David Newman allegations

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Did Newman study at Oxford by the way?

 

[DrDrummer]

I don't think he's ortho.

No, but his only other post is a similarly longwinded, self-congratulatory post about how he backdoored his way into hand surgery (with a long description of how much money he makes via the old own an ambulatory surgery center, do many self-referrals for imaging, own the imaging, etc. route) after he was finished saving these poor polytrauma patients from the ineptitude of the emergency physicians who sought to poison them with analgesics. Such a champion of life.

 

[Birdstrike]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. CXR with maybe some haze in the LLL. Lines placed. O2 mask on, tachycardic but who wouldn’t be? I’m zoned in on a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy. The bullets couldn’t have hit the aorta or an iliacs, if so the guy would be dead by now, so I’m thinking low pressure retroperitoneal injury? Renal vein? Spleen? Something in zone III? a mesenteric vessel? ****. New, young ER attending in a white button down oxford shirt and a tie wants to put in a left chest tube. Massive hemothorax ain’t the problem, the volume of blood that you would need to give you hypovolemic shock parked in the thorax won’t give you that x-ray but whatever, my PGY2 he needs the practice, so I tell him to prep.

It’s more than the usual degree of chaos, even for 1am at Luke’s. The guy had been shot by the cops so blue waves keep crashing into the trauma bay door requiring regular dispersement. Not that the cops give the impression of actually giving a ****, it’s December of 2004, Ferguson is a decade away and this was in the days when cops still shot young black guys in Harlem because it was part of their job description. Still they were curious to see just what type of paperwork was going to have to be filled out. Patient himself seemed to be opting for the form that didn’t have a time of death on it. The lad is definitely showing bit more spunk than you would expect from someone en-route to his reward via exsanguination but sometimes they can fool you. The other guests to the party were some nurses, my team of exhausted pissed-off surgical residents wishing they were anywhere except responding to a trauma call with me as the chief, and the ER team, maybe six of them all delighted for a distraction from asthma attacks, UTI’s and drug seekers, hoping to see something like on TV and lead by that tense looking attending in the white button down oxford and tie, looking like a guy from NASA in the 60s.

Oxford shirt dude is now standing at the foot of the bed, Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube in and I’m standing behind Pete trying to figure out what happens next. I’m the senior surgeon in the room, closest surgical attending is maybe half and hour away and if we’ve got to do an emergent exploratory laparotomy it’s my problem and frankly I’d rather pass. It would be nice to think my conservative stance was on account of higher principles, a wish to spare homeboy a big midline incision, a lifetime of adhesions and a few days in house getting over his ileus but in reality I just wanted to get back to sleep. My two year old is not all that into sleeping and my wife nine months pregnant is not all that into not being grouchy. I’d been working all day and had to be in the OR all the next day. Yup, this was when things sucked but not in the “crap I’ll be home tonight at 5:30 rather than 4:30 and have to cut short my time at the gym” sucked, or in the “it’s so difficult to decide, should we ditch the kids and go to Santiago or London next month honey?” sucked, but in the “when will this **** end and how can I get another twenty minutes of sleep” way. Perhaps you can relate? Anyways, an unnecessary ex-lap might not be doing shot-guy any favors but it would ruin my night for sure. So when oxford-shirt-with-tie ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation.

Most ER guys differ to the surgeons, after all, they have only the haziest idea of what happens once the patient leaves the trauma bay, understand their limitations and sensibly stay out of the way. But this guy is different; he has his own ideas, probably went to a lecture recently on “pain being the sixth vital sign” or some such bull**** and he says “I’m going to give morphine.” This gets my attention, I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision. “Better not” I say. Unbelievably, he is not dissuaded, his team is looking on and he takes a stand. He tells me he’s the attending physician, he is board certified, he is in charge of this patient while the patient is in the ER and he is going to give the morphine.

It is at this point that certain things are alleged. The surgical team is on record that in calm and respectful tones their chief guided the care of the patient with a graceful firm and steady hand to it’s successful conclusion. Bless them. Meanwhile, the ER team over the ensuing days spilled a fair amount of ink all alleging this and alleging that. Something to the effect that allegedly the senior surgeon at the trauma allegedly told the attending emergency medicine physician in the white short sleeved oxford that were each the same amount of time out of medical school the only difference being the two being that one had done a short residency and one had not. That the ER attending's lack of judgment was threat to this patient, and that therefore the ER attending should get **** out of this trauma bay and find someone with an earache to treat before he hurt somebody. It is agreed upon by all parties that at some point the ER attending dismissed the senior surgical resident from the case ordering the surgical resident leave the area at which point it has been alleged that the senior surgical resident inquired if said ER attending possessed the skill set to open the abdomen or chest and control an exsanguinating injury? Furthermore it has been alleged that the senior surgeon then pointed out that since dismissing the only person currently in the hospital with the skill set to treat this potentially life threatening injury would be equivalent to murder, perhaps the ER attending should just go borrow one of the cops guns and shoot the patient himself and get it over with. It has also been alleged that the when the attending in the short sleeved white shirt, now bright red in the face, insisted that he was the physician in charge of the care of the patients in his emergency room and physically attempted to give the morphine via the IV, the senior surgeon in the room, who was six inches taller and 50 pounds heavier than him and had captained his college rugby team positioned his body in such a manner to make such actions impossible and, it has been alleged, in doing so threw a body block that nearly knocked the ER attending over.

The chest tube returned nothing. The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day.

With that trauma over the next one began. Young white-short-sleeved-oxford guy screamed for blood. He demanded dismissal of the surgical resident, he demanded that the medical board launch an investigation, he demanded formal sanctions, he demanded the senior surgical resident be banned from the ER. He got a lot of snickering from the Department of Surgery and a dripping letter of apology.

So why bring this up?

David Newman was the guy I had to push out of the way. He was a wanker then, he's a wanker now.

You sure as hell didn't save anyone's life in this story, but you definitely saved the life of SDN Emergency Medicine from impeding death from metastatic stage IV boredom, at least for a little while. For that, I thank you.

On the other hand, whether or not you proved beyond a shadow of a doubt one of the Universe's great theorems known as "Ain't Karma A Bitch?" only time and a jury of twelve "peers," will tell.

 

[BAM!]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. CXR with maybe some haze in the LLL. Lines placed. O2 mask on, tachycardic but who wouldn’t be? I’m zoned in on a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy. The bullets couldn’t have hit the aorta or an iliacs, if so the guy would be dead by now, so I’m thinking low pressure retroperitoneal injury? Renal vein? Spleen? Something in zone III? a mesenteric vessel? ****. New, young ER attending in a white button down oxford shirt and a tie wants to put in a left chest tube. Massive hemothorax ain’t the problem, the volume of blood that you would need to give you hypovolemic shock parked in the thorax won’t give you that x-ray but whatever, my PGY2 he needs the practice, so I tell him to prep.

It’s more than the usual degree of chaos, even for 1am at Luke’s. The guy had been shot by the cops so blue waves keep crashing into the trauma bay door requiring regular dispersement. Not that the cops give the impression of actually giving a ****, it’s December of 2004, Ferguson is a decade away and this was in the days when cops still shot young black guys in Harlem because it was part of their job description. Still they were curious to see just what type of paperwork was going to have to be filled out. Patient himself seemed to be opting for the form that didn’t have a time of death on it. The lad is definitely showing bit more spunk than you would expect from someone en-route to his reward via exsanguination but sometimes they can fool you. The other guests to the party were some nurses, my team of exhausted pissed-off surgical residents wishing they were anywhere except responding to a trauma call with me as the chief, and the ER team, maybe six of them all delighted for a distraction from asthma attacks, UTI’s and drug seekers, hoping to see something like on TV and lead by that tense looking attending in the white button down oxford and tie, looking like a guy from NASA in the 60s.

