50/50

Continuing from yesterday, I want to share my own personal theory of chance.  Many times, when a patient gets a diagnosis of cancer the first thing they will want to know is how long do they have left.  The oncologist will discuss survival rates in terms of months or years and will ultimately give them a percentage alive at x years.  The next thing that happens is they see me.

“Doc, I’ve met with the oncologist and surfed the internet, and things are dismal.  They say I’m not likely to be alive this time next year.  What should I do?”

Me – “Personally, I don’t believe in looking at odds. Realistically, the odds of me being alive this afternoon are 50/50.  Either I will be alive, or I won’t.  They’re the same for you.  Either the chemo and radiation treatment will work, or they won’t.  Life is a roller coaster ride, once you’re on it, you have to take it to the end.”

“Doc, what if the treatments make me worse?  They say that 20% of patients won’t tolerate the meds.”

Me – “Again, either you will tolerate the treatment, or you won’t.  We’ll have to cross that bridge if we get there. They say that living in the past causes depression and that trying to live in the future, causes anxiety.  They are right!  The hardest thing you have to do is work at not creating future scenarios in your head.  They serve no purpose and cause immense anxiety.  In this case, anxiety is your enemy.  You’re on this coaster for better or for worse.  I’ll take the ride with you and hold your hand till the end.  Hopefully, the highs won’t be too high, and the lows won’t be too low.”

My 50/50 theory assumes that everything is a binary choice; either it will or won’t be.  No matter how well you plan, once you start the journey of life the only firm rules are that the course your coaster takes is uncertain. It would be great if you could enjoy the ride, taking each high and low point as they come, without becoming too anxious about what lies around the next corner.  Unfortunately, anxiety over what’s around the next corner often steals your ability to savor life and rarely does anything positive for you.

In the case of my patient with liver injury, I often wonder if rather than saying that there were 7 cases in the world literature, I had said that the odds were 50/50 (either the patient would be number 8 or not), what the patient would have done.  Oops, there I go living in the past.

At this moment in time, the world is anxious.  Journalists pontificate on what Covid is going to do.  They have models predicting who shall live and who shall die.  They act like they know where the ride is taking us.  They don’t!  They have been wrong all along, simply adjusting their future predictions and forgetting their past ones.  Scientists are just as baffled.  Of course, the internet knows everything and everything you can imagine is published as facts on the internet.  It’s been consistently wrong as well.

I keep hearing an old jingle in my head.  It goes:

Buckle up for safety, buckle up.  Buckle up for safety, always buckle.  Show the world you care by the mask you wear, buckle up for safety always buckle, buckle up.

My advice is to buckle up!  Put your mask on, sit as far away from others on this roller coaster called life, and get ready for a long ride. As the coaster goes upwards preparing for a plunge don’t be too nervous. Following a plunge, things normally level out for a while before the next rise and fall, and the next, and the next…..

Here’s your music and a joke.

Psychiatrist to his nurse: “Please just say we’re very busy.  
Don’t keep saying “It’s a madhouse in here!”

Dog Rules for Stress – If you can’t eat it or play with it, then pee on it and walk away.

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