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Tuesday, March 20, 2012

Just Another Day in the E.R.

by Anatoly Belilovsky, M.D.
[Editor's Note: We had some questions about a submission that, while generally well-written, depended on a resolution that seemed to have been written by someone with absolutely no understanding of vertebrate anatomy. We asked Dr. Belilovsky for a few words of advice and he sent us this piece, describing his typical working day.]

There was nothing we could do for the man with the shuriken embedded in his forehead: it had penetrated eleven millimeters into the vital subcutaneous lobe of the brain. Death had been instantaneous. I wrote DOA on his chart and turned my attention to the people with less-severe injuries.

“Here is a man with a GSW to left shoulder,” said Yolanda, my medical student. “That could be serious.”

I gifted her with a benign smile. “Gunshot wounds to the shoulder are rarely serious,” I said. “Here in the Fiction General Emergency Room, you will find that bullets usually enter the subclavian fossa just under the collarbone, make a hairpin turn to avoid the subclavian artery and vein, then navigate the maze of nerves in the brachial plexus, and finally exit just under the glenoid fossa, narrowly missing the head of the femur.”

“Isn't that humerus?” she asked.

“Severe or not,” I said sternly, “gunshot wounds are never humorous.”

She giggled uncontrollably. Some people never develop much of a bedside manner.

A woman walked in on two broken tibiae, using a furled umbrella to support herself. I left her to Yolanda's ministrations while I attended a female police officer who had been shot point-blank with a .50-caliber machine gun. Her flak jacket stopped the rounds, but their kinetic energy propelled her through a brick wall and down two floors to land on the roof of a taxi. While she was unconscious I took great pains to ascertain that her 38DD's had sustained no damage; not even a bruise, in fact. When she awoke she attempted to accuse me of groping, remembering my name from my badge, but since she could not remember her own name, her words were not given due credence.

Near the end of the shift a man ran in. “I have been poisoned!” he shouted. “You must find the antidote! I have 43 minutes to live!” We did our best, but as the 43rd minute chimed, he paused in his recitation of the story of his life, his eyes rolled, and he fell over dead, on cue to cut to the commercial.

In the ensuing silence I heard Yolanda mutter, “...said 'femur' instead of 'humerus'” as she glanced in my direction. “Epic boner,” Nurse Cassie replied.

I smiled.

All in all, an unremarkable day. Straight out of Harrison's Textbook of Stochastic Medicine.
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