Behold, the Awesome Power of Human Stupidity

There are some days that I encounter patients whose actions, driven by an utter absence of common sense, cause me to leave a treatment room shaking my head in dismay and mumbling to myself.

I'm not talking about the basic run-of-the-mill honest mistakes here. These are not the "I thought I had shut off that circuit before cutting the wires" kind of crowd. These are the runner-ups for the Darwin Awards who tried very hard to kill themselves but failed through sheer incompetence, thus disqualifying themselves from glory. Their survival was not so much a matter of God mercifully wrapping His arms around these people. It would be more accurate to say that the Angel of Death simply rejected these people because his pals at the bar would never have believed the story- it would have just been too easy. Even the Angel of Death has his standards, you know.

But just when I think I have seen something that officially qualifies me for the "I Have Seen It All" Hall of Fame, someone else discovers a new and creative way to come this close to finishing himself/herself off, only to survive to tell the tale to his/her grandkids. And oh, yes: they do procreate.

In fact, I think that there is a lost race of human beings whose origins have vanished in the mists of time; a race whose progeny now walk among us, wearing our clothes, eating our food, and sending their children to our universities; and yet these homonids have not quite shed the self-immolating tendencies of their predecessors. This race might very well be the missing link between the Darwin Laureates who managed to extinguish themselves on their own merits, and the Robbie Knievels of today. (By the way: I know a guy who claims, proudly, to have been shot in the foot by the younger Mr. Knievel. But I digress...)

The hallmark of the species is its absence of a state of being merely accident prone, which is more the manner of H. jerrylewisium. Rather, the defining characteristic of the race is its ability to operate in a realm of logic that defies the laws of physics, thermodynamics, organic chemistry, common sense, and fire codes. The three most commonly-observed subspecies (that is, those who wind up in Emergency Rooms across the nation more often than any others) are Homo jackassii, Homo webmedicus and Homo mindblowinglystupidiens.

H. jackassii are a subspecies who instinctively choose to do things, without giving due thought to scientific empiricals, that invariably lead to great personal physical anquish and embarrassment. These are the numbskulls who sit in shopping carts and let their idiot friends push them down a steep hill with parked cars on either side. (I've met them- or more precisely, I've met their parents, who tend to be exceedingly embarrassed when I come out to explain to them why their stupid kid is in the ER this time.) Others of the species choose to car-surf (I've scraped acres of real estate out of their backsides). Still others try to jump their BMX bikes over a busy street during rush hour (not realizing that a mere human on a lightweight bike has inadequate mass to achieve either the velocity or the momentum to carry himself/herself aloft on a trajectory spanning the minimum fifty feet required to clear the cars on the opposite side of the street... and even on the exceedingly rare chance that they do make it to the other side, then landing on both wheels without sustaining a screamingly-painful testicular crush injury or massive vaginal laceration upon impact of the rider's perineal area with that teensy-weensy bicycle seat... yikes!). These yobbos end up with shattered feet, shattered ankles, shattered tibias/fibulas, shattered knees, shattered pelvises, burst testicles, burst ovaries, torn uteri, shattered femurs, compression fractures of the spine, skull fractures, facial avulsions... And do they wear helmets? Nooooooooooooooo...

ERs across the country attest that the jackassii gene is not exclusive to either the X or Y chromosome.

The second subspecies, H. webmedicus is marked by a set of ideas and thought processes regarding illness and treatment that are completely divorced from reality and logic. These are the people who, sometimes without benefit of a high school diploma, declare themselves more medically-savvy than the guys who go to school for up to fourteen frigging years because they "googled" their symptoms and decided to treat themselves with mail-order prednisone from the internet... only to arrive at my ER in a state of steroid-induced psychosis and refractory shock after suddenly stopping the medication because they felt better. They usually leave either gorked (brain-dead) or so physically demolished that the rest of their lives promise to be an ordeal of physical and emotional agony beyond their wildest nightmares. These are the ones who think that one does not need to go through years of school to understand the intricacies of a human body that even now remains insanely, humblingly complex to even the greatest medical and nursing minds.

