Road warrior

For those who haven't heard, I have been riding my bike to and from work - about 10 miles each way - for the past couple of weeks. I have loved it - I feel like I get good exercise, I have felt invigorated when I get to work and when I get home, and have felt like my thighs are each getting to be the size of my waist.

Well, all that has come to a crashing halt. I was riding my bike home last night, and got in a wreck.

The way it happened was this: I was riding home on a relatively low-traffic road in Sacramento. I came to an intersection where the cross street had a stop sign and I did not. A lady in a late-model Mercedes stopped at the stop sign, glanced both ways, did not see me, and pulled out in front of me. I hadn't planned to stop, since I had the right-of-way. Despite slamming on the brakes, I ran into the side of her car on the driver's side.

My bike tore the driver's side rear-view mirror off the car and made a big dent in the driver's side fender. I flew off the bike, landed on the hood, then rolled off onto the ground in front of the car, taking off the hood ornament on my way. I was glad she stopped - she could have run me over.

I got up slowly, and had the following injuries, some of which are seen in the picture, though Amy points out that the picture does not do my road rash or the gauges in my fingers justice:


- Scrapes on the middle, ring, and small fingers of the right hand.
- A large road rash across my right forearm.
- A swollen, scraped right shoulder right at the point of the bones at the top of the shoulder.
- Two small scrapes across my right forearm.
- A swollen scrape across my left forearm.
- A scrape across the back of my left upper arm.
- A scraped, bruised right knee.

I also have a scraped and dented helmet, and a sore ego (as well as a sore bottom).

Thinking back, I realize that I don't remember visual images of the whole accident. I remember thinking "Oh no! I'm going to hit that car!" and yelling out loud "Noooo!" Then, I have the recollection of a series of thumps (probably me flying onto, then rolling down the hood) and a bigger thump as I landed on my right side on the ground.

Another bicyclist who had seen the accident stopped and gave me her business card, in case I need to get corroboration for my story.

The lady felt awful - she was more shaken than I was, as might be expected for one who has seen a grown man go flying across the hood of her car. She called her husband, who courteously brought his pickup truck and gave me and my somewhat-worse-for-wear bike a ride back home.

When we arrived, a troop of worried girls came out to greet me. My three-year old wore a grave expression, and kept coming up to point at my bleeding knee with both terror and fascination. My wife reports that she has been perseverating about her daddy, repeating over and over that "Daddy has big owies!" and looking out the window for me.

My wife gave me the "I told you so" look when I got home. She has never felt safe about me riding a bike, and now feels vindicated and upset that I didn't listen to her warnings. I feel wretched, but not nearly as wretched as I would have felt if I were paralyzed or dead.

I showed up to work the next day, showing off my bruises and scrapes (and kind of enjoying the attention - this story gets better every time I tell it). My father-in-law, attorney that he is, points out that I am not being a very good client - I should have stayed home, with my neck in a soft collar, moaning and groaning.

I think my days as a road warrior are over. Like Chief Joseph of the Nez Perce, "I will fight no more forever."

More stories

Favorite stories from today:

"44-y man who fell asleep while riding his motorcycle, wiped out, and hit a tree." (He broke his right hip pretty badly).

Stories

Best story from today:

"67 y/o woman fell down at home and was unable to get up. When her family came to help her, the family dog, a pit bull, bit her on the face."

Some guys have all the luck

This 19-year old man was "minding his own business" when he heard four gunshots and felt sharp pain across the front of his chest. He saw some small wounds on either side of his chest, and drove himself to the hospital.

His blood pressure and pulse remained normal. He had no trouble breathing.

A CT of his chest showed the following:



The dark spots across the front of his chest are specks of air in his pectoralis major muscles. There were skin defects at the upper right and left chest, but no other injuries. Basically, the bullet did the following, missing everything else important:

More good stories

"32-yr old man who went out to dinner with his friend. After dinner, during an argument about who would pay the bill, the friend stabbed the patient in the chest with a steak knife. In an ironic twist, neither of them wound up paying due to the arrival of police and paramedics. (Incidentally, patient's blood alcohol level was 0.400 at the time he arrived at the hospital.)"

"28-yr old man who became depressed, drank some alcohol, then jumped off the roof of a gas station."

"46-yr old woman who lost consciousness when her boyfriend assaulted her, punching her in the face. She awoke to find her house on fire and a bystander dragging her from the blaze."

"29-yr old man who presented - incidentally, on the night of his birthday - immediately after being shot in the abdomen."

Yup, those are my patients!

Histories

My favorite histories from the ER today:

"23-year old man who arrived at a party and shot several of the partygoers. The other partygoers responded by assaulting him, beating him about the head, chest and abdomen with hockey sticks and cricket bats."

"36-year old man who was attempting to shoplift some alcohol from a liquor store when another patron tackled him. He presented after he fainted while in police custody."

Yup, those are my patients!

Anti-smoking ads

These are some of the most clever advertisements I have ever seen:

Singing Cowboy

Focus on the Positive

Miscarriages

Hitchhiker

Knife and Gun Club

When I am working in the Emergency Department, I see the CT scans and X-rays of nearly every injury that comes into the hospital. I am getting really discouraged by the superabundance of some specific injuries:

1. Gunshot wounds to the spine. Way too many teenagers and young adults are forever paralyzed from the neck or mid-chest down as a result of careless or, more likely, malicious people shooting them. I'm not sure what these patients were doing to induce others to shoot them, and I really don't care that much. Although I am sure that a significant proportion of those who are shot were engaged in illegal activities at or shortly before the time they were shot, it doesn't make me feel any better about these patients whose lives are now infinitely harder than they would otherwise have been.
   
