You nice and tight for Daddy? Post Comment Note: All fields are required. Your email address will not be published. He's 62, history of hypertension, untreated. Obvious swelling around his left eye, has a laceration there.
No other injuries as far as we can tell. This was obviously not going to be one of those "fun" stories, just another drunk asshole who pissed off the wrong guy. A quick but thorough evaluation of a very slovenly Rufus showed no injuries below his neck, only what I could only assume was several years' worth of built up grime beneath his fingernails. Clean that shit up, people. It was becoming painfully obvious that this would be 1 a boring story, 2 a quick run through the CT scanner, 3 a few sutures, 4 a litre or four of saline to sober him up, and 5 a discharge to whatever cave Rufus called home.
Lord blessh Charlie Mopsh, the man who invented beer beer beer. His CT scans showed no brain injury and no facial fractures, as expected. He continued singing he may have gotten one note on key, possibly as many as two as I tried to renovate him to his former glory and place a few sutures in his creased face.
Well , my Innter Pessimist reminded me, at least his singing career can continue, though his modeling days are clearly over. My Inner Pessimist can be a bit of an asshole sometimes. At 11 o'clocks we'll ssstop for 5 short sheconds, we'll remember Charlie Mopsh. By the time the police arrived to take his statement, I was already filling out his discharge paperwork. He gets up in my face real close, so naturally I take a swing at him.
You know. Well, he takes his arm off and. Nor was the ensuing laughter from everyone within earshot of this conversation. After Rufus was finished with his story, the police confirmed that they already had in custody both the suspect and his weapon of choice: his prosthetic arm. The next 20 minutes were filled with pretty much everyone over the age of 35 asking if Rufus' real name was Richard Kimble. Alas, it wasn't. I only know that because, unbeknownst to me, I was about the 14th very uncreative and not-quite-as-clever-as-I-thought person who asked.
Wednesday, 23 October Break. Yeah yeah yeah, I know I've been gone for over four months, and my Inner Egotist has been yelling at me regularly that my loyal readers the few I may still have have probably been missing me and wondering what may have happened.
I have also taken several months off Twitter as you may or may not have noticed , and when my brother recently asked me why, I replied simply, "Sanity".
I realised that I was taking inordinate amounts of time writing, and that isn't fair to my family, and it isn't right. They deserve better. Writing this blog isn't difficult, but it can be time consuming.
Coming up with a patient to write about is easy, but making a blog post out of it can be cumbersome, because I don't want my stories to be trite, boring, or repetitive. So instead of putting out boring short stories, I consider it better to put out nothing and keep people wondering. Well wonder no further, because the patient I'm writing about today was easy to come up with. It is I. No, I wasn't in a car accident, and I wasn't stabbed or assaulted, and no I didn't cut off my finger with my table saw or have any other kind of traumatic injury.
But over the past few months I have seen three different doctors, including a specialist, a sub-specialist, and a sub-sub-specialist, and I now have an official diagnosis. In the interest of my own privacy, I will not be revealing what the diagnosis is or the type of doctor that I've been visiting.
I will, however, divulge that just this past week I was diagnosed with a very rare degenerative disease that is incurable, progressive, and potentially disabling, though it is not in any way deadly.
It's not multiple sclerosis, and it's not ALS or any other motor neurone disease. I'm not dying. The good news is that this condition was diagnosed very early, and it was only found based on a hunch that the second doctor had. He very easily could have chalked up my symptoms to aging and let it go, but he decided to investigate further.
Usually this disease isn't diagnosed until much later in life once significant and irreversible damage has already been done, but mine was found before any of that happened, so my long term prognosis seems to be good. The bad new is that no one knows the cause of this disease because it is so rare. It was only first described about 30 years ago, but no one took it seriously until about 15 years ago when it was discovered that it was indeed progressive. Because of that, there is no textbook treatment.
