None of them, it turned out, proved to be correct.
"Hi Doc, this is Clara. She's stable, oxygen sats 100% during transport. She tried to kill herself this morning by shooting herself in the chest with a hunting rifle."
Ah. That explained her look of sheerest despondence.
Clara dropped her head and stared at the gurney, her face still impassive. I was half expecting her to either complain, deny, or cry, but she did none of those things. She just sat. While I felt terrible for her and her obviously hopeless situation, it was also a very troublesome situation for me, because I then had to say something that I knew damned well she did not want to hear.
"Hi Clara, I'm Doctor Bastard (not my real name™). I understand you were trying to hurt yourself, but I need to make it clear to you that it is my job to make sure that you do not succeed."
She merely glanced at me briefly, nodded once, and returned to staring at her lap.
The entry wound was in the upper outer portion of her left breast, and the exit wound was on the outer portion of her left back. Based on the trajectory (and the fact that her lung sounds were clear and equal), it didn't look to me like the bullet had entered her chest, but obviously I needed to be sure.
Her chest X-ray was completely clear (except for a few small bullet fragments in the subcutaneous tissue), an ultrasound of her chest was normal, and a CT scan confirmed that no major damage was done. No fractured ribs, no pneumothorax, no injury to the heart. As soon as I saw the pictures, I walked into the scanner to tell her the good news, which (I realised as I was saying it) she would take as bad news.
I put my hand on her shoulder and said simply, "Hi Clara. I just looked at your scan. I know you don't want to hear this, but the bullet did not enter your chest. There's no major injury." Before I could even finish, her emotionless expression started to break down. "It's ok. You're going to be ok. We're going to get you the help you need."
With that, the flood gates opened, and Clara started openly sobbing. "Oh no! Oh god, no! I can't do this anymore. I'm 53 years old, I've lost my husband and both of my kids, and I just can't do it. I can't do it any more. I just can't!" She continued to sob as I tried to figure out what to say next. What could I say? Is there anything that could make this hopeless situation remotely better?
Ultimately I decided that there was nothing I could say to her that would assuage anything. I simply gave her arm one final friendly squeeze, smiled meekly at her, and walked out, while I looked up the name of the psychiatrist on call.
Yes, today is April Fools' Day, but this is not a joke or a hoax. This is a 100% true story. Clara is a real patient, a real person, with real problems that are clearly worse than I could possibly imagine, bad enough that I had a great amount of trouble empathising with her.
I'm posting this purposely on April 1 to give everyone a break from the silliness that reigns on this date, simply to remind everyone that life isn't a joke for everyone.