Haven’t had much to blog about lately but the events in Boston yesterday have stirred me.
Of course the first thing you think of when you see those horrifying images of people who lost limbs is the overwhelming sadness and disgust with the event itself. However, as an ER doctor, I immediately start thinking about what it would be like to be working at a hospital nearby (Like the Brigham). How many really badly injured patients did they get? How many people were working. How in the Hell would I handle that huge bolus of unstable patients were I there?
But then I remember that when the shit REALLY hits the fan like in this circumstance, everyone goes from a whiny, grumbling, complaining about everything (drug seekers, bogus pts, etc) mode into superhuman mode. The adrenaline surge takes over, your mind becomes razor sharp, and you become a machine. You work harder than ever without a break and you don’t even think about it. You become more efficient than usual and your skills increase. You are at your best when you are needed most. You put that fire out.
Just like after that tragedy in Joplin,MO after that tornado that nearly destroyed a hospital, I look forward to hearing stories from the ER staff and other firsthand accounts from EMS and Police. I’m sure they’ll be impressive. I’ll wonder how I could ever do something like that but then I remember that they would be thinking the same thing were they the ones reading the stories. The worst does indeed tend to bring out our best.

This is sort of like a Keith Richards post.
Want I mean is how is it possible that someone could abuse their bodies as much as Keith Richards does and still remain alive?
However, in this case I mean how could some people who are riddled with as much diseases they are still keep coming into the ER week after week after week, month after month after month, and year after year after year?
Clearly nothing appears to be able to kill them. Not +4 pitting edema with weeping liquid coming out of everywhere. Not a massively dilated left ventricle and an EF of 25%. Not hemoglobin A-1 C of over 10.0. Not two packs of cigarettes today. Not a diet which appears to consist solely of Big Mac extra value meals, washed down with a 32 ounce high fructose corn syrup laden soda beverage.
There’s only one answer besides luck, genetics.
Others are victims of the complete opposite.
They have the bad luck to get sick die way too early.
One day in the future I’m sure we will be able to predict what someone’s likelihood of getting illnesses is when they are young based about their genetic makeup. Those at low-risk will be able to go on and smoke,drink, eat, and not worry about anything. Those with the bad genes will know they have to do something to prevent it.

Sometimes heard as an utterance expressing exasperation, it sometimes carries a more literal meaning. Take this chief complaint:

“disturbed man brought in by police for being witnessed defecating in a bucket in his front yard”