Friday, December 28, 2007

We've Got a Hasselhoff in Room 13

Several media outlets ran stories recently about the British Medical Journal's Christmas edition which, in keeping with its tradition, published lighthearted articles on the culture of medicine. One of these was a short list of new medical terminology. There's some good stuff in there, including the terms "blamestorming" (a group of doctors trying to find a scapegoat for an egregious error), "tesiticulation" ("the holding forth with expressive hand gestures by a consultant on a subject in which he or she has little knowledge") and "Jack Bauer" (a doctor still up and working after 24 hours on the hob) but the kicker of the compendium was "Hasselhoff."

The term "Hasselhoff" refers to a patient with an injury (or injuries) that are not plausibly related to the explanation given for them. David Hasselfhoff (of Knight Rider and Baywatch fame) was injured at a London hotel in 2006 while shaving. Shaving, at least, was the explanation he gave for a head injury and a severely injured right arm (with tendon and artery damage). Hasselhoff's story (to this day) is that he hit his head on a bathroom chandelier while shaving, which caused the chandelier to break and to send a shard of glass through his arm. It's hard to imagine a plausible manner in which this could have occured; was he wearing a pair of stilts while shaving? Or trying to use the chandelier glass to get a closer look at his nose hair?

Recently, we had a "Hasselhoff" in Room 13 of our emergency department (ED); a middle-aged man who had hurt his ribs and chest while getting out of bed to get a glass of water. Perhaps he was a little tipsy, he said, and had stumbled against a railing. As the x-rays revealed, there were more to his injuries than just a banged-up rib cage. This guy was walking around with numerous broken ribs, including the first and second (which are very difficult to break) and a "flail" area of the chest - where the ribs paradoxically sucked in (rather than expanding out) with inspiration. There was no doubt that this man had suffered a high velocity and high impact injury - but he, in vintage Hasselhoff form, stuck to his story (even when the admitting surgeon, a gruff and no-nonsense type of guy, called bullshit.) We kept waiting for the police to show up, inquiring about a man who had abandoned his car in a precarious position, but our curiousity was not to be satisfied. Like Hasselhoff's mysterious chandelier incident, this fool's story may remain fuel for an active imagination.