cross the border, and sometimes they don't, in which case they dump the body on our side of the border. That way, the Israeli taxpayer can foot the bill for their treatment.

The latest victim of Egyptian hospitality was a young  African man evacuated by helicopter. In the Trauma room, he had a pulse, barely. He had gun shot wounds to his abdomen, left leg, right arm, and just to add insult to injury, one bullet ripped through his genitals.

We rushed him into surgery, the surgeons did damage control, stopped the bleeding and and resected damaged bowel. Despite packed cells, plasma, thrombocyte and crystalloid infusions, he wasn't stabilizing. "He's bleeding somewhere else",  I said to the surgeons. I put the chest film on the screen, normal. So, no bleeding in the chest cavity.

We removed the drapes and found blood dripping from the leg and the forearm. The orthopedic surgeon came in. The x-ray showed that the midshaft of the femur was totally pulverized. There was a pulse in the lower leg, so the artery wasn't damaged.  Ortho stabilized what was left of the femur with an external fixator and the bleeding stopped. Vascular came in to find the ulnar artery torn. That was ligated and finally there was no more bleeding. We took the patient up to the ICU in stable condition.

Yep, those lovable Egyptians. Not only are they hospitable, but they are great shots too!

Do NOT jump to conclusions.

Warning, scenario number 4 may not be appropriate for all viewers...

Happy Passover!

I'm reposting my all time favorite matzah video:

I couldn't have said it better myself.

Hat tip: Jamil

The Iron Dome Game

Update: over 50 missiles have been fired into Israel since Saturday morning according to the Jerusalem Post. There should be no mistake, this is causus belli. Now the Hamas political wing is distancing itself from the military wing. We're not fooled. They are murdering savages as they always have been.

The boys in the neighborhood have invented a new game called "Iron Dome" (The antimissle system that has successfully intercepted and destroyed several of the missiles. The system intercepts only those that endanger major population centers): One kid throws a ball into the air, and another tries to knock it down with a frisbee.

Children remain children, even during war.

A Terrible Miracle

I was planning to post more about the doctor's strike because the media is repeating Treasury's propaganda about money hungry doctors. The best laid plans of mice and men...

The Hamas terrorism by missles has escalated. This is actually not true. There are always missles and mortars and katyushas, but this time the results were tragic. But that's not true either. The ongoing terror of Southern Israel by the barbaric arabs of Gaza is ever present. Whether there are casualties or not is irrelevent. The disruption of life is enough. This the world doesn't want to understand in it's quest to champion the cause de jour. We left Gaza, it was painful and traumatic for us. Despite Arab probaganda there is no shortage there of food, fuel or any commodity. What more do they want? It's obvious, they want us dead. To justify their barbarism the Arabs continue to perpetuate the lies that we are oppressing them, when it's the exact opposite. They oppress and terrorize us, and have been doing so for a 100 years.

I was supervising anesthesiologist in the OR two days ago. The alert came: send an anesthesiologist to the trauma room. There was a missle attack on a school bus, one critically injured child is being evacuated by helicopter. "Only one?" I thought to myself. Either there was a terrible tragedy and only one survived or there was a terrible miracle and only one was injured. As it turned out, the bus was empty except for that one boy and the driver. Minutes before, 50 children had alighted the bus. A disaster was narrowly averted. Later, the Hamas took credit for the attack that was perpetrated with an anti-tank missle. This means that the clearly marked bus was deliberately targeted. The bastards.

The neurosurgeon brought the boy, a teenager to the OR. The expression on his face told me all I needed to know. Critical head injury requiring a craniectomty to relieve the elevated intracranial pressure. We did all medicine can do. Now it's up to God.

When we transferred the boy to the PICU (Peds ICU), the parents were in the waiting room. The father stoicly quiet, and the mother crying silently.

Heartbreaking.

Self Service

I've been doing this medicine gig for over 14 years, if you count medical school it's been about 20 years that I've been living, drinking and eating medicine. During these two decades, I've seen some pretty astounding things. And every time that something extraordinary presents itself, I say, "That's it, now I've seen everything. I will never be surprised again." There is a limit to how many surprises one can encounter.

Right?

Wrong. 

Every time something else pops up. And it leaves me scratching my head in wonder. So yesterday I was on call in the OR. The surgeons were bringing down a guy who had stumbled into the Emergency Dept.  a few days ago drunk as a duck after having been savagely beaten by, as he put it, "some very bad people".

The CT scan found some sort of cyst or hematoma in the area of the pancreas and an intimal flap (a small tear in the inner surface) of the aorta.  He was in the ICU and so I prepared the room for an anesthetized ventilated patient. These preparations are actually quite simple since they come from the ICU fully monitored. I call these patients, "plug and play". Just hook 'em up to the anesthesia machine and the monitors and let the games begin.

The intercom crackled that the patient from ICU had arrived, so I hastened to the entrance of the OR. Not surprising, the patient was intubated. Not surprising, the patient was not sedated. Most patients develop a tolerance for the breathing tube, after a couple of hours if there is no other indication, they need little or no sedation. 

The BIG surprise, the thing that made this patient unique, the thing that made my jaw drop and rub my eyes in disbelief, was that the patient was not connected to a ventilator. Well, that's no surprise, I often transfer patients to and from without a ventilator and I ventilate by hand with an ambu bag. However, in this case, the accompanying physician was not ventilating the patient. In fact, the patient was being ventilated by ...

The patient! 

There he was, sitting upright in the bed, an ambu bag connected the the endotracheal tube, and he was ventilating himself.

Now that's  Self Service!

Now I've seen everything...until next time.