X-rays, Locking Screws, and Antlers

“Ok! This is a time-out for Brian Cole. He’s a 34-year-old male who has signed a consent for Dr. Connor to do an Open Reduction Internal Fixation of the right distal radius. He has no known drug allergies. He is under general anesthesia, and he was given two grams of Ancef. We have Nadia as our scrub tech, Matt is in anesthesia, Andy from radiology, Ron is here as our representative from Surgical Supply, and I am Terry circulating. The right side is the correct side.”

“I agree. Tourniquet up.”

“I agree.”

“I agree.”

“I agree. Tourniquet up at 14:55.”

“I agree to patient and procedure.”

“Andy, why do you always have to be such a smart ass?”

“What?”

“What do you mean ‘patient and procedure’?”

“Incision.”

“Hey, I’m just the radiology tech. I can only verify the patient and what we’re doing. Oh, and the right wrist is the correct wrist. I can neither confirm nor deny the rest. I’m not being a smart ass.”

“Incision at 14:56. Yeah, Andy. You’re never a smart ass….”

“I’m not! What do I know if he’s been given two grams of Ancef or not?”

“Uh huh. ‘Can neither confirm nor deny…’”

“Ha ha! Ok, maybe a little bit of a smart ass. This time. But at least I didn’t rap the time-out!”

“Rap the time-out?”

“Don’t you remember that, Nadia?”

“Oh, that’s right! Last week…was it last week? Yeah, last week we had a guy named Percival who needed a cervical disk fusion with Dr. Green, so Terry was rapping ‘Percival cervical’ for the time-out.”

“It was pretty awesome.”

“Percival cervical?”

“Oh, I was here for that! Yeah, that kicked ass.”

“She had, like, four different verses.”

“Terry, can I get a different scalpel? You know, that reminds me of a time I had a patient who was trying to rap when he fell off his friend’s roof.”

“Oh, here comes another Dr. Connor story.”

“Hey, you pipe down there, anesthesia! I like his stories.”

“Yeah, they’re in that last cabinet. Terry, can you get a 15 blade from over there?”

“There is no possible way that story is true. You did not have a patient rapping on the roof.”

“No, it is, Matt! It is true. But I’ll tell you a different story, better than that one. I had a dead deer in my driveway a few weeks ago. You’ll like this one, Matt. Nadia, the drill with K-wire.”

“Terry, you want me to ‘plus one’ that blade on the counts?”

“Yeah, thanks.”

“So, you had a dead deer in your driveway?”

“And it came back.”

“IT CAME BACK?”

“Like, came back to life?”

“Nuh uh.”

“Oh, I’ve got to hear this.”

“Yeah, I think we all need to hear this!”

“Well, wait for it. Andy, come on in with C-arm and we’ll get an X-ray.”

“You want me to bring it under the table, Doc, or….”

“No, I’ll just move his hand off the side here. So, here’s what happened. I found a dead deer at the end of my driveway, and I can’t do anything about it myself because it’s against the law. X-ray.”

“That’s a little blurry, hang on. Ok, try it again.”

“X-ray. Ok. Again, X-ray. Ok let’s see that, X-ray. X-ray. Good. Ron?”

“Looks good to me. That one bone fragment still looks a little displaced posteriorly, but we can correct that when you screw in the plate.”

“Yeah, I think it’ll be alright. You can move the C-arm back out. Nadia let’s use a five-screw distal plate.”

“Five-screw distal plate.”

“So, anyway, you can’t move roadkill yourself. You have to call the State Department of Conservation and they come out and deal with it.”

“Why can’t you move it yourself?”

“Who knows? Probably they don’t want diseases getting spread or, I think there’s something about needing a salvage tag for hunters or something. I don’t know exactly. But anyway, I called the SDC, and a few days later I came home, and the deer was gone. Great, right? And then about four days later, it’s back in the same spot, blocking the end of my driveway. Same exact deer. Come on in for another X-ray.”

“I can’t see my laser guide. I think I might need to come in a little more proximal.”

“That’s fine. Let’s see that. X-ray.”

“How could you tell it was the same deer?”

“That’s what I was going to say. Or ask.”

“X-ray. Well, I knew it was the same deer because of my neighbor. X-ray. Ron, what do you think?”

“That proximal end can maybe move a little toward the ulnar side, but I think it’s ok.”

“It’s not too distal, do you think?”

“No, I think you’re good.”

“Ok move fluoro back out.”

“Watch your knee there, Doc.”

“Remember all that rain we had? What happened was the SDC, when they come to take care of the deer or whatever roadkill you have, they just find a spot close by to bury it. Depth gauge. I’ll take a 14-locking screw, Nadia. So, they buried the deer right across the street. It’s just the edge of woods on that side of the road. But they buried it shallow.”

“Here’s 14-locking. So, the deer woke up and was able to get out? I don’t understand.”

“Depth gauge. Uh…12-locking. No, he didn’t wake up. He was dead. The deer was not alive, ok? It was dead. Like I said, remember all that rain we had? All that flooding?”

“Oh god, tell me about it. Andy’s basement flooded three times. Right Andy?”

“Don’t remind me.”

“Well, I’m at the office one day after that last time it rained really badly, and my neighbor calls me on the phone. Depth gauge. Give me another 14-locking.”

“14-locking screw.”

“And he is LIVID. ‘What the hell do you think you’re doing you son-of-a-bitch’ and all that, but he’s too angry to articulate whatever he’s trying to say. I have no idea what he’s talking about, but at the time I figured it had something to do with the flood. Like, I don’t know, I have a broken gutter spilling water onto his garden or something. I can’t calm him down, but I’ve got patients waiting so I can’t just stay on with him. I figure I’ll talk to him later.”

“Huh.”

“Now here’s where it gets interesting. Depth gauge.”

“Oh, now it gets interesting!”

“So later that night as I’m pulling into the driveway, that damn deer is right back where it had been the week before. 8-locking.”

“So, what does the neighbor have to do with, I mean, I’m missing something here.”

“Well, here’s what happened. The little grave they dug for the deer was so shallow that the rain must have washed away the, uh, the topsoil or whatever and the deer carcass floated up. For a while, we had floodwater about two feet deep in the front yard. 8-locking.”

“And so, it ended up back in your yard? 8-locking.”

“Well, it turns out that the deer floated up with the rain and ended up in my neighbor’s yard, and settled there even after the floodwater had all receded. And apparently, he remembered seeing the dead deer in my driveway the week before.”

“Ok. I think I know where this is going.”

“12 non-locking. Yeah, so he doesn’t get that the storm did it. He thinks that I took the deer from my driveway and dragged it into his yard to get rid of it. So, he’s so upset he calls me to complain, and then just drags the deer back into my driveway where he’d last seen it. Come on in for an X-ray.”

“Watch your knee under the table one more time, Doc.”

“Oh, thanks. So now the deer’s back at the end of my driveway, and I had to call the same damn SDC to have the same damn deer removed from the same damn spot, just a week later.”

“Ha ha! That’s funny.”

“It was like a glitch in the Matrix with this deer. X-ray. X-ray. Ron?”

“Looks good.”

“Ok save that one. X-ray. Save that one, too. We’re done with fluoro, Andy.”

“Matt, what do you have for blood loss?”

“Uh… let’s call that 32 cc’s, Terry.”

“And I’ve got 22.4 seconds of total fluoro, Terry.”

“Thanks, Andy!”

“You bet.”

“Yes, hello? Could somebody please have the family for Cole, Brian brought to consultation room two? Dr. Connor is about to close.”