   To wit, they will, for the rest of their lives, have no bowel or bladder control. They will need surgery to enable them to put catheters into their own bladders or to divert their urine into a hole on their abdomen so that it can be collected in a bag. They will either need surgery to divert their feces into a colostomy or will need their diapers changed for the rest of their lives.
   
   Of course, they also will be unable to move independently for the rest of their lives.
   
   I am further disgusted that these patients are now wards of the state. You and I, the taxpayers, are and will be paying for the lifelong care of these patients - for both the cost of their surgeries and the salaries of those who change their diapers and roll them around in bed. It sickens me that these patients are only unable to care for themselves because some other person made a rash and/or evil decision to pull the trigger of a gun.
   
   
2. Gunshot wounds in general. Way too many people get shot around here. Gunshot wounds are devastating injuries, shattering bones and organs alike, and causing all kinds of mayhem. While many people survive their injuries, those who get shot in the head tend not to.
   
   
3. Motorcycle accidents. These are a touchy subject for many motorcycle aficionados, but let's get real - every day I see horrible injuries sustained by people who are doing innocuous things on a motorcycle. For example, this man was riding his motorcycle at 10 miles per hour.
   
   
   
   He got clipped by a car, which shattered his left foot. He had to have his leg amputated below the knee.
   
   No matter whose fault it is, a motorcycle accident will always leave the motorcyclist in a world of hurt.
   
   
4. Lung Cancer. This is another subject that gets me somewhat upset. Way, way too many people are dying early because of smoking and its deleterious effects. Take, for example, this woman. An ordinary chest CT would have lungs on both sides of the chest, with the heart on the patient's left.
   
   This woman's heart has been displaced into the right side of the chest by this enormous aggressive mass that replaces pretty much her entire left lung.
   
   
   
   It is also making its way out of the chest cavity by bulging out between the ribs. What a crummy way to die.
   
   
   

Anyway, those are four of the most preventable problems in our society, and we see far too much of them. I wish, like Alma, that I could cry repentance with the voice of thunder, that all men everywhere might repent, that there might not be more sorrow upon all the face of the earth.

EtOH

After an experience I had the other day, my conviction that alcohol is not for the body and not good for man is much stronger.

I was reading CT scans from the emergency room, and a young man came in who had been backed over by a slow-moving car. His pelvis was smashed to smithereens, and he suffered facial fractures.

I was chatting with some of my associates about how he could have sustained such an injury, when it occurred to me to ask if his blood alcohol level had been measured when he came to the ER. It was twice the legal driving limit. I am sanguine that the blood alcohol level of the driver that backed over him was also quite high.

The next patient was a man who had fallen off his bicycle while attempting to get on it. Passersby noticed that he was struggling to get up and summoned the police, who brought him to the hospital. His alcohol level was 4 times the legal limit.

The next patient had been assaulted and stabbed. He was also drunk.

For the next several patients, I inquired as to the alcohol level of the patient. Every one of them had been too drunk to legally drive when they arrived in the emergency room - meaning that their blood alcohol level when they were injured was even higher.

Now, there could be a number of confounding factors in this sample; perhaps the emergency room has a lower threshold for ordering CT scans on drunk patients because the physical exam is less reliable, or maybe it was random chance. However, it is clear based on my experience that being drunk is a risk factor for being irradiated if you go to the emergency department. I would also suggest that, based on the mechanisms of the injuries I described above, being drunk is a risk factor for being injured.

So unless you want me to see some really embarrassing pictures of your insides, it's best not to drink alcohol in Sacramento or its environs.

I like the looks of these

bakingsheet: SHF #7: Graham Crackers

Homemade Graham Crackers
1/2 cup all-purpose flour
1 3/4 cups whole-wheat flour
1/2 cup sugar
1 teaspoon baking powder
1/2 teaspoon baking soda
1/2 teaspoon salt
1/4 teaspoon ground cinnamon
1/2 cup cold butter, cut into 1/2 inch cubes
2 tablespoons honey
2 tablespoon molasses
1/4 cup cold water
1 teaspoon vanilla extract

In a food processor, mix together the flours, sugar, baking powder, baking soda, salt, and cinnamon. Add the cold butter and process until the mixture resembles coarse meal, about 30 seconds or so. Add the honey, molasses, water, and vanilla. Mix until the dough startes to come together in a ball, another 30 seconds. Scrape dough out of the mixer.
Between 2 sheets of waxed or parchment paper, roll the dough 1/8-inch thick. Chill for at least 1 hour, until firm (I chilled for several hours).
Preheat oven to 350F. Retrieve dough and roll it a bit more if it is not yet 1/8-inch thick. With a sharp knife or pizza cutter, cut into 2-inch squares. Arrange the crackers on parchment lined baking sheets. With a toothpick, prick several holes in each cracker.
Bake for 15 minutes, until lightly browned at the edges. Remove from the oven and let cool on the pan.
Yield: 48 crackers

Note: If you cut the dough through but leave the squares together, you can break them up after they're baked, just like a store-bought graham!