blood sports

i love rugby. i used to play on a fairly low level, but when i injured my acromioclavicular joint i knew i needed to stop. it was fun but i was not willing to put my body on the line any more. it seemed too dangerous for me. recently i have reviewed this decision.

the first patient i touched on in a previous post. during a game of soccer the goal post fell on him and split his pancreas in two. the tail then slowly shrivelled up into a hard fibrotic mass. the story came to a happy ending when i removed that distal portion of the pancreas. by that time it was embedded in scar tissue and it was quite something to peel it off the renal vein behind it and the splenic vein above it. somehow everything went well. i was just left with a sense of how dangerous soccer can be.

the next patient was playing a game of snooker. i can only assume he was winning and by quite some margin because his opponent seemed to get annoyed at a stage during the game. i know this because he suddenly shot my patient. and he didn't shoot him once or twice. for good measure he put four bullets through him. he must have had an unassailable lead in their friendly game of snooker. unassailable by the standard rules anyway.

so, recently having treated two casualties of the blood sports of soccer and snooker, i realise rugby was really not that dangerous at all.

pancreas

recently i did a distal pancreatectomy (i removed the tail of the pancreas). it was an exciting operation. the guy was the victim of a soccer goal post falling on him, causing fracture of the pancreas. the injury was about two months old, just enough time for the pancreas tail to become a hard rubbery fibrotic mass adhered to everything. i took it out without removing the spleen (with supreme difficulty) and was very proud of myself. i thought back to the days of old.

when the prof felt we didn't have full control of the ward, he'd let us have it and he wouldn't let a thing go (as i have mentioned before). i remember once when he ripped into me in front of my students, but worse still in front of the patient i was to operate the next day. she must have felt great to hear that the guy who was going to take a knife to her the next day was 'useless and had lost all control of his ward'. it must have engendered in her a feeling of safety and comfort.

anyway, one of the imageries the prof used regularly was of someone riding a bike without handle bars, implying loss of control. i remember him telling me in front of my junior colleague, all my students and my patient that my ward was chaos and i was riding the bike without handle bars (i had failed to remember the sodium value for one patient and needed to refer to the results). as usual he went on for some time.

a while later we admitted a guy with a fracture of his pancreas. the next morning, as usual, we presented our cases to the prof in front of all the registrars. the prof asked the usual questions about diagnosis, presentation, treatment options and so forth. one of the things he wanted to know was how it had happened. it is usually the result of blunt abdominal trauma. the pancreas gets caught between the vertebral column and whatever caused the blunt trauma. in this case the patient was riding on his bike, he did a jump and came unstuck in mid air. he then fell with his abdomen onto the handle bars.

in the very formal setting of the morning meeting i had just presented the case to the room full of stern faces with the prof looking for a gap to have a go at some poor unsuspecting sod when my junior leaned across and whispered in my ear;
"that's why i think you should always only ride the bike without handle bars!"

i could not hold back my laugh. the prof was not impressed but it was worth it.