The final subspecies is characterized by sheer abject stupidity with regard to self-care. One shining example of H. mindblowinglystupidiens can best be described in the following recent encounter:

A young man came to my ER treatment room with a garbage bag over his lower leg, which was placed by the triage nurse. He was whisked back to me before being fully triaged. The triage nurse apologetically told me that when she saw how badly he was bleeding through his dressings, she made the decision to bring him straight to the available trauma room.

Well, the guy was simply lolling back and forth in the wheelchair, deathly pale and clammy. The ER Techs and I gowned up and gloved up. We chair-lifted the guy from the wheelchair to the gurney and put him on the monitor. He was tachycardic (fast heart rate), tachypnic (fast breathing rate), and just not at all well. I removed the garbage bag that covered his leg and noted at least a pint in there. I began to move faster. His full-length wool sock was wringing wet with blood. There's another pint. Still more blood was pouring through the dressing. So how long has this guy been bleeding? At least half an hour?

I slough the sock off the foot and it falls into the bag with a wet slap. I then notice the dressing: thick layers of tape covered the gauze below. There was no way to find the end, so I had to cut it off. I ordered one tech to hold up the leg, ordered another to get me a couple of pots of 4x4 gauze and Kerlix rolls, and whipped out my trauma shears.

As I began cutting carefully through the dressing, I asked the man to tell me what happened. He informed me that he had been seen in the ER yesterday because he was cutting down cardboard boxes with a fresh box knife and accidentally cut his leg while bracing a box against it. Honest mistake, I thought to myself. The automatic assumption is that the sutures failed, or an artery suddenly decided to "let go."

As I finished cutting, I told the two techs to get ready and I carefully peeled back a section of the dressing. A jet of bright red blood shot from under the dressing and painted the drape four feet away, Jackson Pollack style, before arcing straight up and narrowly missing the Tech holding the patient's leg. She let out a startled yelp and jerked her head away reflexively. I clapped the dressing back over the leg, grabbed gobs of gauze from the other tech (a veteran of the ER who simply said "Hmph"), and calmly (I thought) told him to get the MD pronto.

I once again raised the old dressing, prepared for the "pumper" this time, and slapped new gauze over a distinctly new and very deep wound just below the wound that was sutured last night.

I stopped wrapping the leg, ordered the female tech to hold pressure, and stepped over to the meet the patient's gaze. I leaned over the man, directing his eyes toward mine.

I walked out of the room to get the MD, shaking my head in dismay and mumbling to myself.

Either that or you don't know anything about mechanics, unless you consider Asimo to be better engineered. (That's a joke, but I'm guessing that I have to spell things out for you). There is no mechanical device that even remotely compares to the human musculo-skeletal system. It's a staggeringly complex system, considered solely from a mechanical perspective. Ask any mechanical engineer.

It's staggeringly complex. It's pretty obvious that the engineer chose some really bad places to insert unnecessary complexity.

Two words: "veriform appendix." No self-respecting engineer would include such a subsystem that (a) performs no useful function and (b) readily becomes a hazard to the entire system's function, unless he was getting a kickback from the AMA. Not that long ago, inflammation of the appendix was guaranteed to be fatal.

Next, the bladder. Did you know that the first thing you should do in a fight is urinate in your pants? That's because if you don't, one solid kick to the lower torso will rupture what is essentially a water balloon full of lethal poison. When I was a cop, I responded to two traffic accidents where one of the involved drivers should have lived, because they wore their seat belts like they were supposed to--except that their bladder ruptured and they went toxic. There are other plausible methods for dumping waste out of the body that would work better.

Finally, I notice that you deleted the prime criteria: that the engineer would then brag about having done so. Other engineers would laugh at him. Mercilessly.

BeHold: without getting into a theological discussion, I would like to respectfully submit a couple of things to you.

The first regards the vermiform appendix. While its function may not be clearly understood, it does, in fact, contain a multitude of lymph nodes. Without getting into a major A&P lesson, it is sufficient to say that the lymph nodes are where the immune response really gets its oomph. They are major arenas where macrophages gobble up the bad guys. They are where antibodies are produced. Are you immune to a disease? Thank your lymph nodes. And returning to the vermiform appendix, there are, as I said, a whole lot of lymph nodes there.