The disease is thought to be autoimmune, so I will be taking immunosuppression medication for the rest of my life to keep it at bay. I'm not looking for sympathy. I'm not interested in anyone's thoughts or prayers. Yes this sucks, but I have accepted the diagnosis and am hitting it with everything I can.
Ignoring a problem like this won't make it better, and pretending it doesn't exist will only make it worse. You're on notice, antivaxxers. Wednesday, 12 June Magic bullet. Nor is it about the JFK assassination or the Seinfeld parody thereof. So delete your nastygram, sit back down, and stay tuned. Let me first take you back a couple of weeks before I met Belle. My previous call before Belle's I had gotten a stabbing victim at 8 PM who needed a laparotomy.
The call before that I got a car accident victim at PM who needed a laparotomy. The call before that I had gotten a fall victim at PM who had needed a laparotomy. Cases like these are relatively rare, so getting three in a row at essentially the same time of day is extremely uncommon. But as we all know, bad things tend to happen in threes. Or fours. Yes, that's foreshadowing. Now fast forward back forward? I was in the midst of getting over a cold, so I started my day by nearly begging the Call Gods to let me off easy.
In retrospect this was a Very Bad Idea. About halfway through the shift the Call Gods proved that not only are they evil and vengeful, but they are also cold and heartless and have no goddamned regard for my feelings. Not that I ever suspected they did. My pager told me I would be getting a level 1 gunshot victim in 5 minutes. I looked at the clock, and when I saw it was PM, I actually looked up at the sky because somehow in that moment I figured that's where the Call Gods were hanging out and laughing their cruel, heartless asses off and vigorously and repeatedly cursed them with every single bit of foul language my brain could come up with.
Then I took a deep breath and realised I had a job to do, and imprecating some nebulous nefarious fantasy creatures would help neither me nor my patient in the slightest. At least it isn't 2 AM, right? Belle arrived a few minutes later, and while she didn't necessarily look close to death, she was certainly having some difficulty breathing.
Blood pressure has been stable, oxygen sats in the 90's, but decreased breath sounds on the right. This bodes poorly because I have no idea what direction the bullet was traveling when it hit her or what happened to it once it did. On examination her heart sounded fine, but she had no breath sounds on the right, a sign that she had either a pneumothorax collapsed lung , haemothorax blood in the thoracic cavity , or both.
Fortunately the treatment of both of these problems is the same - a chest tube. But whenever there is an entry wound with no exit, the main two questions I always have to answer are: Where did the bullet go? What did that bullet go through? The good news is a simple chest X-ray should answer both of those questions within a minute or so. As the nurses were getting IV's started and checking vital signs which were fine , I was finishing the physical exam which revealed no exit wound and was also otherwise fine and the radiology techs got the chest X-ray done.
Holes in any of those things are by definition Very Bad Things, and holes in a few of them can be rapidly fatal, though obviously she shouldn't have any of those.
At least she wasn't dead yet. The problem is that an X-ray can't tell me if the bullet is in the soft tissue of the back which would be fine , the soft tissue of the front which would be much less fine, since it had to go through the entire body to get there , or somewhere in between which would also be not at all fine , nor can it tell me what the bullet went through to get there.
If the bullet was just in the soft tissue of the back, all she would need is a chest tube and no major abdominal or thoracic surgery. But you've already seen me foreshadow, so you know goddamned well that's not what happened. A chest tube was rapidly inserted, and about ml of blood drained immediately then stopped.
While this sounds pretty bad, that's actually not a huge amount, and the fact that it stopped means there was no active bleeding from the chest. Since her blood pressure and heart rate had remained essentially normal, I had time to get a CT scan for further evaluation. It didn't answer my questions, it only muddied the waters further. Not Belle's abdomen Th scan showed the bullet tract through the right back into the right chest, bouncing off a rib and shattering it, then ricocheting I guess towards the left side.
And there bullet was, sitting somewhere in the left upper abdomen not the soft tissue in the back. There appeared to be a blush of contrast in the stomach indicating active bleeding within the stomach which was of course full of food , which as you can imagine is indeed a Very Bad Thing.