Oxford shirt dude is now standing at the foot of the bed, Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube in and I’m standing behind Pete trying to figure out what happens next. I’m the senior surgeon in the room, closest surgical attending is maybe half and hour away and if we’ve got to do an emergent exploratory laparotomy it’s my problem and frankly I’d rather pass. It would be nice to think my conservative stance was on account of higher principles, a wish to spare homeboy a big midline incision, a lifetime of adhesions and a few days in house getting over his ileus but in reality I just wanted to get back to sleep. My two year old is not all that into sleeping and my wife nine months pregnant is not all that into not being grouchy. I’d been working all day and had to be in the OR all the next day. Yup, this was when things sucked but not in the “crap I’ll be home tonight at 5:30 rather than 4:30 and have to cut short my time at the gym” sucked, or in the “it’s so difficult to decide, should we ditch the kids and go to Santiago or London next month honey?” sucked, but in the “when will this **** end and how can I get another twenty minutes of sleep” way. Perhaps you can relate? Anyways, an unnecessary ex-lap might not be doing shot-guy any favors but it would ruin my night for sure. So when oxford-shirt-with-tie ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation.

Most ER guys differ to the surgeons, after all, they have only the haziest idea of what happens once the patient leaves the trauma bay, understand their limitations and sensibly stay out of the way. But this guy is different; he has his own ideas, probably went to a lecture recently on “pain being the sixth vital sign” or some such bull**** and he says “I’m going to give morphine.” This gets my attention, I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision. “Better not” I say. Unbelievably, he is not dissuaded, his team is looking on and he takes a stand. He tells me he’s the attending physician, he is board certified, he is in charge of this patient while the patient is in the ER and he is going to give the morphine.

It is at this point that certain things are alleged. The surgical team is on record that in calm and respectful tones their chief guided the care of the patient with a graceful firm and steady hand to it’s successful conclusion. Bless them. Meanwhile, the ER team over the ensuing days spilled a fair amount of ink all alleging this and alleging that. Something to the effect that allegedly the senior surgeon at the trauma allegedly told the attending emergency medicine physician in the white short sleeved oxford that were each the same amount of time out of medical school the only difference being the two being that one had done a short residency and one had not. That the ER attending's lack of judgment was threat to this patient, and that therefore the ER attending should get **** out of this trauma bay and find someone with an earache to treat before he hurt somebody. It is agreed upon by all parties that at some point the ER attending dismissed the senior surgical resident from the case ordering the surgical resident leave the area at which point it has been alleged that the senior surgical resident inquired if said ER attending possessed the skill set to open the abdomen or chest and control an exsanguinating injury? Furthermore it has been alleged that the senior surgeon then pointed out that since dismissing the only person currently in the hospital with the skill set to treat this potentially life threatening injury would be equivalent to murder, perhaps the ER attending should just go borrow one of the cops guns and shoot the patient himself and get it over with. It has also been alleged that the when the attending in the short sleeved white shirt, now bright red in the face, insisted that he was the physician in charge of the care of the patients in his emergency room and physically attempted to give the morphine via the IV, the senior surgeon in the room, who was six inches taller and 50 pounds heavier than him and had captained his college rugby team positioned his body in such a manner to make such actions impossible and, it has been alleged, in doing so threw a body block that nearly knocked the ER attending over.

The chest tube returned nothing. The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day.

With that trauma over the next one began. Young white-short-sleeved-oxford guy screamed for blood. He demanded dismissal of the surgical resident, he demanded that the medical board launch an investigation, he demanded formal sanctions, he demanded the senior surgical resident be banned from the ER. He got a lot of snickering from the Department of Surgery and a dripping letter of apology.

So why bring this up?

David Newman was the guy I had to push out of the way. He was a wanker then, he's a wanker now.

Sorry you had to go through that. I understand you were sleep deprived, which is a real challenge. But Jesus, just give him 2mg of morphine. Or better yet some fentanyl. It's not going to kill him. Last thing you or the hospital wants is an interdepartmental war with your colleagues. Especially in front of a patient.

Good for your Surgical Department leadership by trying to smooth things over with the ED. But by the tone of your post, I question whether you learned anything from your experience.

 

[Boatswain2PA]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. ..... The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day....

I'll leave it up to the others to comment on the rest of your story, but this part makes no sense. Frangible rounds ARE designed to break apart, but not when they "miss their target", but rather when they hit ANYTHING. They expend ALL of their energy in the first few centimeters of contact instead of slowly expending their energy as they travel tens of centimeters through a contact like a jacketed round. They are great rounds to have in your house because they have very little penetration, and can even be stopped with two layers of sheetrock - like what is inside your house. That way if you shoot at a bad guy in your house, it won't go through your walls and hit your kids.

However when a person is hit by a frangible round, that energy doesn't just disappear, it dissipates into that first couple of centimeters, which means if your supposed patient had three GSWs to the back from frangible rounds he would be toast. 40 cal frangible rounds have taken limbs off.

 

[TBoneKoko]

I took it to mean the frangible round ricocheted off a brick wall (or something) next to him, so he just got hit by the fragments.

 

[Hyde]

But Jesus, just give him 2mg of morphine. Or better yet some fentanyl. It's not going to kill him...But by the tone of your post, I question whether you learned anything from your experience.

Osler gave us the findings conclusion, so he provides 20/20 vision for us and coulda/shoulda comes easily in now time. But put yourself in Osler's shoes 11 years ago, December 2004, with a shot up patient with "a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy...Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation...I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision." I think Osler was right to be concerned about what 2 mg morphine might do to this particular patient, whose life was hanging in the balance. And Osler would be the one who'd have to deal with any complications resulting from Dr. Newman's questionable judgement call. Why take the risk of further compromising an already very unstable patient to soften 3 minutes of pain from the chest tube insertion? Even as a mere MS1 I know that first do no harm has actual real life and death applicability in patient care. It's not just an empty Hollywood tv series saying.

 

[Boatswain2PA]

I took it to mean the frangible round ricocheted off a brick wall (or something) next to him, so he just got hit by the fragments.

Fragments of the brick wall (or whatever).....maybe. But not of the frangible rounds. And superstar surgery resident can't tell the difference between a fragment strike and a GSW?

 

[WilcoWorld]

Osler gave us the findings conclusion, so he provides 20/20 vision for us and coulda/shoulda comes easily in now time. But put yourself in Osler's shoes 11 years ago, December 2004, with a shot up patient with "a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy...Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation...I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision." I think Osler was right to be concerned about what 2 mg morphine might do to this particular patient, whose life was hanging in the balance. And Osler would be the one who'd have to deal with any complications resulting from Dr. Newman's questionable judgement call. Why take the risk of further compromising an already very unstable patient to soften 3 minutes of pain from the chest tube insertion? Even as a mere MS1 I know that first do no harm has actual real life and death applicability in patient care. It's not just an empty Hollywood tv series saying.

Why don't you put in a couple of chest tubes in awake patients without analgesia and then let us know how you think about that? Osler21's concerns were not entirely unreasonable, but they were also not the obvious way to go. Let's keep a couple of things in mind here:

1 - The patient did well under Dr. Newman's care after Osler21 was excused from the case.
2 - Osler21 claims that it was "alleged" that he body checked Dr. Newman, then later reports that "I had to push him out of the way".
3 - Osler21 says that the Department of Surgery sent a "dripping letter of apology" but also claims he was almost fired over this.

2&3 above seem to contradict themselves. In any case, pushing people out of the way never works well in a trauma bay.

By the way, Osler21 - Sir William Osler was an internist.

 

[deleted480308]

I'll leave it up to the others to comment on the rest of your story, but this part makes no sense. Frangible rounds ARE designed to break apart, but not when they "miss their target", but rather when they hit ANYTHING. They expend ALL of their energy in the first few centimeters of contact instead of slowly expending their energy as they travel tens of centimeters through a contact like a jacketed round. They are great rounds to have in your house because they have very little penetration, and can even be stopped with two layers of sheetrock - like what is inside your house. That way if you shoot at a bad guy in your house, it won't go through your walls and hit your kids.

