Sunday, October 14, 2007

More chicken-stapling and a simple wish for Christmas

Santa, Baby, hurry to the unit tonight....

All I want for Christmas is total and complete immunity, starting now, from all derangements of the nervous system for myself, my family, and all my friends. That's all I want.

Because, frankly, when you say to a coworker "I've seen one too goddamn many cases of brain cancer this week", you have to stop and reconsider what you're doing for a living.

Sarcoma. Lymphoma. Glioma (high and low-grade both, inoperable and semi-operable both). More sarcoma. Metastases. Astrocytoma. Every-darn-thing-oma you can think of. And, of course, the worst cases were in the most pleasant and productive people. One of my favorite patients in a long time showed back up due to complications of his particular -oma, and he'd lost 40 pounds in two weeks.


So it was with relief that I took report on a patient who'd had the misfortune to catch some sort of weird necrotizing disease. It wasn't that flesh-eating bacteria, nor anything you can get from, say, a bug bite--it was something I'd never heard of and couldn't spell, and promptly forgot the name of as soon as the shift was over. At any rate, it was a nasty case of face-eating whatever.

You know the mask the Phantom wears in the Lloyd Webber musical? Imagine the lines of that mask, but including the entire nose, covering your face. Now imagine that everything inside the outlines of that mask is gone. Eyelid, nose, cheek, mouth--down to the bone, including muscle and fat. That's what happened to this dude. He'd gone on vacation to somewhere lovely and quiet (Belize, maybe?) and come home rested and tanned. Three weeks later, his face had rotted off.

So he came to us and we rebuilt him in a series of surgeries. I got him after the second-to-last one. He'd already had all the nasty infected stuff cut and scraped away, and his eyelid and cheek and lip rebuilt (and the surgeons did a hell of a job, I have to say). This last surgery was the basic structure of his nose, and used rib bone and grafts from various tender places like his thigh. (Query for those more experienced with flaps than I am: if you take a flap from the upper thigh and build a nose out of it, won't it...uh...grow hair like it would if it were on the leg?)

Here's the really shocking thing: Two weeks after his last surgery, the eyelid-and-mouth rebuilding one, his eyelid and mouth looked essentially normal. I mean, give him another month to heal up and you wouldn't know anything was ever wrong with the guy. Plastic surgeons don't get nearly enough credit for doing really good work.

In other news, the war sucks. So does the Gubmint.

Take a 23-year-old kid. Put him in a tank in Iraq. Hit that tank with a shoulder-launched rocket. Make sure that a piece of shrapnel takes out a chunk of his right temporal lobe and a bit of one of his frontal lobes.

Medivac him to the nearest mobile unit so they can save his life. Then send him off to Germany, where he will get comprehensive, high-quality care. Once he's stable, send him home without a plate in his head. They can always replace the plate at the VA, right?


And in so doing, they can totally fuck him up.

I'm not exaggerating when I say this: our local Veteran's Administration hospital is the sort of place you wouldn't send your worst enemy. One of the residents I trust implicitly came back from there with stories of dirty surgical instruments--packets of stuff for brain surgeries coming from Central Sterile with blood and Cheetos inside. Nurses I've worked with tell stories of coding patients who are cold and stiff. It's bad. There are rats in the bathrooms.

So Army Boy ended up there. And underwent a total of twenty-eight surgeries to clear infections that would never have happened had he gone to a facility that took basic pride in, you know, keeping wounds clean and administering antibiotics. Eventually, as it will, something bad happened: he ended up in septic crisis and stroked.

So now he's 25, permanently and severely disabled, addicted to Demerol (a pain medication that no sane person ever uses for neurosurgery patients, as it's neurotoxic in large doses), and is rated at 40% disabled by The Gubmint.

Which means, essentially, that he's going to be living on 40% of his already crappy private's pay for the rest of his (probably shortened) life.

I am not usually political on this blog, but I have to say this here: Of all the harebrained, poorly conceived, abysmally managed, and based-on-bullshit things I've ever seen in my life, this current war is the worst. It's competing neck-and-neck for disdain with the way the VA here treats its patients.

We do get veterans from time to time, usually with some problem that the VA can't fix. I had one guy early on in the Iraq war who'd had half his face blown off by an IED. I had a woman with a tricky trio of amputations that had to be revised--she'd gotten hit by enemy fire while serving in a "support" role. 'Cause women aren't allowed in combat, don't'cha know.

Every time I see one of these guys or girls, it breaks my heart. It's one thing to take care of a 70-year-old with CNS's another to care for a 19-year-old girl who's missing both legs and an arm, and to know that that condition arose from the lies and grandstanding of someone who never saw combat.

And now I will stop. Nurses believe in God, I think, primarily to have somebody to blame. All I can say is, when God and I meet up at the end of my life, we are gonna have one Hell of a Come-to-Jesus meeting.


Penny said...

Since you got political, may I take the opportunity to get religious?

When He Who Thinketh Not departs from this plane, he's going to stand before Jesus, get looked right in the eye and hear, "Depart from me. I don't know you."

And as wrong as it is, I take huge comfort in that.

Which doesn't do a damn thing to help any of the people mentioned in your post, or any of the hundreds of thousands of Iraqis. Which is also why I'm reading a lot of Patricia Cornwell these days.


overactive-imagination said...

Yes, the hair grows....and then they go for laser hair removal. Pretty easy fix and a hell of a lot less traumatic than what it sounds like many of your recent patients have been through.
Agreed...on the political rant. It's truly a sad state that we are treating our soldiers in this manner, really makes me angry.

Fighin Dirty said...

Omg, that is terrible. It is said, "If you want peace, prepare for war.". All of our servicemembers are volunteers. It's my hope that before signing any papers recruits fully recognize the hazards of their chosen profession.