Weeeeell, shit. To the theatre we go. It was PM. Because of course it was. I re-examined her after the scan and just before wheeling her to surgery, and indeed her left upper abdomen was now mildly tender. Certainly no signs of peritonitis yet , but the exam was decidedly different than it had been just a few minutes before.
I told her she needed emergent surgery to find out what damage the bullet had done, and then hopefully fix it. As I listed off the potentially injured organs, I gave her no guarantee that she would survive the surgery just like I do with every such patient, because no matter what I suspect and no matter what I find, it is always both a challenge and a surprise.
Belle seemed to take the news well: "Just do the best you can, doctor" was all she said. I promised her nothing more and nothing less than that. And while I did get a surprise, it was just not the one I could have anticipated: Nothing.
I was expecting to find a hole in her stomach with spilled gastric contents, a diaphragm laceration, liver laceration, lacerated intestine, perhaps a lacerated spleen. But there was no blood in her abdomen, no spillage of food, no injury to any organ whatsoever. Well, almost nothing. Knowing the bullet was somewhere in her left upper abdomen, I reached up into that area expecting to find a free-floating bullet between her stomach and spleen like I saw on the CT.
I found the bullet alright, and it was indeed free-floating. In her stomach. Wait, what?? How the fuck did that get there? I made a small incision in her stomach to retrieve the bullet, which was deformed from having passed through soft tissue and bouncing off a rib , so option 1 was definitely out. I searched for at least an hour trying to find a hole in the stomach, looking at every square millimetre of its surface, both back and front, top and bottom.
So option 2 was out. He came up with the idea of repurposing the temporary VA clinic into a homeless shelter for veterans. His focus will be pushing the VA to get on board and help make this idea happen.
The hope is to not only house homeless vets, but also to give them the boost they need to get their lives back on track. Inventory of historical buildings in St. Augustine will soon get underway thanks to grant funding. Buildings like the St. Benedict School are part of the fabric of St. The surveys will also help leaders figure out how best to protect the city from sea-level rise.
The grants will help hire consultants to go door-to-door to visually inspect buildings and document each one. The last time a survey like this was done was in the 70s and 80s. Wolfe said the information they gather will go a long way to securing more funding in the future. He says they need to install good climate control, quality lighting and processing space so the staff can have room to work on the collections.
Cindy scrambled to the side. But when her foot touched the top of the wooden outline, the lash of a long whip snapped right next to her cheek. She froze, then glanced over at Rudy. He was coiling the whip behind him, preparing to strike again. Cindy turned to face Serena. She had never seriously fought anyone in her entire life, and she didn't have a wisp of an idea of what to do.
Fists doubled, Serena launched herself and drove both feet into the younger girl's stomach. Air exploded out of Cindy's lungs as she was slammed down onto her naked ass. The fiery red-haired girl twisted on the ground and sprung like a cat at Cindy's face.
One knee tried to find her jaw, but it was twisted out of the way. Cindy was driven to her back on the floor, and the older girl tried to pin her hands and arms to the plastic.
A knee was shoved roughly into Cindy's groin as her legs were partially spread with the dildo riding down the length of her cunt-slit as it searched for her asshole. Cindy smashed a fist against the side of Serena's face, pitching her off and onto her side on the floor. Cindy swatted a hand at the other girl, but Serena ducked and stepped inside. Long-taloned fingers laced into Cindy's blonde hair and she was yanked off her feet. Her scalp exploded in pain as she went to her stomach, the other girl riding her down as she bowed back Cindy's neck by pulling on her hair.
A shoulder hit Cindy squarely in the back then, once again, a knee worked between her thighs while the threatening dildo slapped against her, this time, on her bare asscheeks.
Her neck ached from the pressure and a large circle of scalp threatened to tear loose. Serena's knee drove between her legs and the dickhead of the phony prick slid down the greased crack of her ass. But, when she felt it nestle right up to her creamed asshole, Cindy panicked and threw herself to one side.
