The Gambler

Yesterday at a clinical shift in the ER, I met a fiesty elderly man who I shall call the Gambler. He was suffering from pain and discoloration to his right lower leg. It was cool to the touch and had no palpable pulse. Our Doppler scan found a weak pulse, but not one strong enough to sustain perfusion to his foot. (I know I'm using a lot of medical terms here, but bear with me.) Without adequate blood flow reestablished soon, he would lose that leg. The ER doc was quick to decide on getting the Gambler out to a facility with a vascular surgeon. Luckily, a regional city has two fine facilities and one has a great LifeFlight team that was immediately available. (Seeing the chopper take off was a very exciting experience, but one for another story.) After wishing him and his flight staff a safe flight, I watched from the garage door and reflected on this man.
In the world of an emergency medicine you meet many people. It's not uncommon for me to meet a dozen or more each day. Some you remember as what their emergency was, but others you remember for who they are. This was the case for the Gambler.
While I can't give any identifying details, I can tell you a little about his past. He was in the Air Force. Though he didn't fly while enlisted, he took up pilot training on his own and learned to fly a Cesna aircraft. He enjoyed it, but due to the expense, had to give it up. He was the typical stubborn Finlander/Swede that you meet in my area. Strong-willed and no-nonsense. Had he ever had a flu or pneumonia vaccination? "Never in my life, and I don't want one now." When did the pain start? "Around Thanksgiving." Thanksgiving?? "I thought it'd go away." Uh-huh. Any medications? "No." Okay. How about smoking? "Been smoking a pack a day or more since I was eight years old," he said with a grin that said any advice towards quitting was futile. I filled out the form and got his baseline vitals with a feeling that he'd make it through even though he shouldn't. His will to survive was still very much intact. Once you've been around the sick and dying, you see how important that drive is. Sometimes I think it's the only thing that "works" in some patients. The minute they give up, they let go and are gone.
Anyway, my gambling friend comes by his nickname very honestly. He's been to Las Vegas 35 times and is a frequent flyer at the local casinos. His game of choice? "Blackjack. Good ol' 21. Sometimes roulette, but you can have those slots, got no use for them."
"You're quite the gambler, then, huh?" I asked, more rhetorically than anything.
He lowered his eyes which had been staring up at the ceiling, seeing something long ago and far away to meet mine and asked, "You gunna be alive tomorrow?"
I blinked, then smiled. "I don't know."
His grin was wide. "Then you're a gambler, too."
"Crazy thing about life, none of us get out alive."
He laughed. One single 'ha' from deep within, then settled back into his daydreamy gaze and recalled the casinos in Vegas. The Four Queens. That was his favorite. He used to like the Strip, but "It's changed so much."
"Everything changes."
He nodded. I had to leave the room for a moment. Upon my return, I asked him if he knew that Kenny Rogers song, "The Gambler". Both of us started at the chorus, "You got to know when to hold 'em..." Another smile. While rough around the edges, he had a charming smile. I imagined him flirting with the cocktail waitresses that had brought him his drinks at these velvet-wallpapered casinos. Him winking and maybe even reaching out to tap one on the behind, because in those days he could. I could see the tacky uniforms the dealers wore. The green brimmed visors on his fellow card sharks. It was a scene from Fear and Loathing in Las Veags brought to an eeire, hazy life. Through smoke and booze, I heard his younger self tell me his story through old eyes. And I was captivated.
The conversation turned back to his health history. "Why did you wait so long, really?" I asked.
"I figured it'd pass. I've never been really sick in my life. Had a hip replacement done, but..." he paused. "Haven't had a cold in 35 years or more."
"So you've had good odds," I said, without even realizing what true meaning that statement had. He heard it right away and smiled again, though not as wide.
"Yes, I have."
As we packaged him up to fly in a helicopter for the first time ever, I wished him luck. He patted my hand.
"Pray she'll be a lady."




(A few days after I wrote this, the man died from his condition. Though I only knew him for a brief time, I will never forget him or the many others that whisper from my memories, teaching me to do better. To treat wisely. To show love unfailingly.)