Episode 15: The Time I Was an ER Patient

This episode I share the painful and terrifying event that landed me Inside the ER...as a patient. Graphic details kept as minimal as possible!

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Transcript

Welcome, welcome! My name is Padraic Gerety, I’m an ER doc, and this is Inside the ER. 

Today we’re going to do something a little different, just for fun. I’m going to share a story, like I often do, but the difference being, it’s my story. This happened to me and led to me being the patient, not the provider, for the first time Inside the ER. Oh wait, that’s not true I guess. When I was like 4 or something a heavy chair fell on me and my dad took me to the ER. I remember peeing blood afterwards, but I did fine. Anyway after our last episode about the Pitt, all that talk of physical and emotional trauma, I figured it’s time to share some of my own.

Ok so it was December of 2021, on a Monday, I was at home on my day off. My son was only a few months old at the time and I decided to take him and our dog, ya know so both my babies, on a walk before nap time. It was cold that day, I remember bundling him up and putting on my winter coat.

I often think about the confluence of events that lead us to a single moment. If I hadn’t taken my babies out right when I did, if I hadn’t taken them to the park, if I was slower to respond, then my involvement never would have happened. Maybe it would have gone better without me, maybe someone more agile would have showed up to help, or maybe it would have been worse? We’ll never know.

Anyway there I was pushing my son in his stroller, my dog’s leash in hand, walking into the park on a chilly afternoon. That’s when I heard it. A scream. Not then and not since have I heard a scream like that before. Shrill, piercing, filled with pain and fear, followed by a desperate, pleading cry for help. You might think an ER doc has heard it all before, but not like this. We see patients in agony, but not in active danger, that’s the difference. There was terror in her voice. 

I’m going to use fake names from now on, or else this is going to be hard to follow. Before I had gotten to the park, two friends, Sara and Lisa, volunteers at a local animal shelter, met up. Each had brought a newly adopted dog. Sara’s was Bosco, a brown mutt with hanging jowls, and Lisa’s was Rex, a trim, white pit mix. The two dogs were meeting for the first time. They sniffed each other, Sara’s hand went to pet, but then something went wrong. Rex snapped. This is when it happened, this is when I heard the screams, Sara’s screams. I instinctively parked the stroller, tied up my dog’s leash, and sprinted over.

Others joined me and we found the grizzly scene. Rex had somehow bitten down simultaneously on Sara’s hand and Bosco’s face. Both were in his crushing jaws and he would not let go. Lisa strained on her leash to pull Rex back but to no avail. Sara cried out, her face and voice panicked, as she tried to free herself with her other hand. Bosco simply whimpered. There was a brief moment of hesitation, and then, as if on command, the others and I each grabbed a dog and worked to pull them apart.

I’ve heard that you should yank on a dog’s back legs to stop a fight, but I’m not sure how that works when it’s got a woman’s hand in his mouth, so I went for a headlock instead. By sheer luck, I came upon the scene closest to Rex, no one next to me, so he was mine. The dogs came apart easier than I expected and Sara was pulled away. Someone was already calling 911, an off duty medic appeared out of nowhere like Superman, and began bandaging Sara’s hand, we all breathed a sigh of relief. Only one problem…I was still holding onto Rex.

My grip was firm, but not tight enough to hurt him. Should I have just sprung away as soon as I had pulled him off of Sara? I don’t know, maybe that would have prevented what happened next? Or maybe it would have sparked some chase reflex inside Rex and made it worse. Well what did happen is I was stuck there I was in a half-crouched position, holding onto Rex’s neck. He occasionally would try to squirm out of my grip but I held firm, afraid to let him go. Lisa held onto the leash, she was bleeding too, just a few scrapes, and lamented what would happen to Rex now.

 Now don’t forget a crucial fact, I brought my kid and dog along on this walk. It might have seemed irresponsible to dart into this scene but thankfully I live in a very family friendly area and had no reason for fear for my two babies. I strained my head and was relieved to see the woman who had called 911 was standing guard at my stroller. My son had begun to whine and at my request she gave him his pacifier and rocked the stroller. You parents out there know that babies want the stroller to keep moving.

All right, now back to the main problem: what to do about Rex. I strained to maintain my awkward half crouch while gripping him, his occasional thrashing never letting me relax. A couple minutes went by and I started to cramp. I couldn’t hold him like this much longer. That’s when he started to growl, a low, guttural sound, and look up at my neck. A police officer had just arrived and was trying to make sense of the scene. I called to him but he told me to just keep holding on, as I seemed “secure.” That was no help. Rex was gazing more intently at my neck now, and I decided it was time to get the hell out of there. I told Lisa and she agreed.

