I was camping not too long ago when my oldest son and I were lucky enough to see the most amazing shooting star I have ever seen in my life. Not the one pictured above -- I didn't have a camera handy -- but it looked about the same. (See the Bad Astronomer for the awesome backstory on the above picture.) It was the coolest thing I have ever personally seen. It lit up half the sky as it streaked across with the most incredible speed; it was brighter than any firework I have ever seen. And in an instant, it was gone. We continued to hang out by the campfire for a while, every so often reflexively looking back at the sector of the sky where the fireball had been, as if it might be there again. It was certainly the most remarkable event of an eventful day. As we walked back to the cabin, my son asked me a question that kids must have been asking their parents for millennia: "Dad, that shooting star was cool, but what did it mean?"
I explained that it didn't mean anything. It was just a hunk of rock becoming superheated as it slammed into our atmosphere at thousands of miles per hour. Ultra cool science-y explanation, but it clearly left him unsatisfied. He was hoping for something more. I could imagine in ages past how a father might make up a satisfying explanation regarding the anger of the gods, or an omen of good fortune, and how readily a prescientific community would accept such an explanation. It was the most amazing event -- it just had to mean something.
I've noticed that this is just the way people are. We have a deep seated need to look for patterns, to find the deeper meaning in things. It's how we make our living, evolutionarily speaking. We figure out how things work, find the causation, and exploit it to our advantage. It's natural and a highly adaptive trait.
But it also is one that drives me nuts, in my professional life. That terrible question -- "What does it mean?" -- is one that one that stops me in my tracks, raises my hackles and induces an involuntary inward cringe.
I see a lot of people who come to the ER after experiencing an unusual physiologic phenomenon. Whether it's a fainting spell, or sudden loss of vision, or an intense bout of dizziness, they are often really freaked out. I don't blame them. I've experienced vertigo -- it's a shocking thing to go through. Nothing in your experience prepares you for the feeling that the world is whipping around at 33-1/3 rpm. I do my thing -- check them out, make them feel better, and explain the cause in as much detail as seems appropriate. Generally, patients are grateful and receptive, especially once I've reassured them that what they are experiencing is not dangerous. It never seems to fail, though, that as I put my hand on the proverbial doorknob to step out, I get that awful question, "But doctor, what does it mean?" Just like the fiery streak across the sky, when it happens to you it's such a remarkable thing that it simply has to have some deeper meaning.
This question is an absolute rhetorical haymaker because, just as with my son and the technical explanation of a meteor, the technical explanation of vertigo (or syncope, a TIA, etc) is completely unsatisfactory to the patient. Unlike a seven year-old child, however, the patients are adults, infinitely more concerned, and I have something of an obligation to answer their concerns. And it just can't be done. 99% of the time the answer to "what does it mean?" boils down to either "I really have no clue what actually happened" or "it's just one of those things." You can guess how well that goes over. You offer up such weak tea to an anxious patient and you are either guaranteed an irritated and unsatisfied patient, or a thirty-minute question-and-answer session till they're finally content.
I've learned that the best response is a redirect: "You know, the ER's not really the best place for philosophy..." and then to bring it right back to the pragmatic concerns: "What it doesn't mean is that you are at increased risk for having a stroke..." or whatever seems to be the real underlying fear the patient may have been harboring. That seems to work as well as any other response I've tried.
Every time I hear that question, I swear it takes years off of my life.