by Robert Lanz LCSW
Occam’s Razor is a principle stating that among competing hypotheses, the one with the fewest assumptions should be selected or when you have two competing theories that make exactly the same predictions, the simpler one is the better.
Turns out that Mr. Occam’s razor cuts both ways. In most cases if you hear hoof beats you expect to see horses about the same time. But there are times when the circus is in town and an errant zebra breaks loose from its moorings and runs up on you. But since you are in horse response mode the zebra can sneak up and bite you on the butt. That is a clue you are on the wrong trail and need to adjust your intervention appropriately.
I love living in southern California. We get to do things all year long that many people never get to do. We love our surfboards and skis and off road vehicles and all that sunny weather. We often joke that if we want a change of season we just get into our vehicle and drive to it. Want winter? Go up to Big Bear. Want summer? Drive out to Palm Springs. If the weather is really good you might have a problem finding a parking place at the beach on Christmas day. And, of course, we love our motor cycles because we can ride them all year long.
Springtime however will always bring about a spate of accidents associated with those pesky two wheelers. The first really warm day gets everyone out, dusting off their bikes and riding gear and heading out to one of the local canyons that end not too far from my hospital. Motorcycles and springtime are a difficult combination if you get stuck working the weekend shift in the ER where the trauma guys in helicopters will be working overtime-and so will you- bringing in the results of too much fun at high speed.
All the trauma doctors and nurses and the phlebotomists and x-ray techs are too busy to tend to the non-medical needs of the trauma victims. The social worker thus becomes the last member of the team to actually speak to the patient but will be responsible for the “Everything Else” list that doesn’t pertain to the patient’s actual medical care.
That includes securing the patient’s stuff, often in a hazmat bag- clothes, boots helmet, gloves, money and cell phones and anything else that might help with friends, family, police, trauma doctors or maybe even the coroner. The patient may be unconscious or near death or so confused as to not serve as a decent witness to his own accident.
On the Sunday it was my turn, I gathered all the stuff and secured it in my office, separating the wallet and cell phone from the rest of the property. For the first fifteen years of my career there were no cell phones so I was in detective mode. Fortunately the last fifteen years were easier. A cell phone in your pants is like carrying a laptop with you and has just about all the information we will ever need. Pretty simple to speed dial the last number on the phone or go to the “Mom” button. Too bad that when it was my turn for the “Mom” button, the phone was crushed. The interchangeable SIM card hadn’t been perfected yet so there I was back to the pre-digital age again. Anyway I was sort of on top of things or thought I was when the far off hoof beats still sounded like horses.
I spoke to the highway patrol officer who was investigating the accident. He told me the patient was apparently riding alone and hit some gravel on the outside of a curve and went down pretty hard. His helmet had significant damage and the young rider was confused with no recollection of falling. An obvious head injury with unreliable memory and no one to help us out as to what really happened.
By the time it was my turn to see the patient I still didn’t have enough information to contact anyone who knew about him. Back from the CT scan he was sitting up on the gurney and seemed in OK spirits despite the gravity, or near gravity, of the situation. He didn’t remember the accident but he did remember the start of the day, having breakfast then heading out for the canyons with one of his riding buddies.
Wait a minute. One of his friends? There were no friends with him. He was laying there on the side of the road for half an hour before the helicopter got to him and none of the other motorcyclists enjoying the day seemed to know anything about him either. Doubtful that one of his friends would just blow by him and keep going. When I discussed this with the trauma surgeon she just thought he was showing post concussion confusion. She thought my information was solid since it came from the paramedics and the highway patrolman. They didn’t see any zebras either.
It was about that time the patient’s wife called the hospital and was patched through to me and I quickly explained his medical condition and the circumstances of the crash.
“Where’s Harold? Was he hurt too?” she asked.
“Who’s Harold?” I asked tentatively.
“His best friend. They went to breakfast together then up to the canyons.”
“On the same bike?”
I was immediately and momentarily terrified thinking that maybe Harold got tossed over the edge of the cliff and down into a thicket of chaparral. It’s happened to me before up in the canyons when one of those people who doesn’t believe in seat belts gets thrown from the car as it goes over the edge and is found laying in the bushes.
“No. Harold has his own motorcycle.”
I heard a click on the phone and the wife said,
“Hold on a minute. I have another call. It’s Harold’s wife.”
It seemed forever and it seemed to me that maybe the circus was in town.
“That was Harold’s wife.”
Turns out the Harold was just a couple of minutes behind our patient who had a better memory than we thought.
“Harold was up in the canyon laying beside the highway with a broken leg. He’s stable enough to go by ambulance. I guess they used the helicopter for another guy.”
“Uh, Dr. Veronica. I finally contacted the trauma’s family. Those hoof beats I told you about that came from the highway patrol.”
“Yeah, sure Bob.”