Now the plan was to slowly let go of Rex and back away. I guess I thought if I was calm, he’d be calm? But after hearing what I just told you, I agree that’s kind of stupid. I guess I should have leapt away, and risked his chase instincts taking over? I’m not sure. If you have any experience with this kind of thing, any advice, please write in to insidetheer@gmail.com and let me know.

Anyway, what did I think was going to happen, he’d bow his head and thank me politely. No, he did what you think he’d do, he bit me. As soon as I released his neck and tried to back away, he snapped his jaws fast and hard, grazing my left hand and fully crunching my right. I screamed in a way I never have before as my hand exploded in pain. I managed to stumble away before collapsing, cradling my hand, moaning, while my blood oozed onto the grass.

I’m sure you’ve heard of, or perhaps experienced, the phenomenon where people in dangerous situations can dissociate as a coping mechanism. Now I don’t think Rex thrashed much, he honestly let go pretty quickly, but the intense pain and fear when he was actively biting me seemed to stretch out in my mind. And in those seconds of agony, I had a brief moment of dissociation, as if those sounds were coming from someone else. There was a single dispassionate thought, “Oh, that’s what my screams sound like,” before reality crashed down onto me and I tumbled into the grass.

Thankfully, Rex did not pursue me further and Lisa kept his leash tight. She could have dropped it or ran off in fear he would attack her next, but she held firm and I was the last victim. Again, like Superman, that off duty medic swooped in and bandaged my hand. When the pain became bearable, I got to my feet and checked on my babies. They were both whining, the kind woman’s efforts not quite enough, but otherwise fine. I asked the man who had helped pull Sara away to fish my phone out of my pocket to call my wife and then text my Er doctor group’s whatsapp to let them know I was gonna need a few shifts off. I was supposed to work an overnight shift that night, whoops.

My wife arrived quickly in our car, and the small crowd that had formed at that point helped us load our babies and stroller. I’ve said in previous episodes that knowing what hospital to go to is very important, and this case is no different. At the time I had no idea how bad my injury was, I hadn’t gotten a good look before the superhero medic wrapped it up, so just in case I had my wife drive me to our regional hand center. On the way over my hand throbbed and I rocked back and forth trying to distract myself. My wife was clearly upset but kept her composure, though did note with fear that my dominant hand had been injured. An ER doc needs their hands, was my career over?

My hand was on fire at that point, it felt like each heartbeat made the throbbing pain intensify. I walked into the waiting room, to find, of course, people waiting! I got registered and was dreading the wait, when they called me back to triage and lo and behold, I recognized one of the techs from my hospital, who apparently also worked at this one. ER techs are a jack of all trades, helping with everything from transporting, vital signs, blood draws, IVs, chest compressions during CPR, you name it. I told her what happened and she let the charge nurse know who I was. Did that have something to do with my short wait time…probably, I guess it’s cheating, I’m sorry, I’m sorry! In my defense, I was the only one with an obvious wound in the waiting room.

I met my doctor in the back, a nice fellow, who took my history as he unwrapped my hand. This was the first of many times I was asked over the next month “Wait, this was your dog? No? Who’s dog? Wait, what happened?” By the end I had boiled it down to: “I saw a random woman and her dog being attacked in a park and went to help and I got bit.” Hmm, I guess I coulda summed up most of the episode with that, right? Oh well, too late!

Anyway, the unwrapping actually made my hand feel much better, the superhero medic ties a tight knot, and I braced myself for my first viewing of the wound. I felt a moment of panic right before, worried if my career, and more importantly my video game hobby, was over. It’s rare for a patient to let out a huge sigh of relief when they see their wounds but I did. My hand had scattered skin tears, an inch long laceration at the base of my thumb, and three puncture wounds. Not good, but not nearly as bad as it coulda been. I ranged my fingers, satisfied that I was gonna be ok. My doc soaked my hand in soapy water, ordered my X-rays, and called the Hand Surgery team.

All right, let’s break down some dog bite basics. Assuming we’ve controlled the bleeding and all that, my next concern is rabies. While there are very few dogborne cases of rabies in the US, the disease is universally fatal, so anytime a dog’s vaccination status is in question, we’ll vaccinate the patient, and they’ll need a few more shots over the next two weeks. If the patient hasn’t been vaccinated for rabies before, then we’ll inject rabies immune globulin, basically antibodies, into the wounds, ouch I know. I’ve already had my rabies shots, thank you Peace Corps, and the dog was from an animal shelter, so I knew that I was OK.

Next if there’s any possibility of a fracture or a retained tooth fragment perhaps, then the patient needs an xray. Open fractures, when there’s a wound over the fracture, may need IV antibiotics, surgery, or at least close follow up. Thankfully, my X-rays were normal. Now let’s assess the wound itself. Did it injure artery, connective tissue, or nerve? The patient may need surgery then. In my case, my radial artery was uninjured, my hand was perfusing well, I could move my fingers albeit painfully.

