WARNING #2: I'M NOT TRYING TO SOUND LIKE A CALLOUS ASSHOLE
WARNING #3: I DON'T GIVE A FUCK IF I SOUND LIKE A CALLOUS ASSHOLE
I wear two hats on a daily basis. Under the first hat is a general surgeon who is trying to save the world from appendiceal disease one goddamned appendix at a time at 2 AM (always at 2 AM). I'm also trying to cure the world of breast cancer, gall bladder disease, colon cancer, chronic wounds, skin cancer, hernias, and a host of other problems, some big and some small. But under the trauma surgeon hat, I'm mainly dealing with stupidity. And as comedian Ron White said, "You can't fix stupid".
And then there are people like Stuart (not his real name©).
Superficially, Stuart was little different than many of the other motorcycle victims I've seen over the years. He was a large fellow in his mid-20s, covered with tattoos, and he fell off his bike when he took a turn too fast and hit a patch of gravel. He tumbled over and over, narrowly avoiding getting run over by the car behind him. When he arrived at my trauma bay, he was clearly in discomfort, mainly in his lower back, left chest, and right thigh. A quick look at his right thigh told me something bad was going on - it was swollen and deformed, a sure sign that his femur was broken. When I touched his chest he yelped, so I immediately thought of rib fractures. An X-ray confirmed a simple fracture of his femur, and a CT of his torso showed a pneumothorax (collapsed lung) on the left but no broken ribs. He did have three minor fractures in his lower back, but they were clinically insignificant, the type of fracture that is annoying but doesn't cause any disability.
About 18 hours, one chest tube insertion, and one femur repair later, I entered his room on my morning rounds, and Stuart barely opened his eyes to greet me. "How are you?" I asked in my cheeriest voice (as cheery as I can be at 7 AM before my first cup of coffee).
"Terrible," he droned. I didn't expect him to be nearly as cheerful as I was less than 24 hours after his accident, but I would have at least appreciated him making an attempt to open his eyes and acknowledge my presence. Typically pain starts to improve dramatically the day after surgery, so the next morning I figured he would be a bit peppier.
Day 3: "Terrible," he moaned, again without even bothering to look at me. After discovering that he hadn't even tried to work with the physical therapist the day before, I nicely explained that today was the day for him to get out of bed and start working on his recovery. I also gave him some good news - I would be removing his chest tube that morning, so hopefully that would help alleviate his pain and encourage him to get out of bed. I expected to be able to send him home later that day, or the next morning at the latest.
Day 4: "Terrible," he groaned. He barely opened his eyes before telling me that he didn't bother trying to get up the day before. Again. "Ok, I know you're in pain, but let's work on getting that under control and getting you up and walking today so I can get you home," is what came out of my mouth while GET UP is what was going through my mind.
Day 5: "Terrible," he whined. He still hadn't even made an attempt to get out of bed despite my encouragement. His nurse the day before had also tried encouraging him, giving him a bit of tough love that he obviously needed. She tried to get him to be an active participant in his recovery. His response was to demand a different nurse, a request that I flatly refused. GET UP!!
Day 6: "Terrible," he whimpered. Somehow he had still avoided getting up out of bed. I tried explaining how bedrest doesn't make you better. Quite the opposite - the longer you stay in bed, the weaker you get. He just turned over in bed. GET YOUR ASS UP!
Day 7: "Terrible," he cried. The therapists, with the assistance of 4 nurses and aides, had finally managed to get him up into a chair. It had also been the first day he had even allowed the nurses to change his bedsheets since his admission. Despite our encouragement, he continued to actively prevent his own recovery. GET YOUR LAZY ASS OUT OF THIS FUCKING BED, YOU GODDAMNED SLUG!
I won't bore you with days 8-10, because they were eerily similar to 1-7. His array of injuries should have resulted in a 3-4 day hospital stay and him walking out of the hospital. Instead, he stayed for well over a week and ended up going to a rehabilitation facility to finish recovering, all because he refused to participate in his own care.
If you're ever unfortunate enough to be a patient of mine or one of my colleagues, keep one very important thing in mind: the biggest advocate you have for your own health is you.