Tuesday, 12 August 2014

Predictions

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.

18 comments:

  1. I can kinda understand not being able to focus much on curtesy right before emergency surgery. Having to have surgery is freaking terrifying! You probably get to perform more surgeries during a shift than an average person has during a lifetime, so while each and every one of them poses a challenge for you and keeps you on your toes, all the surrounding details are routine for you. Not for the person on the gurney though. I'm in my mid-thirties and had four surgeries total so far, two very minor (was able to go home within two days), two a bit bigger (was able to go home within a week), all of them scheduled. I was terrified each and every time. I mean, I'm going to be put to sleep and have people I don't know invading my body with sharp objects while I am out and I don't get to see it, hear it, feel it (thanks for that!), nor am I able to say something if I notice anything going wrong (like them operating on the wrong leg or something). Each and every time I was praying to the Universe for the doctors to be well rested and not on the tail end of a 36 hour shift. Because, as a patient you don't get to know. You don't get to ask. You can just hope. That's no excuse to be impolite though, just not as thoughtful as one would normally be.

    I can still understand not thinking about "Thank you"s the next morning, when one is still a bit woozy from the anaesthetics and full of questions. Although I think I did thank the surgeon at that point, but I'm not really 100% sure.

    But the next time I saw them, before I went home? And at the follow up? I did thank them profusely.

    And, from your story, the young man in question didn't even seem to be as nervous as I was.

    In the place of all the people who are alive because of your abilities and determination, let me say THANK YOU! Because you deserve that acknowledgement.

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  2. ugh, what the fuck.

    I hope you didn't get him any water.

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  3. It would be wonderful if you could somehow anonymously hook him up with the little lovely who was in awhile back after being bumped by a car. It sounds like they were made for each other. Or, maybe not. You might end up seeing them more often as they tried to kill each other.

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  4. I LOVE the references you make, almost all of which are cherished favorites of mine and my family, which we quote at each other in the course of common conversation. (In fact, I think that movie quotes make up a larger percentage of our conversation than actual, original thoughts…)

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  5. This guy's a gansta? His real name's Clarence (not his real name)

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  6. This one's a little too recent to give any further detail without bending HIPAA.

    the relevant quote is "If you let XXXXX die, I'll kill you"

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  7. Remember to get back to the little speech, later, BTW.

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  8. Probably not a popular opinion here, but might this fool's ungratefulness be due to the fact that he's not at all worried about any medical bills? I sure know that I thank the doctors and nurses for their efforts in partnering with my health care, because I have an investment in my care. The co-pay and 20 percent not covered sure is a big deal to me and for anyone who helps me minimize costs by giving me good care—well, let's just say I am eternally grateful. The fool in this story has no cash invested in restoring him to good health—he knows he can do this over and over, and you will fix him up for FREE because that's what you do and that's a "benefit" to living where he lives (and to me, that's the problem with universal care—no personal investment, you are going to pay taxes anyway).

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    Replies
    1. I think you are reading too much in the wrong direction. those I have talked to who have single payer coverage (read: soshulized med'cine) have had a huge appreciation for it. particularly compared to the way I feel when I get the idea that a doctor is simply padding his retirement at my personal expense.
      there is a reason it is called "the healthcare industry" in the US.

      I would say the reason he is not concerned about medical bills, or common courtesy, is the same reason he is not concerned about dying from a gunshot would to the abdomen - he's an idiot.

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    2. CaliGirl -

      I say "Thank you" to the person who holds a door open for me. I say "Thank you" when someone picks up a pen I accidentally dropped. Those are free services too, yet I thank someone for doing something for me.

      It's common courtesy show appreciation for little things. It's quite another thing to show NO appreciation for saving your life.

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    3. I don't know, while I was still a practicing nurse, the people who nearly always showed gratitude were those who were insured with co-pays, or Medicare folks. I can't remember a single person on MediCal ever saying thank you for anything—for being prompt and polite when responding to call bells and bringing medication quickly or bringing a snack from the kitchen. As a matter of fact, I can think of 4 situations where I was pretty much verbally abused by uninsured instant MediCal patients and their families, I guess for not breaking rules and not being subservient enough (this was in L&D and postpartum setting; in California an uninsured woman who presents in labor is given instant MediCal coverage.).

      I say "please" and "thank you" in any life situation. I have always acknowledged health care workers who have done for me, for my family. A little kindness goes a long way when your back and feet are hurting and you would rather be anywhere else but the hospital. A little cruelty stays with you for a long time, at least in those specific situations I am remembering in my case. Makes me grateful for my back injury which effectively removed me from the profession.

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  9. You should have removed his nuts.

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  10. Hopefully his mother was mortified. It'd be a shame if she raised him to be that way.

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  11. Whenever I have an interaction with a jerk, I always give thanks that the person is not a relative or a neighbor.

    You are a wonderful person and doctor to give as much as you do.

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  12. Pretty obnoxious but I had to laugh at each line- "whatever, just hurry up", "whatever, can I get a glass of water"...bravado because he was really terrified?

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  13. Guessing that shithead didn't get any water from you! Gotta love the shmucks that make people of my age group look like complete assholes... not

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