However when a person is hit by a frangible round, that energy doesn't just disappear, it dissipates into that first couple of centimeters, which means if your supposed patient had three GSWs to the back from frangible rounds he would be toast. 40 cal frangible rounds have taken limbs off.

For safety sake, I need to point that this isn't true. Frangible rounds definitely still go through drywall.

You simply can't depend on a residential wall to be the end of a bullet path...you need to know what's on the other side or be willing to roll those dice

 

[Hyde]

1 - The patient did well under Dr. Newman's care after Osler21 was excused from the case.

Maybe it was because Osler prevented Dr. Newman from complicating the patient's initial unstable situation? Based on my reading of Osler's narrative, Osler left the patient to Dr. Newman's care AFTER the chest tube insertion was done without morphine sedation and the chest tube "returned nothing." Osler's choice of screen name says nothing about his degree of humility - that's a stretch to say the least. Maybe I'm looking at osler's narrative from a naive MS1 perspective who is/was shocked that an ER leadership voice might have serious character flaws ( if 2 patients' allegations are true) while others are looking at osler's story from a (somewhat jaded?) political ER dept vs Surg dept rivalry and/or Resident vs Attending angle? Otherwise I don't understand why several posts are focused on criticisms of osler's ego/ his lack of professionalism/lack of humility and little is said about what the narrative ( if accurate) reveals about Dr. Newman's ego, professionalism, humility.

 

[BoardingDoc]

Maybe it was because Osler prevented Dr. Newman from complicating the patient's initial unstable situation? Based on my reading of Osler's narrative, Osler left the patient to Dr. Newman's care AFTER the chest tube insertion was done without morphine sedation and the chest tube "returned nothing."

You misread his statement.
"Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube..."
"...ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. "
"3 minutes of pain from the chest tube insertion vs dropping the blood pressure"

The plan was evidently to give opiates pre-procedure, not post.

As for the rest of your comment. 1: this story makes the ED doc look like a giant ass. 2: it makes the surgery resident look like a giant ass.

 

[WTEngel]

Seems as if it has to be 1 of 4 scenarios:

1.) The plaintiff is fabricating the story outright, and does not have any evidence whatsoever, or has attempted to also fabricate some sort of evidence, that will be found not to match Newman's.

2.) The plaintiff is halfway falsifying the claim, however the act that occurred was consensual, and now she has changed to story in order to seek some sort of judgment against Newman, the Hospital, etc.

3.) The plaintiff is telling the entire truth to the best of her recollection, however under the influence of drugs, the perpetrator managed to convince her that he was Newman, when in fact the person who committed the crime was not Newman.

4.) The events occurred exactly as they were described by the plaintiff and Newman is guilty.

If she was given a narcotic, I doubt it was morphine. Something like versed seems better for a crime like this. Either way, if what she claims happened did actually happened, controlled meds were used, and hopefully the tracking of those meds is tight enough that any dispensing can be tracked to specific individuals. I agree with an earlier poster, it might raise some eyebrows if the doctor all of sudden, on this specific day, decided to withdraw from the omnicell (or whatever they use there) his own narcotics to give to a patient. Who knows, maybe he withdraws his own narcotics all the time.

If he did withdraw the narcotics, then it should be linked to a patient record, and that would be pretty damning with the accusations at hand...

Without any personal knowledge of the situation, and from simply reading the horribly written story, I am leaning on 90% scenario 1, 5% scenario 2, 0% scenario 3, and 5% scenario 4.

Last thing I will add is that if this crime actually did happen, this is not the sort of thing someone just all of a sudden decides to do. Sexual predators tend to build up to things like this, and in general, do not just do it once. There would almost certainly be some sort of pattern of odd behavior noticeable by those around Newman if he was this type of person.

I just have a hard time believing this story, and the poorly written article certainly didn't help out at all.

ETA: It looks like another person has come forward with similar accusations...

http://www.cnn.com/2016/01/20/us/new-york-doctor-sexual-abuse-allegations/

 

[iish]

Can we stop responding to Hyde? He/she is a first year medical student. If this person came to shadow in the ER, how much respect would we shower on his/her clinical understanding? NONE. He/she would stand in silence in the back of the room with no clue what was going on. Let's give them just about that much consideration on here. What Hyde has to say about opiates, hypotension, trauma, anything clinical doesn't matter.

 

[Hyde]

If she was given a narcotic, I doubt it was morphine. Something like versed seems better for a crime like this.
If he did withdraw the narcotics, then it should be linked to a patient record, and that would be pretty damning with the accusations at hand...
Last thing I will add is that if this crime actually did happen, this is not the sort of thing someone just all of a sudden decides to do. Sexual predators tend to build up to things like this, and in general, do not just do it once. There would almost certainly be some sort of pattern of odd behavior noticeable by those around Newman if he was this type of person.

If your #4 scenario happened, I doubt Dr. Newman would have left red flag bread crumbs leading back to him. Keep in mind that he was the Director of Clinical Research at Mt. Sinai School of Medicine so in that position as a physician-researcher he'd have an alternate route to access meds. Dr. Newman has a meded website
called channel line and recent subjects of discussion involved case studies re: ketamine and propofol. It could be an unfortunate coincidence in light of the January patient's allegations. But no doubt the D.A.'s office is already on that website like white on rice. Regarding sexual predators, the smart ones probably are careful not to show obvious "odd behavior" tell signs. There was a case in Canada recently ( 1 year ago) wherein a highly regarded popular anesthesiologist sexually assaulted 21 female patients while in the OR with staff nearby not being the wiser. I truly hope Dr. Newman is innocent of the alleged crimes. But if he is guilty, he needs to pay dearly. http://www.thestar.com/news/crime/2...ht_gets_10_years_in_jail_for_sex_assault.html

 

[Cinematographer]

@iish Placed hyde on my ignore list yesterday. I have no regrets.

 

[WilcoWorld]

@iish Placed hyde on my ignore list yesterday. I have no regrets.

Is that Frank Ocean in your avatar? If so, nice.

 

[Hyde]

Can we stop responding to Hyde? He/she is a first year medical student. If this person came to shadow in the ER, how much respect would we shower on his/her clinical understanding? NONE. He/she would stand in silence in the back of the room with no clue what was going on. Let's give them just about that much consideration on here. What Hyde has to say about opiates, hypotension, trauma, anything clinical doesn't matter.

Osler, a surgeon, presented a patient case summary that happened 11 years ago that he and Dr. Newman handled. Any comments I made were in regards to what Osler, a surgical chief resident at the time, described he did or did not want to do in that particular case. It was Osler who described his concerns regarding opiates/hypotension/trauma - NOT ME. As a chief surgical resident at the time and a successful surgeon today his comments and concerns are legitimate points for discussion. Case studies are discussed in med school and after ( continuing ed). Why you're trying to pull rank in a situation outside hospital wards speaks to your insecurity or to the fact you may have a personal interest in the larger criminal case that started this thread. It's obvious you want shut down this Dr. Newman allegations thread for some reason. Be honest about your end goal at least instead of making faux characterizations of an uppity MS1.

 

[odoreater]

Osler, a surgeon, presented a patient case summary that happened 11 years ago that he and Dr. Newman handled. Any comments I made were in regards to what Osler, a surgical chief resident at the time, described he did or did not want to do in that particular case. It was Osler who described his concerns regarding opiates/hypotension/trauma - NOT ME. As a chief surgical resident at the time and a successful surgeon today his comments and concerns are legitimate points for discussion. Case studies are discussed in med school and after ( continuing ed). Why you're trying to pull rank in a situation outside hospital wards speaks to your insecurity or to the fact you may have a personal interest in the larger criminal case that started this thread. It's obvious you want shut down this Dr. Newman allegations thread for some reason. Be honest about your end goal at least instead of making faux characterizations of an uppity MS1.