Next, let’s think about wound care. In general, you want to limit suturing animal bites due to their propensity for infection. Tightly suturing a bite wound will not allow it to drain and instead create a nice pocket where bacteria can brew. This is especially important with cat bites. While dog bites cause more obvious tissue damage, cat bites may leave only a small puncture but those long skinny teeth have introduced bacteria deeper into the flesh. With any significant animal bite, hell a human bite too, the patient is going on antibiotics, often augmetin.

Obviously if it’s a long or deep wound, some amount of closure is necessary or it won’t heal properly. You just won't stitch it as tightly together as you would a cleaner wound, especially on the extremities, which get less blood flow than your face or torso. For my situation, the hand surgery PA  came down, examined me, and confirmed thankfully I won’t need surgery. We decided on a single suture across that laceration to help it heal. That way the sides would be left open to drain and prevent infection. 

Otherwise my ER visit was mostly over. The PA wrapped my hand, instructed me to soak it in soapy water every day, and to follow up with their office later in the week. Funny enough, as I was waiting for my discharge paperwork, I found out Sara was next door. Fortunately, her wounds weren’t as bad as we feared, and we exchanged phone numbers to check in later. My ER doc discharged me with a script for augmentin and I was on my way.

My cab driver was an…interesting…lady. She told me she didn’t trust the COVID vaccine because someone sent her a video of people having seizures and becoming violent after taking it. For all I know it was a passed off clip of “28 days later” or something…that’s a zombie movie for you uncultured ones listening. 

When I got home my wife was relieved that my injury wasn’t more serious, but we realized the simple fact that having a freshly bitten hand is not great for taking care of a baby or changing diapers. I’m sorry my love! That night, I had trouble falling asleep, flashes of the bite replaying in my head but eventually I settled and slept fine afterwards. I took a few shifts off and got back to work once I felt confident I could intubate. Hiding a bandaged hand from patients and keeping it clean was quite annoying.

A few days later I had my appointment with the hand surgeon and he was pleased with my healing thus far. I could move everything, but my hand felt stiff and numb, especially my thumb and index finger. He told me that the main problem with these bites is the crush injury of the nerves, especially from a pitbull. I know it’s disputed whether certain dog breeds bite more or cause more injuries. All I know is I’ve seen many pitbull bites, such as my own, and not a single one from a golden retriever. He said it would take a long time to heal and it did. My sensation didn’t improve for months. And even now, over three years later, as I type this script, my hand still feels sore.

I contacted Sara the next week to see how she was doing. She also followed up with a hand surgeon, except her wound needed debridement. Debridement is when you cut away dead tissue, it can be very painful but thankfully she got through it and was recovering. Bosco, with his bit cheek, was home with her and seemed completely fine, thick skin perhaps.

I’m a little ashamed to admit this now but I’ll just be honest. Afterwards, I wanted Rex put down. I expected that’s what would happen. So I was surprised and frankly upset when Sara told me that he was back in animal shelter’s custody where they would try to rehabilitate him. That’s it, that’s his  punishment? It’s so stupid, I know. What did I want, justice, from a dog? 

But later I realized something. Make no mistake, if Rex wanted to kill me, he could have easily. He coulda ripped out my throat or at least mangled my hand beyond repair. Instead he bit me and then let me go. So, ok, he gets to live, I’m ok with that now. If the animal shelter thought they could make him better then sure, let them try. I never heard from anyone again, but I hope they did well and that Rex is a good boy in a loving home.

In the end, knowing what may happen, would I have intervened again? Yeah. When you see, and especially hear, someone in trouble like that you have to help. It was instinctual, I couldn’t resist. Sure I second guess myself on the minutiae of my actions, I might have tried a couple things differently, but I know two things for sure. First, I had no choice but to intervene, and second, if I had to do it again, I woulda put on my winter gloves first.

This is Inside the ER, my name is Padraic Gerety, and that was my story. If you’re morbidly curious and want to see pictures of my wounds and the healing process, go ahead and email insidetheer@gmail.com and I’ll send ‘em to you.

We’ll back in about a month, and in the meantime, if you’ve got any friends you think would like the podcast, or if you have any enemies you wanna torture with my voice, please direct them to our website insidetheer.buzzsprout.com. If your friend/enemy wants to dip their toe in first with some audio clips they can visit us on our social media instead, ya know TikTok, instagram, blue sky, youtube. If you wouldn’t mind subscribing yourself to Inside the ER on your preferred social media site, that would also really help.

Thanks for listening and all the best.