It is interesting to note that the vermiform appendix also lies at a crucial juncture of the bowel, between the cecum and the ileum. Considering the function of lymph nodes, the multitude of which are in the vermiform appendix, and the location of the appendix, I would hypothesize that its existence, function and location, while not entirely understood by man, are no accident. We just don't understand it. And our inability to say "Aha! This is why we have a vermiform appendix!" doesn't make it useless. It simply means we have not figured it all out yet.

As a final note regarding the vermiform appendix, more people get along just fine with it in their bodies until they die at a good old age than those who develop acute appendicitis. We don't get a great deal of "appies." We do, on the other hand, get a helluva lot of other "butts and guts" cases, which are chiefly caused by years of high-fat, low-fiber diet. But I would also venture to guess that most people get along just fine with their large intestines, too.

Second, regarding urine and the urinary bladder. Urine, while in the body, is sterile. And look at a skeleton. Notice that that great big bony bowl formed by the pelvis: within that bowl is exactly where the urinary bladder lies. It is rather well-protected, and would require a helluva lot of force to burst it. A trauma team is concerned about burst urinary bladders, of course. But look beyond the bladder. In order to burst the bladder, a force of great magnitude would have to first shatter the pelvis. Of course, if the bladder is full, somewhat less force may be required, but the pelvic structure must be compromised nonetheless. It must be remembered that with the exception of penetrating trauma, destruction of the pelvic structure is what destroys the bladder. Penetration by the pelvic bones is the primary cause of bladder ruptures in a car accident.

Regarding the whole "peeing the pants in a fight" idea: As I am sure you are aware, that response is purely involuntary. When I was getting fired on as a soldier, I did not consciously decide to pe my pants. In fact, I did not pee my pants. I did, on the other hand, bite quarter-sized chunks out of my underwear- also an involuntary thing. (The layman calls it "pucker factor.") The parasympathetic nervous system governs the involuntary loss of bladder function. It is the negative feedback system gone too far, as evidenced by that spreading wet spot on a person's trousers. It is not a defensive thing; it is a physiological manifestation of the body's natural compensatory respose to extreme stress.

Now consider this: the bladder is not the only organ protected by the pelvis. The femoral arteries and the large bowel are also ensconsed therein. So when a crush injury destroys the pelvis, the bowel and femoral arteries are more likely to be damaged than the urinary bladder, because the bladder is a really tough organ. It's designed to stretch a great deal, and is quite muscular.

Remember here that while in the body, urine is sterile unless the person happens to have a bladder infection, of course. Sterile fluid is sterile fluid, no matter where is happens to go. The body can handle that. What happens in a traumatic injury to the pelvis is that the bowel usually ruptures. That's where you get the massive peritoneal invasion of bacteria- not from the urinary bladder. Further compromise of the vasculature opens the door for bacteria to invade the whole circulatory system- that's called septicemia, which leads to septic shock, MODS, ARDS, and if beyond the ability of medical science and know-how to thwart, death.

Anyway, that's the mechanism behind the whole pelvic trauma/sepsis thing. This is not my imagination talking, but rather the thousands of dollars worth of books I have acquired and the years of trauma experience I have gained. Your experience is meaningful, but medically speaking, it is isolated.

The bottom line is simply that there are an awful lot of body parts whose purposes are not fully understood. The uvula, the tonsils, the funny little divot under your nose, nipples on men, and so on. That does not make them useless, or proof of evolution. It merely makes them little understood.

Please allow me to propose this theorem: The human body is fantastic. It is so complex that we still, after thousands of years of research, have not figured the thing out. Whether one chooses to attribute the complexity to intelligent design, or whether one chooses to attribute to little-understood parts to evolution, is neither here nor there.

I sincerely hope that you do not take this post as a rebuke of any kind. Far from it! Rather, I felt the need to clarify the points for all concerned. I appreciate your contributions to this discussion. I welcome your perspective.

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