Serena's legs was caught between Cindy's, and the older girl was levered over, slamming into the ground. Cindy pushed herself to her feet. She backed up until she hit the outside ring of the pit, then she circled around, trying to keep as far away as possible from the other girl.
She had tried to win quickly, thinking Cindy would be petrified by fear. Now that that hadn't worked, she would brutalize Cindy until she gave up. The red-haired girl rushed again, and Cindy tried to step to the side. But when she did, she walked right into a crushing blow that landed dead-center on her right tit. Blinding pain lashed through her chest and, before her eyes could clear, another fist battered into her other fleshy tit-mound.
Her legs collapsed, and she dropped straight to the floor on her ass. And this time Serena's knee found her chin, causing stars to shoot before her as she tumbled onto her back.
Serena's glistening naked ass slapped wetly on Cindy's exposed stomach, knocking the air from her lungs. Fists pounded into Cindy's tits, battering the tender flesh.
A nightmare of punishing pain flowed through her chest and each blow added to the soreness. Her tits flushed red from hot blood, and even her ribs felt bruised. Cindy found the strength to swing a stiff right arm into the side of Serena's face, knocking the older girl to the side. Cindy rolled from under Serena's upraised leg and gasped in agony as her tits were pressed into the floor by her own weight.
More than one hundred pounds of screaming girl hit her on the back but slipped off Cindy's oily skin. Cindy twisted, then rolled away and regained her feet before the other girl could launch herself again.
Cindy stared aghast at the red-haired demon. Her tits still ached from the violent beating and a patch of her scalp was still sore. Cindy's efforts had been aimed at keeping the monstrous dildo out of her ass, but the other girl was trying to beat her into submission.
Sweat stained Serena's brow as her eyes burned with the fire of cruelty. She poised on the balls of her feet like a cat ready to strike as her eyes poured over Cindy's naked body. A depth of lust marked Serena's features and her blood boiled with the heat of desire to skewer the younger girl on the shaft of the dildo.
She would impale and crucify the younger girl's asshole as every inch of the massive dildo was corn-holed into her guts. That was all that would satisfy her and Serena expected nothing less. Cindy braced herself, then leaped when Serena sprang toward her. Their bodies collided in the center of the ring.
Serena's move had been expected, but Cindy wasn't, as she buried her shoulder into Serena's chest. Cindy drove Serena down to the floor. They scuffled, slapping and tugging without either of them able to gain clear advantage. Cindy was on top, but she couldn't pin the wild girl, whose arms and legs were flying in every direction. Oily feminine skin rubbed nakedly together as hands and knees bumped against titties and asscheeks.
Cindy twisted to sit on one of Serena's arms, pinning it to the floor, but the older girl's hand curled into Cindy's crotch. Cindy went over onto her side, trying to relieve some of the pain, but the red-haired girl had coiled up onto her knees. Serena gripped the hair of Cindy's pussy and a small patch of hair was ripped from the tender skin. Cindy's shriek blasted around the room as the red-haired girl scrambled onto her knees, then mashed the cunt hair into Cindy's face.
Cindy clutched at her pussy where it felt like the skin was on fire. Serena's doubled fists pounded into Cindy's unprotected tits, with the nipples becoming the targets for all the punches.
Cindy rolled onto her stomach, and Serena leaped, hurriedly trying to pull apart Cindy's asscheeks as the phony cock bobbed up to the exposed shithole. But Cindy squealed in pain and frustration, twisting beneath the older girl until she was lying on her side. Then, with a mighty effort, she forced her body upward and dumped Serena on her ass.
Both girls thrashed about on the plastic liner of the pit, hitting, then grabbing at each other to try to gain some advantage. Oily skin caused fingers to slip as they tumbled over with no one able to settle on top.Check out Best of Killswitch Engage by Killswitch Engage on Amazon Music. Stream ad-free or purchase CD's and MP3s now on newwave.zulkikreegavinrarathorgagra.infoinfo5/5(2).