Surprises – in life and in medicine

Last night I attended a surprise 30th birthday party for my friend Caroline. I had been somewhat reluctant to go. My disinclination had nothing to do with Caroline, who’s a lovely lass; it was because I have a strong aversion to such ambushes, in both concept and execution.


Why? Like many of our favourite patients do, let me present you with a list.

First, as much as beloved partner/parent/sibling/friend thinks they know who to invite, friendship nuances often elude them. This can make organising the guest list a treacherous business, akin to playing leapfrog with a rhino. Oh, and a word of advice to the social-network-naïve: Facebook “friends” are not actual friends. Accepting a Facebook friend invitation from an old schoolyard tormentor may be a sign of maturity and forgiveness, but it doesn’t mean you want to see him or her in your living room.

Second, most members of the fairer sex like to spend a considerable time preparing their external surfaces pre-party. To arrive, as poor Caroline did, in sweaty gym clothes, with dirty hair and not a scrap of make-up, at a room full of primped and preened women in party dresses, can be rather disconcerting, to say the least.

Third, for those of us who enjoy the lead-up to social gatherings as much as, if not more, than the event, being cheated out of the anticipatory excitement substantially decreases the overall enjoyment quotient.

Finally, unsurprisingly, courtesy of an inadvertent (or advertent) slip, the surprisee often finds out about the party, and then the dilemma arises — does one drop the “surprise” and just go with “party” or does the surprisee feign astonishment when friends jump up from behind couches?

There was no pretence on Caroline’s face when she stepped, tired and smelly, through her front door last Friday night. It crept in later, as she tried to be a gracious host to her guests. I suspect that she felt more like a hostage, doing her best to make people feel at home, while wishing that they were all at theirs instead. “All I wanted to do tonight was eat pizza, watch crappy TV and sprawl on the couch in my PJs,” she confessed.

I’ve never been fond of fabricated surprises of any sort. I like to know the who, how, what, when, where and why in advance, whenever possible. Some may say this indicates that I’m a control freak, but I choose to think of it in Boy Scout terms: I like to “be prepared”.

Luckily, I have a much more open attitude towards unplanned surprises — the type we encounter in general practice on a near-daily basis. The discovery of a suspiciously hard breast lump in a routine health check; the BSL reading of 24mmol/L in an unwell four-year-old; the well-dressed, articulate 50-year-old woman speaking of a 20-year history of domestic violence; the vasculopath giving up cigarettes, alcohol and fatty food after years of seemingly pointless encouragement … these surprises make our work the interesting, challenging and unpredictable beast that it is, and I relish them.

Surprises in general practice go both ways. Patients throw us curve-balls but we give as good as we get. In general, I like to prepare my patients the best I can, minimising the surprise element, especially when it comes to delivering bad news.

However, I must confess that at times I deliberately surprise my patients. I’m in favour of springing a smear on a Pap-avoider or an overdue immunisation on a needle phobic, for example … as long as no one tries such trickery on me!

Published in Australian Doctor on 18th August, 2011:  On Surpises