 

[Hyde]

"Medicine is a social science, and politics is nothing else but medicine on a large scale."

If that's what you truly believe, it gives context to your comments on this thread.

 

[odoreater]

If that's what you truly believe, it gives context to your comments on this thread.

 

[Zebra Hunter]

 

[BoardingDoc]

Be honest about your end goal at least instead of making faux characterizations of an uppity MS1.

 

[HoosierdaddyO]

To continue the theme of "pure speculation" lol....let's say for arguments sake that he is found guilty of this crime....what does or how does this translate to the future of Emergency Medicine and the way things are practiced, whether it be tighter control on narcotics, having a scribe in every room from now on, to cameras in every patient room etc etc etc?! Or does nothing change at all besides reinforcing the notion that its frowned upon to ejaculate onto a patients face, or if you do do it...not to get caught lol? And on the flip side if he is found not guilty what measures can be taken to make sure you never find yourself in this situation, where you have a patient bringing false accusations upon you?

 

[tsbqb]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. CXR with maybe some haze in the LLL. Lines placed. O2 mask on, tachycardic but who wouldn’t be? I’m zoned in on a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy. The bullets couldn’t have hit the aorta or an iliacs, if so the guy would be dead by now, so I’m thinking low pressure retroperitoneal injury? Renal vein? Spleen? Something in zone III? a mesenteric vessel? ****. New, young ER attending in a white button down oxford shirt and a tie wants to put in a left chest tube. Massive hemothorax ain’t the problem, the volume of blood that you would need to give you hypovolemic shock parked in the thorax won’t give you that x-ray but whatever, my PGY2 he needs the practice, so I tell him to prep.

It’s more than the usual degree of chaos, even for 1am at Luke’s. The guy had been shot by the cops so blue waves keep crashing into the trauma bay door requiring regular dispersement. Not that the cops give the impression of actually giving a ****, it’s December of 2004, Ferguson is a decade away and this was in the days when cops still shot young black guys in Harlem because it was part of their job description. Still they were curious to see just what type of paperwork was going to have to be filled out. Patient himself seemed to be opting for the form that didn’t have a time of death on it. The lad is definitely showing bit more spunk than you would expect from someone en-route to his reward via exsanguination but sometimes they can fool you. The other guests to the party were some nurses, my team of exhausted pissed-off surgical residents wishing they were anywhere except responding to a trauma call with me as the chief, and the ER team, maybe six of them all delighted for a distraction from asthma attacks, UTI’s and drug seekers, hoping to see something like on TV and lead by that tense looking attending in the white button down oxford and tie, looking like a guy from NASA in the 60s.

Oxford shirt dude is now standing at the foot of the bed, Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube in and I’m standing behind Pete trying to figure out what happens next. I’m the senior surgeon in the room, closest surgical attending is maybe half and hour away and if we’ve got to do an emergent exploratory laparotomy it’s my problem and frankly I’d rather pass. It would be nice to think my conservative stance was on account of higher principles, a wish to spare homeboy a big midline incision, a lifetime of adhesions and a few days in house getting over his ileus but in reality I just wanted to get back to sleep. My two year old is not all that into sleeping and my wife nine months pregnant is not all that into not being grouchy. I’d been working all day and had to be in the OR all the next day. Yup, this was when things sucked but not in the “crap I’ll be home tonight at 5:30 rather than 4:30 and have to cut short my time at the gym” sucked, or in the “it’s so difficult to decide, should we ditch the kids and go to Santiago or London next month honey?” sucked, but in the “when will this **** end and how can I get another twenty minutes of sleep” way. Perhaps you can relate? Anyways, an unnecessary ex-lap might not be doing shot-guy any favors but it would ruin my night for sure. So when oxford-shirt-with-tie ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation.

Most ER guys differ to the surgeons, after all, they have only the haziest idea of what happens once the patient leaves the trauma bay, understand their limitations and sensibly stay out of the way. But this guy is different; he has his own ideas, probably went to a lecture recently on “pain being the sixth vital sign” or some such bull**** and he says “I’m going to give morphine.” This gets my attention, I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision. “Better not” I say. Unbelievably, he is not dissuaded, his team is looking on and he takes a stand. He tells me he’s the attending physician, he is board certified, he is in charge of this patient while the patient is in the ER and he is going to give the morphine.

It is at this point that certain things are alleged. The surgical team is on record that in calm and respectful tones their chief guided the care of the patient with a graceful firm and steady hand to it’s successful conclusion. Bless them. Meanwhile, the ER team over the ensuing days spilled a fair amount of ink all alleging this and alleging that. Something to the effect that allegedly the senior surgeon at the trauma told the attending emergency medicine physician in the white short sleeved oxford that each was the same amount of time out of medical school with the only difference between the two being that one had done a short residency and one had not. That the ER attending's lack of judgment was a threat to this patient, and that therefore the ER attending should get **** out of this trauma bay and find someone with an earache to treat before he hurt somebody. It is agreed upon by all parties that at about this point the ER attending dismissed the senior surgical resident from the case ordering the surgical resident to leave the area at which point it has been alleged that the senior surgical resident inquired as to weather said ER attending possessed the skill set to open the abdomen or chest and control an exsanguinating injury? Furthermore it has been alleged that the senior surgeon then pointed out that since dismissing the only person currently in the hospital with the ability to treat this potentially life threatening injury would be equivalent to murder, perhaps the ER attending should just go borrow one of the cops guns and shoot the patient himself and get it over with. It has also been alleged that the when the attending in the short sleeved white shirt, now bright red in the face, insisted that he was the physician in charge of the care of the patients in his emergency room and physically attempted to give the morphine via the IV, the senior surgeon in the room, who was six inches taller and 50 pounds heavier than him and had played a whole lot of college rugby positioned his body in such a manner to make such actions impossible and, it has been alleged, in doing so threw a body block that nearly knocked the ER attending over.

The chest tube returned nothing. The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day.

With that trauma over the next one began. Young white-short-sleeved-oxford guy screamed for blood. He demanded dismissal of the surgical resident, he demanded that the medical board launch an investigation, he demanded formal sanctions, he demanded the senior surgical resident be banned from the ER. He got a lot of snickering from the Department of Surgery and a dripping letter of apology.

So why bring this up?

David Newman was the guy I had to push out of the way. He was a wanker then, he's a wanker now.

Wow great story. I cant imagine anyone getting in an argument with you. You seem like such a laid back guy

 

[goodoldalky]

 

[Boatswain2PA]

For safety sake, I need to point that this isn't true. Frangible rounds definitely still go through drywall.

You simply can't depend on a residential wall to be the end of a bullet path...you need to know what's on the other side or be willing to roll those dice

I said frangible rounds "can" be stopped by two layers of sheetrock. Some makers, like DRT, make "penetrating frangible rounds" (makes no sense to me). Meanwhile Glaser makes frangible rounds that are designed for minimal penetration.

Wasn't trying to say you should depend on residential wall to end the path of a bullet. Thanks for the clarification.

 

[The White Coat Investor]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. CXR with maybe some haze in the LLL. Lines placed. O2 mask on, tachycardic but who wouldn’t be? I’m zoned in on a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy. The bullets couldn’t have hit the aorta or an iliacs, if so the guy would be dead by now, so I’m thinking low pressure retroperitoneal injury? Renal vein? Spleen? Something in zone III? a mesenteric vessel? ****. New, young ER attending in a white button down oxford shirt and a tie wants to put in a left chest tube. Massive hemothorax ain’t the problem, the volume of blood that you would need to give you hypovolemic shock parked in the thorax won’t give you that x-ray but whatever, my PGY2 he needs the practice, so I tell him to prep.

