Monday, April 21, 2008
Revenge, a Dish Best Served Cold [(or how i learned to stop worrying and love dr. deborah peel (with propofol)]
A tri-malleolar ankle fracture is shown above. This is also a dislocation. The red dots are placed to show the track of the multiple fractures, the white arrow shows the tibia, the large, weight-bearing bone of the leg, translated forward on the talus bone of the foot. This is an orthopedic emergency as with a fracture-dislocation the vascular status of the foot can be compromised, so we have to put this back in place and this is done, usually, with a drug like propofol, and some cranking on the heel to pop it back in. Then it is splinted while traction is maintained, and then the patient gets an orthopedic procedure to fix it definitively. Recovery is usually quite complete in young healthy folks but you've got to get it back in place quickly.
Okay, kinda boring I guess. What is not boring about this particular patient is that he happened to be one of my medical school professors. He still teaches at my medical school and I recognized his name immediately. Turns out he has family in the town in which I currently practice. I saw his name on the board and went right in to see if it could possibly be the same person.
This patient, let's call him "Dr Peel", had insisted when the paramedics got to him, that he be flown immediately to his home institution. I told EMS on the radio 'absolutely not'. Besides the fact that we don't fly ankle fractures, we also can do them just as good as anyone else right here in Podunkville.
He was a little nicer when he realized that I was one of his graduates and I came back to the doctor's area and told everyone that I was living a wet-dream. I mean, here's a guy in great pain who is a PhD and made my life miserable for a year, with a bad injury, and completely at my mercy.
I gave him great treatment and got his ankle fixed up but I couldn't resist the following. This guy had taught anatomy and physiology, a first year medical school course, and knew it cold (as one would expect). This course is one of the many 'hoops' courses in med school. It's not that it will be important for us to know it in such detail, and for some of us it's not important at all, but you've got to jump through the "hoop" or you won't finish medical school. It's hard, it's incredibly detailed, and we had to know it all. So, when I gave Dr. Peel the propofol, instead of having him count backwards from 100 to get an idea of when sedation was adequate for me to pull on the ankle, I asked him to define the branches of the brachial plexus. At this point in my career all I can tell you about the brachial plexus is that it exists, and it's a bunch of nerves that extend from the lower C-spine out to the shoulder.
Dammit if Dr. Peel didn't get it all exactly right, even with high doses of propofol and a sloppy tongue. 100% correct. Damn. I got a nice note from him a few weeks later, he did well. Damned eggheads.
Also, as an interesting aside, google ads continues to plop a whole bunch of JCAHO ads on my site. Probably because it's bot sees the word "JCAHO" a lot here. Also, "CMS". I hate to have these businesses advertise on my site simply because we write "JCAHO" and "CMS" a lot. Of course, if all of you were to click on these ads these companies, parasites on parasites, would have to PAY ME BITCH! So, I do recommend clicking these ads often and seeing what wonderful services these douchebags offer. JCAHO. CMS. Click click. JCAHO, CMS, JCAHO, CMS.