Tuesday, November 03, 2009

it's probably not funny

we have a different sense of humour. we just do. what we find funny can be macabre to most people. it is probably part of our general desensitization or maybe it's a way of dealing with the things we see. you can't get emotionally involved with everything. i remember realising this many years ago. but more recently i saw it again in a very strange turn of events.

i was a fifth year student in paediatrics. for ward rounds we were accompanied by physiotherapist students and social worker students. that morning we arrived for rounds. one of the sixth years asked the sister where one of his patients was because the bed was empty. the sister informed him the patient had died during the night. i got the feeling from their interaction that it wasn't totally unexpected. the sixth year turned to one of his colleagues and laughingly said;
"yesterday i was so busy, but today seems to be my luck day. two of my patients were discharged and one died. now i only have one patient."
the social worker happened to be within earshot. her face was one of absolute horror. she was devastated. but the sixth year didn't mean it in a bad way. he was simply not emotionally connected to the clear human drama that had played itself out. maybe he had been one too many times or maybe he was just like that. i just remember being impacted by the difference in reaction to the same news by the two people.

the second story happened when i was already qualified as a surgeon. i was on call. while i was waiting for theater time i was sitting with the radiologist going through scans (this is something i tend to do still). at a stage the radiographer came through. she wanted his opinion on a scan. apparently she couldn't understand what the contrast was doing and wanted to know if she needed to do a late phase scan. we both went through to see.

the patient had been referred to the hospital as a head injury patient after a car accident. he was intubated at the referring hospital as is good practise for these patients so he was already on a ventilator. the casualty officer suspected he was coning (a preterminal event where the brain stem gets pushed through the opening where the spinal chord exits the skull due to increased intracranial pressure, usually due to trauma inside the skull) and had therefore phoned the neurosurgeon. he had in turn instructed him to do a scan of the brain. the casualty officer decided to do an abdominal scan at the same time because he wanted to make sure there wasn't also abdominal trauma. and thus the patient ended on the ct scan table with the radiographer wondering what was going on with the contrast.

as we entered the scan room i too was perturbed by where the contrast lay in the abdomen. the contrast had been injected through a central line in the neck. it had gone straight through the right atrium into the ivc. there it had moved into both the right hepatic vein as well as the right renal vein. it was nowhere else to be seen. the radiologist immediately made the obvious diagnosis (in retrospect).
"i know what's wrong," he proclaimed. "this patient is dead." of course with the patient on a ventilator it was not immediately obvious. the radiographer went through to feel for a pulse, which, looking at the scan, i knew he would not have.

i started laughing. everyone else was shocked, more at the fact that i was laughing than at the fact that there was a dead guy on their scan table.

maybe they are right, it's probably not that funny.

13 comments:

DHS said...

actually. it is funny. I think having to diagnose death (via imaging, blood tests) is always funny.

amanzimtoti said...
This comment has been removed by the author.
rlbates said...

Well, I guess I'm with DHS and amanzimtoti. I am "horrified" that the diagnosis of death had to be made by radiologic imaging.

amanzimtoti said...

I must admit, when I first heard this story, I also thought it was very funny. It's true that we see humour in things that aren't funny to others or joke about patients being selfish to come in or deteriorate when it's inconvenient to us. Of course we don't really mean it, but lay people seem to be offended by that sort of thing. Sometimes we have to adjust, depending on what company we're in. We do get touched by the human side of it, but it's also easy for us to dissociate or move on quickly. Most of the time.

Vijay said...

:)

…{ :) }…

PS. first smile for the story. i've diagnosed death on imaging. the second smile between parenthesis is an in joke between me & the great bongo!

Mel Content said...

Very funny story...you've just updated the "House of God's" First Resus Rule=always check your own pulse first

Jabulani said...

Different senses of humour don't just apply to medicos and lay people. It's a cross-cultural phenomenon too. I've been in the UK for nearly 20 years and STILL I have to watch myself. I used to think I just had a warped sense of humour until I encountered other South Africans here. Now I know it's not just me. That's inordinately comforting, but not to these Poms ;)

Anonymous said...

question - i'm not in medicine but enjoy reading about it: are there no monitors on the patient during the scan process that would indicate death? or is it only because the abdomen was scanned that there weren't monitors to tell you when the heart stopped?

Vijay said...

Anonymous 5:42 AM

I'm a radiologist.

I'm surprised that an unstable, severely injured patient was shifted to scan without attached pulse-oximeter &/or ECG monitor. In radiology we don't routinely attach monitors except for cardiac scans.

Jayne said...

I think the somewhat warped sense of humour is a coping mechanism & without it - particularly the medical professionals - would be complete nutcases! I thought your story was funny :-)

When I collected my fatherinlaw's ashes from the funeral director, I just made it outside of the building before bursting into a fit of hysterical laughter......I honestly couldn't help myself. I just thought to myself "'ey up grandad, you're alot lighter now than what you were when you went in!" Even my motherbylaw had to laugh :-)

Bongi said...

anonymous, i actually don't know what monitors were on this patient. however probably the only one worth anything in a move to the ct bed would have been the pulse oxymeter, which can be deceptively unreliable.

neurosurgery can be a very philosophical field. no neurosurgeon is going to cut a guy's skull open without a scan. if he is already coning it's probably already too late to do anything. the casualty guy phoned the neuro guy and carried out his instructions. between casualties and ct, obviously something happened. i'm not sure it was avoidable. it was already too late.

DHS said...

two discharges, one death, one patient remaining: how can you be having a busy day unless they were all Whipples?

NesQuarX said...

The sense of humour is a very personal thing as I have found. It's just that the differences get particularly highlighted in your profession...