It’s more than the usual degree of chaos, even for 1am at Luke’s. The guy had been shot by the cops so blue waves keep crashing into the trauma bay door requiring regular dispersement. Not that the cops give the impression of actually giving a ****, it’s December of 2004, Ferguson is a decade away and this was in the days when cops still shot young black guys in Harlem because it was part of their job description. Still they were curious to see just what type of paperwork was going to have to be filled out. Patient himself seemed to be opting for the form that didn’t have a time of death on it. The lad is definitely showing bit more spunk than you would expect from someone en-route to his reward via exsanguination but sometimes they can fool you. The other guests to the party were some nurses, my team of exhausted pissed-off surgical residents wishing they were anywhere except responding to a trauma call with me as the chief, and the ER team, maybe six of them all delighted for a distraction from asthma attacks, UTI’s and drug seekers, hoping to see something like on TV and lead by that tense looking attending in the white button down oxford and tie, looking like a guy from NASA in the 60s.

Oxford shirt dude is now standing at the foot of the bed, Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube in and I’m standing behind Pete trying to figure out what happens next. I’m the senior surgeon in the room, closest surgical attending is maybe half and hour away and if we’ve got to do an emergent exploratory laparotomy it’s my problem and frankly I’d rather pass. It would be nice to think my conservative stance was on account of higher principles, a wish to spare homeboy a big midline incision, a lifetime of adhesions and a few days in house getting over his ileus but in reality I just wanted to get back to sleep. My two year old is not all that into sleeping and my wife nine months pregnant is not all that into not being grouchy. I’d been working all day and had to be in the OR all the next day. Yup, this was when things sucked but not in the “crap I’ll be home tonight at 5:30 rather than 4:30 and have to cut short my time at the gym” sucked, or in the “it’s so difficult to decide, should we ditch the kids and go to Santiago or London next month honey?” sucked, but in the “when will this **** end and how can I get another twenty minutes of sleep” way. Perhaps you can relate? Anyways, an unnecessary ex-lap might not be doing shot-guy any favors but it would ruin my night for sure. So when oxford-shirt-with-tie ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation.

Most ER guys differ to the surgeons, after all, they have only the haziest idea of what happens once the patient leaves the trauma bay, understand their limitations and sensibly stay out of the way. But this guy is different; he has his own ideas, probably went to a lecture recently on “pain being the sixth vital sign” or some such bull**** and he says “I’m going to give morphine.” This gets my attention, I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision. “Better not” I say. Unbelievably, he is not dissuaded, his team is looking on and he takes a stand. He tells me he’s the attending physician, he is board certified, he is in charge of this patient while the patient is in the ER and he is going to give the morphine.

It is at this point that certain things are alleged. The surgical team is on record that in calm and respectful tones their chief guided the care of the patient with a graceful firm and steady hand to it’s successful conclusion. Bless them. Meanwhile, the ER team over the ensuing days spilled a fair amount of ink all alleging this and alleging that. Something to the effect that allegedly the senior surgeon at the trauma told the attending emergency medicine physician in the white short sleeved oxford that each was the same amount of time out of medical school with the only difference between the two being that one had done a short residency and one had not. That the ER attending's lack of judgment was a threat to this patient, and that therefore the ER attending should get **** out of this trauma bay and find someone with an earache to treat before he hurt somebody. It is agreed upon by all parties that at about this point the ER attending dismissed the senior surgical resident from the case ordering the surgical resident to leave the area at which point it has been alleged that the senior surgical resident inquired as to weather said ER attending possessed the skill set to open the abdomen or chest and control an exsanguinating injury? Furthermore it has been alleged that the senior surgeon then pointed out that since dismissing the only person currently in the hospital with the ability to treat this potentially life threatening injury would be equivalent to murder, perhaps the ER attending should just go borrow one of the cops guns and shoot the patient himself and get it over with. It has also been alleged that the when the attending in the short sleeved white shirt, now bright red in the face, insisted that he was the physician in charge of the care of the patients in his emergency room and physically attempted to give the morphine via the IV, the senior surgeon in the room, who was six inches taller and 50 pounds heavier than him and had played a whole lot of college rugby positioned his body in such a manner to make such actions impossible and, it has been alleged, in doing so threw a body block that nearly knocked the ER attending over.

The chest tube returned nothing. The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day.

With that trauma over the next one began. Young white-short-sleeved-oxford guy screamed for blood. He demanded dismissal of the surgical resident, he demanded that the medical board launch an investigation, he demanded formal sanctions, he demanded the senior surgical resident be banned from the ER. He got a lot of snickering from the Department of Surgery and a dripping letter of apology.

So why bring this up?

David Newman was the guy I had to push out of the way. He was a wanker then, he's a wanker now.

Fun story and very well told.

Although I think it's pretty obvious to all that there were two people in the trauma bay that day acting like douchebags. You guys got in a physical altercation over a couple of milligrams of morphine? That's a story I'd be embarrassed to tell. If you don't see why that altercation nearly got you fired from residency, you lack some serious introspection. Glad the patient made out okay, despite the doctors!

 

[Tenk]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. CXR with maybe some haze in the LLL. Lines placed. O2 mask on, tachycardic but who wouldn’t be? I’m zoned in on a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy. The bullets couldn’t have hit the aorta or an iliacs, if so the guy would be dead by now, so I’m thinking low pressure retroperitoneal injury? Renal vein? Spleen? Something in zone III? a mesenteric vessel? ****. New, young ER attending in a white button down oxford shirt and a tie wants to put in a left chest tube. Massive hemothorax ain’t the problem, the volume of blood that you would need to give you hypovolemic shock parked in the thorax won’t give you that x-ray but whatever, my PGY2 he needs the practice, so I tell him to prep.

It’s more than the usual degree of chaos, even for 1am at Luke’s. The guy had been shot by the cops so blue waves keep crashing into the trauma bay door requiring regular dispersement. Not that the cops give the impression of actually giving a ****, it’s December of 2004, Ferguson is a decade away and this was in the days when cops still shot young black guys in Harlem because it was part of their job description. Still they were curious to see just what type of paperwork was going to have to be filled out. Patient himself seemed to be opting for the form that didn’t have a time of death on it. The lad is definitely showing bit more spunk than you would expect from someone en-route to his reward via exsanguination but sometimes they can fool you. The other guests to the party were some nurses, my team of exhausted pissed-off surgical residents wishing they were anywhere except responding to a trauma call with me as the chief, and the ER team, maybe six of them all delighted for a distraction from asthma attacks, UTI’s and drug seekers, hoping to see something like on TV and lead by that tense looking attending in the white button down oxford and tie, looking like a guy from NASA in the 60s.

Oxford shirt dude is now standing at the foot of the bed, Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube in and I’m standing behind Pete trying to figure out what happens next. I’m the senior surgeon in the room, closest surgical attending is maybe half and hour away and if we’ve got to do an emergent exploratory laparotomy it’s my problem and frankly I’d rather pass. It would be nice to think my conservative stance was on account of higher principles, a wish to spare homeboy a big midline incision, a lifetime of adhesions and a few days in house getting over his ileus but in reality I just wanted to get back to sleep. My two year old is not all that into sleeping and my wife nine months pregnant is not all that into not being grouchy. I’d been working all day and had to be in the OR all the next day. Yup, this was when things sucked but not in the “crap I’ll be home tonight at 5:30 rather than 4:30 and have to cut short my time at the gym” sucked, or in the “it’s so difficult to decide, should we ditch the kids and go to Santiago or London next month honey?” sucked, but in the “when will this **** end and how can I get another twenty minutes of sleep” way. Perhaps you can relate? Anyways, an unnecessary ex-lap might not be doing shot-guy any favors but it would ruin my night for sure. So when oxford-shirt-with-tie ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation.

Most ER guys differ to the surgeons, after all, they have only the haziest idea of what happens once the patient leaves the trauma bay, understand their limitations and sensibly stay out of the way. But this guy is different; he has his own ideas, probably went to a lecture recently on “pain being the sixth vital sign” or some such bull**** and he says “I’m going to give morphine.” This gets my attention, I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision. “Better not” I say. Unbelievably, he is not dissuaded, his team is looking on and he takes a stand. He tells me he’s the attending physician, he is board certified, he is in charge of this patient while the patient is in the ER and he is going to give the morphine.

