by Micah L. Thorpe
The patient is nervous. He should be. His renal allograft is new, he has an infection and his immune system is compromised. It’s a bad combination. But I’m going to be positive. I’ll emphasize that he is getting better, his white blood cell count is in decline, he seems to be eating and he isn’t coughing. I intend to be reassuring, cautiously optimistic. He’ll be looking for optimism.
His room is in the new hospital tower overlooking Mt. Talbert, which is basically a small hill covered in Douglas Firs. It’s painted an off colored beige, not what I would have chosen, but it wasn’t my decision. There’s a nice window with a decent view of the Douglas Firs. Nothing fancy—this isn’t a hotel—but it’s pleasant enough if you’re sick. I enter the room. We exchange pleasantries. I listen to his heart and lungs, feel the squishiness of his new kidney and ask him some meaningless questions. It’s all a warm up. I’m really here to have the talk. “Your condition is bad, but it will probably get better… Probably.” I try and discuss cautiously-optimistic hard truths, which is pretty much as muddled up as it sounds, but I can tell he’s clinging to the positive parts and failing to hear any of the caution.
Then I see it. It’s sitting on the window ledge outside the room. Big carrion beak, bright red head and flesh-tearing talons. Right there. Ten feet away. Beautiful in the way only natural things can be beautiful.
For a couple seconds I stare. I realize the patient hasn’t seen it. He’s looking at me, not the window. It dawns on me that if he sees a buzzard sitting on his window sill, our conversation won’t be inspiring the kind of cautious optimism I’m trying to relay. I immediately revert my gaze to the patient and make direct eye contact. People don’t look away when you are looking directly at them.
In my peripheral vision I can see the big bird standing on the window sill. I won’t look at it, lest the patient follow my gaze. It’s hard. This is a National Geographic moment. The bird is just standing there, not moving. I try and focus on the conversation and make some big hand gestures to get the bird to fly away. It remains unfazed.
Voltaire said, “The art of medicine consists of amusing the patient until nature cures the disease.” He was a little harsh, but basically correct. I’m an entertainer. A ringmaster in a white coat. The “art” in medicine is learning to accept the futility of it. Death and disease come for all, doctors be damned. Sick or well, there is always a vulture waiting, just outside the window.
Micah L. Thorp is a physician and writer in Portland, Oregon. He is the author of Operation Honeybee and Handbook of Common Problems in Clinical Nephrology. He works as a clinical nephrologist, as VP of Business Affairs for Northwest Permanente and as a researcher in predictive analytics. His hardest (and best) job is raising three teenage boys.
Image credit: Public Domain Pictures