I am asked to make predictions all the time, and it is always a difficult proposition. I can't see into the future, but that doesn't stop people from asking. "How long will I have to be in the hospital?" "What are the chances my cancer will spread?" "How much longer until I poop?" That last one is the most common, believe it or not.
Unfortunately I don't have a crystal ball in which to gaze. If I did, my job would be a whole lot easier. Hell, if I did I would have won the lottery years ago and retired to some beautiful island in the Caribbean.
Regardless, I am often forced to make predictions anyway, but fortunately instead of wild guesses they ultimately end up educated estimations based on a combination of statistics, years of experience, and sheer dumb luck. Usually I'm pretty close, but sometimes I'm way off the mark.
And sometimes I hit a direct bull's-eye.
There wasn't anything terribly interesting or unique about Clarence (not his real name©). He could have been any obnoxious 20-year old kid - skinny, brash, covered in tattoos. And thoroughly obnoxious. Did I mention obnoxious? The main thing that separated Clarence from his colleagues was the fact that Clarence had a gunshot wound in his left lower abdomen. I don't know the details of the shooting, and I didn't really care. And for a change I was smart enough not to ask. When he arrived (at 1 AM, of course - thanks a bunch, Call Gods) he was clutching his abdomen and complaining of severe pain, and when I rolled him over to look at his back I saw that the bullet had exited through his left buttock.
Oh. Shit. There are a lot of very important structures between those two holes. That's the way my brain always runs when I'm looking at gunshot wounds.
I told him that he needed immediate surgery or else there was a good chance he could die. Even with surgery, I continued, he may still die. But I also promised that I would do everything in my power to prevent that from happening. You know, the usual thing I tell all my patients in this situation. (*** I'll get back to this little speech in a future post. Don't forget to remind me.***)
"Whatever," he said as if I were seriously inconveniencing his Saturday night plans. "Just hurry the fuck up," he demanded.
Hurry up? Wait just one damned minute - you've been in the hospital less than 5 minutes, I've already done a full evaluation, decided you need emergency surgery to save your life, called the operating theatre to schedule you, packaged you up, and gotten blood drawn, and you're ordering me to hurry up? Did you expect me to go play 18 holes of golf at 1 AM before doing your emergency potentially-life-saving surgery?
I shrugged off his rudeness and wheeled him down to the operating theatre, doing my best to ignore his rotten attitude as I continued calmly talking to him, trying to tell him what I might find and what I might have to do to fix it. I tried to explain about removing or repairing bowel, possibly doing a colostomy, repairing or removing a kidney . . . anything I had to do to get him through this event.
"Whatever, doc," he mumbled without even bothering to look at me. I felt like if he had his cell phone with him, he'd be on it just then, telling his friend how annoying his surgeon was, blathering at him incessantly. Now there's only but so much crap I'm willing to take as I'm pushing a patient down the hallway towards an operation that I really don't want to be doing in the middle of the night. His attitude was so lousy, so rude, so utterly infuriating that I just wanted to get him to sleep so I didn't have to talk to him anymore. Note to anyone reading this: be polite to the person who is trying to save your life.
As we got him to sleep, I mentioned to my assistant how incredibly contemptible his entire demeanor was.
"And I bet he won't even say 'thanks' afterwards," I finished.
Yes, finally, there is the prediction I predicted in the beginning of this story.
I opened him up and (for a change) was pleasantly surprised at what I found. By some stroke of luck the bullet had only passed through his sigmoid colon then into his psoas muscle before going through his buttock and exiting back into the outside world. I repaired his colon (no colostomy) and thanked his lucky stars that his injuries were not as serious as I had predicted, though he still would have died without surgery. However, despite expecting a full and smooth recovery, I still did not expect any appreciation from him.
The next morning I was rewarded with exactly what I had predicted - nothing.
I explained to Clarence everything I had found and done for him, and with a warm smile I gave him the good news that I anticipated he would go home in only 3 or 4 days. "Whatever, just get me some water. I'm fucking thirsty!" Clarence barked at me. As predicted, he had no complications and went home in 4 days. And just as predicted, he said "thank you" exactly zero times while he was in hospital. And even when I saw him back in my office 2 weeks later for his follow-up appointment, he showed absolutely no gratitude whatsoever, no acknowledgment at all for the guy who saved his life. I may as well have trimmed his shubbery or shined his shoes for all the thanks I didn't get.
The good news out of all of this is that it seems I'm getting better at making predictions. Maybe I should look into that lottery thing again.