Literal...

Libby, my oldest, has the tendency all four-year-olds have of taking everything I tell her very literally. This sometimes has untoward consequences. A few weeks ago, we were heading to the library to check out some books and movies. We had not taken the girls in a while, so we were explaining the principles of appropriate library etiquette. Libby asked why we need to be quiet in the library. "Because," I replied, thinking quickly and trying to be clever, "if you aren't quiet the librarians tie you up."

"Why?" - of course, the standard response.

"Because there are people trying to study, and they need it to be quiet."

She nodded slowly, letting this idea sink in.

I forgot all about this conversation until last night, when, in celebration of my birthday, we went out to dinner, shopping, and finally to the library. It was very late (7:00) by the time we got there. The girls are usually being bathed by that time of day, and their ability to cope with stress was at a low ebb. Immediately the girls began fighting over the library computer, shrieking, and generally being naughty. Audrey had to be taken outside for an attitude adjustment within a few minutes, but she returned a tiny bit calmer and quieter.

Libby, not to be outdone, began screaming at the top of her lungs at Audrey a few minutes later. Amy had had it. She took Libby by the arm and marched her for the door. Libby, terrified, began yelling, "No! I don't want to be tied up!"

All heads turned toward Amy as she walked out the door, a determined look on her face, with a terrified, struggling child at her side. "Where on earth did Libby get that idea?" I wondered, still with no recollection of our prior conversation, and mortified that all the library patrons now believe that Amy and I punish our children by tying them up in the basement or something.

 

When we got home, Amy asked Libby why she had said what she did, and she said "Daddy told me they would tie me up." The recollection of our prior conversation came flooding back. Oops.

 

Amy glared at me. "You can't tell them things like that! You need to clear anything you tell the kids with me first."

 

I'm kidding about that last sentence, but I am sure that is what she is thinking.

Guns and coumadin don't mix

This is a patient who came in after reportedly shooting himself in the forehead with a 25-caliber handgun. He was reportedly taking coumadin, an agent that is used to keep the blood from clotting.


Incredibly, when he arrived in the emergency room he was alert and conversant with the ER staff. They saw the entrance wound on his forehead, but couldn't find an exit wound.

The first image they took was an x-ray of the skull.



The white thing just at the level of the nose is the bullet. The little arrow on the forehead is a marker that the emergency room put on the patient to show where the entrance wound was. It also shows the skull fracture that ensued from the bullet wound.

When he became unresponsive, they rushed the patient to the CT scanner to get a better idea of what was going on in his head. This is what they found initially on the "scout radiograph" - the initial image they take to plan where they will take "slices" with the CT scanner.





This is a side view of the skull. Again, the dot on the forehead shows where the bullet entered the head. The bright thing in about the middle of the head is the bullet, which is embedded in the soft tissues at the back of the patient's mouth. The dark oblong shapes in the middle of the head should not be there - those are indicative of air within the space that should be filled with brain or cerebrospinal fluid.




This is a slice through the patient's head at the level of the forehead sloping back just above the ears. The black dots throughout the head are collections of air that are moving around within his shattered skull. The white rounded area near the top of the image is clot and blood within the brain, marking the path the bullet took as it went down through his forehead, through his nasal cavity, and down into the soft tissues at the back of his mouth.





This image shows the exact path that the bullet took. It is a side view through the head showing the wound (at the upper left of the image) with the bone fragments traveling diagonally downward until you get to the bullet (the bright rectangle at the bottom center of the image).

Suffice to say, this was a non-survivable injury and the patient soon succumbed to increased intracranial pressure - probably from bleeding into the space that should be holding his brain. Gross!