It is at this point that certain things are alleged. The surgical team is on record that in calm and respectful tones their chief guided the care of the patient with a graceful firm and steady hand to it’s successful conclusion. Bless them. Meanwhile, the ER team over the ensuing days spilled a fair amount of ink all alleging this and alleging that. Something to the effect that allegedly the senior surgeon at the trauma told the attending emergency medicine physician in the white short sleeved oxford that each was the same amount of time out of medical school with the only difference between the two being that one had done a short residency and one had not. That the ER attending's lack of judgment was a threat to this patient, and that therefore the ER attending should get **** out of this trauma bay and find someone with an earache to treat before he hurt somebody. It is agreed upon by all parties that at about this point the ER attending dismissed the senior surgical resident from the case ordering the surgical resident to leave the area at which point it has been alleged that the senior surgical resident inquired as to weather said ER attending possessed the skill set to open the abdomen or chest and control an exsanguinating injury? Furthermore it has been alleged that the senior surgeon then pointed out that since dismissing the only person currently in the hospital with the ability to treat this potentially life threatening injury would be equivalent to murder, perhaps the ER attending should just go borrow one of the cops guns and shoot the patient himself and get it over with. It has also been alleged that the when the attending in the short sleeved white shirt, now bright red in the face, insisted that he was the physician in charge of the care of the patients in his emergency room and physically attempted to give the morphine via the IV, the senior surgeon in the room, who was six inches taller and 50 pounds heavier than him and had played a whole lot of college rugby positioned his body in such a manner to make such actions impossible and, it has been alleged, in doing so threw a body block that nearly knocked the ER attending over.

The chest tube returned nothing. The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day.

With that trauma over the next one began. Young white-short-sleeved-oxford guy screamed for blood. He demanded dismissal of the surgical resident, he demanded that the medical board launch an investigation, he demanded formal sanctions, he demanded the senior surgical resident be banned from the ER. He got a lot of snickering from the Department of Surgery and a dripping letter of apology.

So why bring this up?

David Newman was the guy I had to push out of the way. He was a wanker then, he's a wanker now.

Ketamine.

 

[sum dude]

Why don't you put in a couple of chest tubes in awake patients without analgesia and then let us know how you think about that? Osler21's concerns were not entirely unreasonable, but they were also not the obvious way to go. Let's keep a couple of things in mind here:

1 - The patient did well under Dr. Newman's care after Osler21 was excused from the case.
2 - Osler21 claims that it was "alleged" that he body checked Dr. Newman, then later reports that "I had to push him out of the way".
3 - Osler21 says that the Department of Surgery sent a "dripping letter of apology" but also claims he was almost fired over this.

2&3 above seem to contradict themselves. In any case, pushing people out of the way never works well in a trauma bay.

By the way, Osler21 - Sir William Osler was an internist.

1) I was in Med School in 2004... Fentanyl existed then..but Ketamine wasn't used in adults yet, for fear they'd wake up seeing devils stabbing their face and go crazy and jump through windows and stuff
2) Puttin in chest tubes w/o pain meds...total d*ck move. Sedation would be even better. Although unnecessary chest tubes and allegedly ejaculating in patient's face...also d*ck move (pun intended). Torn on this one...you guys should have arm wrestled, or done a walkoff
3) Osler21--I think you meant Halstead21, who was Surgeon bad ass and coke addict. I bet he benched at least 300lbs (or 145 kg, as he preferred to brag)
4) Boy am I glad I don't work in academic center anymore. I haven't had to pull down my pants and boxers down to settle a dispute in a long time

"Medicine is a science of uncertainty and an art of probability." --Osler21's namesake

 

[Dre8]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. CXR with maybe some haze in the LLL. Lines placed. O2 mask on, tachycardic but who wouldn’t be? I’m zoned in on a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy. The bullets couldn’t have hit the aorta or an iliacs, if so the guy would be dead by now, so I’m thinking low pressure retroperitoneal injury? Renal vein? Spleen? Something in zone III? a mesenteric vessel? ****. New, young ER attending in a white button down oxford shirt and a tie wants to put in a left chest tube. Massive hemothorax ain’t the problem, the volume of blood that you would need to give you hypovolemic shock parked in the thorax won’t give you that x-ray but whatever, my PGY2 he needs the practice, so I tell him to prep.

It’s more than the usual degree of chaos, even for 1am at Luke’s. The guy had been shot by the cops so blue waves keep crashing into the trauma bay door requiring regular dispersement. Not that the cops give the impression of actually giving a ****, it’s December of 2004, Ferguson is a decade away and this was in the days when cops still shot young black guys in Harlem because it was part of their job description. Still they were curious to see just what type of paperwork was going to have to be filled out. Patient himself seemed to be opting for the form that didn’t have a time of death on it. The lad is definitely showing bit more spunk than you would expect from someone en-route to his reward via exsanguination but sometimes they can fool you. The other guests to the party were some nurses, my team of exhausted pissed-off surgical residents wishing they were anywhere except responding to a trauma call with me as the chief, and the ER team, maybe six of them all delighted for a distraction from asthma attacks, UTI’s and drug seekers, hoping to see something like on TV and lead by that tense looking attending in the white button down oxford and tie, looking like a guy from NASA in the 60s.

Oxford shirt dude is now standing at the foot of the bed, Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube in and I’m standing behind Pete trying to figure out what happens next. I’m the senior surgeon in the room, closest surgical attending is maybe half and hour away and if we’ve got to do an emergent exploratory laparotomy it’s my problem and frankly I’d rather pass. It would be nice to think my conservative stance was on account of higher principles, a wish to spare homeboy a big midline incision, a lifetime of adhesions and a few days in house getting over his ileus but in reality I just wanted to get back to sleep. My two year old is not all that into sleeping and my wife nine months pregnant is not all that into not being grouchy. I’d been working all day and had to be in the OR all the next day. Yup, this was when things sucked but not in the “crap I’ll be home tonight at 5:30 rather than 4:30 and have to cut short my time at the gym” sucked, or in the “it’s so difficult to decide, should we ditch the kids and go to Santiago or London next month honey?” sucked, but in the “when will this **** end and how can I get another twenty minutes of sleep” way. Perhaps you can relate? Anyways, an unnecessary ex-lap might not be doing shot-guy any favors but it would ruin my night for sure. So when oxford-shirt-with-tie ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation.

Most ER guys differ to the surgeons, after all, they have only the haziest idea of what happens once the patient leaves the trauma bay, understand their limitations and sensibly stay out of the way. But this guy is different; he has his own ideas, probably went to a lecture recently on “pain being the sixth vital sign” or some such bull**** and he says “I’m going to give morphine.” This gets my attention, I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision. “Better not” I say. Unbelievably, he is not dissuaded, his team is looking on and he takes a stand. He tells me he’s the attending physician, he is board certified, he is in charge of this patient while the patient is in the ER and he is going to give the morphine.

