Monday, 9 December 2013

Optimists vs. pessimists


op·ti·mist (op-tuh-mist)
1. One who usually expects a favorable outcome.
2. A believer in philosophical optimism.

I tend to see the worst in any situation, the worst in people, and the worst in the world in general (except when it comes to my children).  If you've read this blog at all, I think I've made that plainly obvious.  But I also think that good doctors, especially good surgeons, should be pessimists.  People who only expect good things to happen can easily overlook potential hazards, dangers, and pitfalls.  On the other hand, people who expect the worst are able to prepare for the worst and then hope for the best.  As much as any other profession, doctors need to be aware of not only what is happening, but what could possibly happen.  In other words, to hell with optimism; I'm a die-hard pessimist.  That isn't to say that I don't have a shred of optimism left.  No, I still have a tiny Inner Optimist that likes to whisper in my ear that everything will be ok if I just keep my chin up and stay positive.

I find my Inner Optimist annoying as hell.

The call at 3 AM was for a guy stabbed in the abdomen, and reportedly he was eviscerated.  In layman's terms this means his guts were supposedly protruding out of his stab wound.  The last time I had got a call for an "evisceration" a few months ago, the medics were frantically running around like starving hyenas as they dropped their patient at my door.  When I removed the gauze that they had placed to protect his supposed innards, what greeted me was not intestine but a small blood clot.  So when I got the evisceration call this time, my Inner Optimist said, "Meh, it's probably nothing.  I'm sure he's fine!  Stay positive!"

The young man smelled drunk and looked uncomfortable.  He smelled drunk because he was drunk.  He looked uncomfortable because, well, I think this picture will make the reason glaringly obvious:

My Inner Optimist took one look at him and passed out.

In case you can't tell what you're looking at (or if you are a big big baby and refuse to look), that's a long segment of his small intestine coming out through a 3 cm stab wound in his left upper abdomen (the stab wound itself is covered by his entrails).  I took him to the operating theatre where I found a total of 6 lacerations in his small intestine.  I repaired all of them, and despite his attacker's best efforts, he's now doing just fine.

My Inner Optimist regained consciousness two days later.  It's a bit weaker after that episode, but it's just as annoying.  "Hey, things could have been worse!" it keeps telling me.  "He could have died!  You should be happy he survived!  You should be more optimistic!"

Maybe, but pessimists get more happy surprises.


  1. How in the hell do you put those back in?

  2. I remember the first time I saw an was while deployed..side note, not a good time to see something like this for the first time.

  3. It says 'through a 3cm stab wound'... Those intestines look waaay wider then 3cms. I don't see how they could easily just 'fall' out. I'm no Doctor or anything but is this 'common' for stabbings or did his assailants just reach in and pull them out?

    1. It's quite common. As the patient coughs and breathes and strains, more and more intestine gets pushed out by the increased intra-abdominal pressure.

  4. Intestines are extremely smooshy (scientific term, of course) and can easily pop out through a surprisingly small laceration. He most likely got stabbed in the exact right (wrong?) location, then instinctively held his breath from the pain...which increased his abdominal pressure, and made his guts squoosh out through the hole. I've occasionally seen similar things happen with surgical patients... they cough a little too hard, a stitch or 2 pops loose and it's back to the OR they go!

    1. Fair enough, I guess that makes sense. Thanks.

    2. Note to self, never EVER need abdominal surgery.

      (I sneeze and cough like a damn hurricane. Yes, very annoying. yes loud, and yes, if done several times in a row it will hurt everywhere.)

  5. My son spent 4 months in the NICU and the baby next to us was born with her intestines on the outside. Very sad.

  6. Um, is there something wrong with me if I immediately started laughing when I scrolled to the picture? Straight after I said "cool!"

  7. It's so… colorful! I thought it was fake at first.


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