Defeating Evolution Yet Again

A good rule of thumb in emergency medicine is that it's the nice, sweet, polite patient that will die. The assholes never do. Today I was reminded yet again of my role in defeating the laws of natural selection.

He was brought in fully immobilised on a spinal board with a cervical collar on, his obese frame strapped (barely) down. Despite the copious amounts of blood splattered all over his front, this didn't seem to have dampened his spirits since he was regaling the paramedics with the tale of this, his latest exploit. I thought perhaps his joviality was secondary to intoxication, but there was certainly no smell of alcohol on his breath. When he had been settled into our trauma bay, I introduced myself to him, and proceeded to elicit the story.

Apparently, the trouble had started with a fuss over garbage disposal. Our good patient - we shall call him G - had decided that since he was disinclined to dispose properly of his bulk garbage, that he would simply place it in a common area by the road, where he presumed someone would come along to pick it up. Unfortunately, given the fact that our roads at this time of year are narrowed by tall snowbanks on either side, his garbage had ended up encroaching onto the road itself.

Enter B, a passing motorist who decided to take it upon himself to heckle G over his un-neighbourly behaviour. Feeling somewhat put upon, G decided to "defend" himself. Crossing over to B's car, he had stuck a fist into the latter's face. Shouting and punching on both sides ensued. At this point, apparently, G had forgotten that although he must have outweighed B by quite a bit, B was in possession of a weapon: the car. He had grabbed B's collar and was shaking him when B, decided he had had enough, proceeded to floor the accelerator.

Not to be outdone, G ran alongside the car for quite a few meters, still hanging on to B's collar. His stubbornness was to be his undoing, as B - perhaps alarmed by G's tenacity - accelerated even further.

"I told him, "Stop! I'm losing my footing!" but he just went faster," G said, "and then I fell."

"Uh huh. So... you were holding on to him and got dragged that way?"

"Yeah, the asshole! He wouldn't stop!"

Needless to say, the result was not pretty - gashes to his head, hands, knees and lots of roadrash. At one point, examining my patient's knuckles, I asked if the wounds were from the punches he had thrown, or from the road - since if the former, he might have required antibiotics as the human mouth is the dirtiest place there is, from which to incur a cut.

"Oh, no, that's the road," my patient cheerfully said. "Though I wish it was from his mouth! It would make me feel better, haha! The idiot should have minded his own business!"

He kept up this barrage as I patched him up, and finally I couldn't resist. "Sir," I said, "what do you think is the moral of the story tonight?"

"Oh," he replied, "ummmm.... don't put your garbage on the road?"

"Yes," I said, thinking perhaps there was hope after all for my patient, "that would be one lesson."

"Ah, but if it was just me I'd understand, but hell, the man down the road does the same thing and nobody yelled at him!"

So I gave up and let him continue to wear my ear out. And by the time I had finished sewing him up, I must have heard a hundred reasons why it wasn't his fault at all, and instead it was entirely, utterly and totally B's fault. I almost wished he were drunk or unconscious by the time I was done - and that was the start of my 8hr shift.

Just before G left, I bid him goodbye and told him that I hoped not to see him again in the emergency department.

"Well, Doctor," he said, "I must say - if it ever happened again, I can't say I'd do anything different except maybe punch him harder."

Sometimes I think I make Darwin roll over in his grave.