It is at this point that certain things are alleged. The surgical team is on record that in calm and respectful tones their chief guided the care of the patient with a graceful firm and steady hand to it’s successful conclusion. Bless them. Meanwhile, the ER team over the ensuing days spilled a fair amount of ink all alleging this and alleging that. Something to the effect that allegedly the senior surgeon at the trauma told the attending emergency medicine physician in the white short sleeved oxford that each was the same amount of time out of medical school with the only difference between the two being that one had done a short residency and one had not. That the ER attending's lack of judgment was a threat to this patient, and that therefore the ER attending should get **** out of this trauma bay and find someone with an earache to treat before he hurt somebody. It is agreed upon by all parties that at about this point the ER attending dismissed the senior surgical resident from the case ordering the surgical resident to leave the area at which point it has been alleged that the senior surgical resident inquired as to weather said ER attending possessed the skill set to open the abdomen or chest and control an exsanguinating injury? Furthermore it has been alleged that the senior surgeon then pointed out that since dismissing the only person currently in the hospital with the ability to treat this potentially life threatening injury would be equivalent to murder, perhaps the ER attending should just go borrow one of the cops guns and shoot the patient himself and get it over with. It has also been alleged that the when the attending in the short sleeved white shirt, now bright red in the face, insisted that he was the physician in charge of the care of the patients in his emergency room and physically attempted to give the morphine via the IV, the senior surgeon in the room, who was six inches taller and 50 pounds heavier than him and had played a whole lot of college rugby positioned his body in such a manner to make such actions impossible and, it has been alleged, in doing so threw a body block that nearly knocked the ER attending over.

The chest tube returned nothing. The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day.

With that trauma over the next one began. Young white-short-sleeved-oxford guy screamed for blood. He demanded dismissal of the surgical resident, he demanded that the medical board launch an investigation, he demanded formal sanctions, he demanded the senior surgical resident be banned from the ER. He got a lot of snickering from the Department of Surgery and a dripping letter of apology.

So why bring this up?

David Newman was the guy I had to push out of the way. He was a wanker then, he's a wanker now.

congrats on being a d-bag!

 

[deleted480308]

I said frangible rounds "can" be stopped by two layers of sheetrock. Some makers, like DRT, make "penetrating frangible rounds" (makes no sense to me). Meanwhile Glaser makes frangible rounds that are designed for minimal penetration.

Wasn't trying to say you should depend on residential wall to end the path of a bullet. Thanks for the clarification.

It's all good brother, (or sister?). I've seen you post enough around that you aren't likely to think you can just shoot willy nilly at someone on the other side of the wall from your kids room. I have however heard a number of people online, and in person, who literally thought that was a thing you could do. That scares me so I go a little overzealous on clarifying whenever it comes up.

 

[EM4life]

Can we stop responding to Hyde? He/she is a first year medical student. If this person came to shadow in the ER, how much respect would we shower on his/her clinical understanding? NONE. He/she would stand in silence in the back of the room with no clue what was going on. Let's give them just about that much consideration on here. What Hyde has to say about opiates, hypotension, trauma, anything clinical doesn't matter.

I agree, I would venture to say you can walk into any trauma ED and ask ANY EM resident/attending about an argument or disagreement with surgery - you will hear stories similar to what Oslar told. Disagreements between surgery and EM are common, and frequently these interactions can be interpreted as unprofessionalism. It happens all the time, what Oslar described happens all the freaking time, and has happened to ALL EM physicians. I can guarantee you that no one on this forum can say that they've never had a discussion with a surgeon regarding care for a patient that hasn't bordered on unprofessionalism.

 

[PlutoBoy]

I agree, I would venture to say you can walk into any trauma ED and ask ANY EM resident/attending about an argument or disagreement with surgery - you will hear stories similar to what Oslar told. Disagreements between surgery and EM are common, and frequently these interactions can be interpreted as unprofessionalism. It happens all the time, what Oslar described happens all the freaking time, and has happened to ALL EM physicians. I can guarantee you that no one on this forum can say that they've never had a discussion with a surgeon regarding care for a patient that hasn't bordered on unprofessionalism.

It never happens with internists 😎

 

[Angry Birds]

In fact, every doctor on the earth has a prototypical story that goes like this:

Dr. X was taking care of patient Y and did Z. Then I took over care of the patient and realized that this was completely wrong and changed the treatment to W and fortunately the patient survived.

This is always the pattern. Never the other way around.

 

[pulmoblast]

I’m an OK surgeon now but almost never got a chance, since I nearly got fired as a resident.

22 y.o. AA male GSW x 3 to the back. CXR with maybe some haze in the LLL. Lines placed. O2 mask on, tachycardic but who wouldn’t be? I’m zoned in on a couple of sketchy B.P.’s, hemodynamic instability in the setting of penetrating injury to the back being an absolute indication for laparotomy. The bullets couldn’t have hit the aorta or an iliacs, if so the guy would be dead by now, so I’m thinking low pressure retroperitoneal injury? Renal vein? Spleen? Something in zone III? a mesenteric vessel? ****. New, young ER attending in a white button down oxford shirt and a tie wants to put in a left chest tube. Massive hemothorax ain’t the problem, the volume of blood that you would need to give you hypovolemic shock parked in the thorax won’t give you that x-ray but whatever, my PGY2 he needs the practice, so I tell him to prep.

It’s more than the usual degree of chaos, even for 1am at Luke’s. The guy had been shot by the cops so blue waves keep crashing into the trauma bay door requiring regular dispersement. Not that the cops give the impression of actually giving a ****, it’s December of 2004, Ferguson is a decade away and this was in the days when cops still shot young black guys in Harlem because it was part of their job description. Still they were curious to see just what type of paperwork was going to have to be filled out. Patient himself seemed to be opting for the form that didn’t have a time of death on it. The lad is definitely showing bit more spunk than you would expect from someone en-route to his reward via exsanguination but sometimes they can fool you. The other guests to the party were some nurses, my team of exhausted pissed-off surgical residents wishing they were anywhere except responding to a trauma call with me as the chief, and the ER team, maybe six of them all delighted for a distraction from asthma attacks, UTI’s and drug seekers, hoping to see something like on TV and lead by that tense looking attending in the white button down oxford and tie, looking like a guy from NASA in the 60s.

Oxford shirt dude is now standing at the foot of the bed, Pete’s on patient’s left giving some lidocaine at the 5th intercostal space and posterior axillary line getting ready to put the chest tube in and I’m standing behind Pete trying to figure out what happens next. I’m the senior surgeon in the room, closest surgical attending is maybe half and hour away and if we’ve got to do an emergent exploratory laparotomy it’s my problem and frankly I’d rather pass. It would be nice to think my conservative stance was on account of higher principles, a wish to spare homeboy a big midline incision, a lifetime of adhesions and a few days in house getting over his ileus but in reality I just wanted to get back to sleep. My two year old is not all that into sleeping and my wife nine months pregnant is not all that into not being grouchy. I’d been working all day and had to be in the OR all the next day. Yup, this was when things sucked but not in the “crap I’ll be home tonight at 5:30 rather than 4:30 and have to cut short my time at the gym” sucked, or in the “it’s so difficult to decide, should we ditch the kids and go to Santiago or London next month honey?” sucked, but in the “when will this **** end and how can I get another twenty minutes of sleep” way. Perhaps you can relate? Anyways, an unnecessary ex-lap might not be doing shot-guy any favors but it would ruin my night for sure. So when oxford-shirt-with-tie ER attending calls for a couple mg of morphine to be given IV to spare the patient a bit of discomfort from the chest tube insertion I say I’d rather skip it. Morphine can cause a transient drop in blood pressure and another couple low BP’s on the monitor and I’m obliged to open this guy up (and stay awake for another couple of hours) so I’d rather not have it on board confounding the situation.

Most ER guys differ to the surgeons, after all, they have only the haziest idea of what happens once the patient leaves the trauma bay, understand their limitations and sensibly stay out of the way. But this guy is different; he has his own ideas, probably went to a lecture recently on “pain being the sixth vital sign” or some such bull**** and he says “I’m going to give morphine.” This gets my attention, I explain, quickly, why this is bad idea. 3 minutes of pain from the chest tube insertion vs dropping the blood pressure and forcing my hand to do an exploratory laparotomy based on information confounded by narcotic is an easy decision. “Better not” I say. Unbelievably, he is not dissuaded, his team is looking on and he takes a stand. He tells me he’s the attending physician, he is board certified, he is in charge of this patient while the patient is in the ER and he is going to give the morphine.

It is at this point that certain things are alleged. The surgical team is on record that in calm and respectful tones their chief guided the care of the patient with a graceful firm and steady hand to it’s successful conclusion. Bless them. Meanwhile, the ER team over the ensuing days spilled a fair amount of ink all alleging this and alleging that. Something to the effect that allegedly the senior surgeon at the trauma told the attending emergency medicine physician in the white short sleeved oxford that each was the same amount of time out of medical school with the only difference between the two being that one had done a short residency and one had not. That the ER attending's lack of judgment was a threat to this patient, and that therefore the ER attending should get **** out of this trauma bay and find someone with an earache to treat before he hurt somebody. It is agreed upon by all parties that at about this point the ER attending dismissed the senior surgical resident from the case ordering the surgical resident to leave the area at which point it has been alleged that the senior surgical resident inquired as to weather said ER attending possessed the skill set to open the abdomen or chest and control an exsanguinating injury? Furthermore it has been alleged that the senior surgeon then pointed out that since dismissing the only person currently in the hospital with the ability to treat this potentially life threatening injury would be equivalent to murder, perhaps the ER attending should just go borrow one of the cops guns and shoot the patient himself and get it over with. It has also been alleged that the when the attending in the short sleeved white shirt, now bright red in the face, insisted that he was the physician in charge of the care of the patients in his emergency room and physically attempted to give the morphine via the IV, the senior surgeon in the room, who was six inches taller and 50 pounds heavier than him and had played a whole lot of college rugby positioned his body in such a manner to make such actions impossible and, it has been alleged, in doing so threw a body block that nearly knocked the ER attending over.

The chest tube returned nothing. The BP’s stabilized and later we learned that the gun shot wounds that we thought we were seeing were really fragments from the frangilble bullets that NYC cops use. These bullets are designed to break apart when they miss their target so as to cause minimal damage when they ricochet off things. The guy went home/to jail the next day.

With that trauma over the next one began. Young white-short-sleeved-oxford guy screamed for blood. He demanded dismissal of the surgical resident, he demanded that the medical board launch an investigation, he demanded formal sanctions, he demanded the senior surgical resident be banned from the ER. He got a lot of snickering from the Department of Surgery and a dripping letter of apology.

So why bring this up?

David Newman was the guy I had to push out of the way. He was a wanker then, he's a wanker now.

I love this ****...this is entertaining ... I read it like 5 times

Reminds me of House of God in some ways

 

[odoreater]

I love this ****...this is entertaining ... I read it like 5 times

Reminds me of House of God in some ways

Which part was your favorite?

Was it the part where he was more concerned with his sleep than patient care or the part where he utilized his "rugby" skills to body check a faculty member? Was it the part where he denigrated an entire speciality or the part where he stated that in the mid 00's cops shot black people in harlem as part of their job description?

I mean so many "entertaining" things to choose from.

 

[e30ftw]

Glad the patient made out okay, despite the doctors!

Agreed, but he did end up with an unneccessary chest tube which could have easily been averted with a bedside ultrasound or a trip to CT.

Being a surgeon I'm sure Oslar knows that up to 1000ml of acute hemothorax can be missed completely on supine portable radiographs and that the sensitivity of of pCXR for hemothorax hovers around 30%.. so if the pt truly had SBP < 90 with tachycardia and mental status changes in the setting of penetrating trauma, chest tube is not contraindicated..

however.. sounds like the guy was mentating pretty normally.

He needs a FAST exam, resuscitation, and if improved at O2 normal, CT - TAP w/ IV contrast. maybe some local wound exploration.

if he's mentating fine and BP rises w/ resus wheel him to the donut of truth and light him up... all questions answered, peace be upon you, discharge .

All hindsight obviously. Both physicians involved certainly come off as childish however legally this was Dr. Newman's patient and the surgical resident had no authority or legal obligation to care for the patient.

It would be absolutely reasonable for the resident to be fired or otherwise disciplined for insubordination and assault.

The entire post shows why patients should implicitly trust and thank their anesthesiologists.

 

[Birdstrike]

1-How long does it take to get a forensic level DNA test back?

2-How long does it take to get a forensic level DNA test back if you've refused to give a sample and a subpoena is required to get one?

 

[deleted480308]

How long does it take to get a forensic level DNA test back?

long enough to ruin a man regardless of the results

 

[Birdstrike]

long enough to ruin a man regardless of the results

In regards to this, there's been enough highly publicized false rape allegations in the past few years (Rolling Stone UVA case, Duke lacrosse, Tawana Brawley, & Jamie Leigh Jones KBR cases, as examples) that a guy this high of a profile, with help from the medical community and the media, hopefully, would have a shot at (at least partially) restoring his reputation and getting the word out about the injustice. In fact, if these allegations do turn out to be definitively false, I know of some people that would be willing to speak out about it. I for one, would consider a KevinMD post about it or maybe even an EP monthly/White Coat Call Room guest-post about it, regarding the damage false allegations can do, and the importance for the presumption of innocence in our legal system.

On the other hand, if the allegations turn out to be true, that's a whole different situation entirely. All in all, it's too early to say much one way or the other, so I'm content to presume innocence and let the process play out.

 

[Danbo1957]

All hindsight obviously. Both physicians involved certainly come off as childish however legally this was Dr. Newman's patient and the surgical resident had no authority or legal obligation to care for the patient.

It would be absolutely reasonable for the resident to be fired or otherwise disciplined for insubordination and assault.

This is problematic on so many levels. I would hate to be a trauma patient in this ED...

 

[deleted480308]

In regards to this, there's been enough highly publicized false rape allegations in the past few years (Rolling Stone UVA case, Duke lacrosse, Tawana Brawley, & Jamie Leigh Jones KBR cases, as examples) that a guy this high of a profile, with help from the medical community and the media, hopefully, would have a shot at (at least partially) restoring his reputation and getting the word out about the injustice. In fact, if these allegations do turn out to be definitively false, I know of some people that would be willing to speak out about it. I for one, would consider a KevinMD post about it or maybe even an EP monthly/White Coat Call Room guest-post about it the damage false allegations can do, and the importance for the presumption of innocence in our legal system.

On the other hand, if the allegations turn out to be true, that's a whole different situation entirely. All in all, it's too early to say much one way or the other, so I'm content to presume innocence and let the process play out.

I 100% agree that a negative on that DNA test basically saves his career. But regardless how many of us believe in that innocence (should it be corroborated) it's a stink that will never quite wash off. It's the danger of those types of allegations.

 

[Angry Birds]

If he was a no-name doctor (like most of us I think), he'd be screwed either way. Hospitals would rather not deal with anyone with even an accusation, even if found not guilty. This is the really sucky thing about it.

 

[southerndoc]

If he was a no-name doctor (like most of us I think), he'd be screwed either way. Hospitals would rather not deal with anyone with even an accusation, even if found not guilty. This is the really sucky thing about it.

As an employee, he has rights that wouldn't be afforded to an independent contractor. I'm not sure if he is eligible for tenure.

 

[e30ftw]

This is problematic on so many levels. I would hate to be a trauma patient in this ED...

Such as a trauma center with 24hr in-house attending surgical coverage where care is managed professionally by physicians with medical licenses and hospital privileges?

Both of them were acting childish and inappropriately, however as a resident you cannot "body check" an attending to prevent him from providing care for his patient without expecting some sort of consequence.

Feel free to seek care wherever you like..

 

[Danbo1957]

Such as a trauma center with 24hr in-house attending surgical coverage where care is managed professionally by physicians with medical licenses and hospital privileges?

Where exactly was that surgical attending during this trauma? And did you say "trauma center"? Trauma should be run by surgeons...

 

[odoreater]

Where exactly was that surgical attending during this trauma? And did you say "trauma center"? Trauma should be run by surgeons...

This thread is a microcosm of all the joys of emergency medicine circa 2016.

 

[Danbo1957]

And when Newman is convicted this thread...

 

[odoreater]

And when Newman is convicted this thread...