April 22, 2013


The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

     A falcon floated by the window behind the patient, 28 stories above the earth inside the medical tower.  He had developed an inclination to look off while thinking heavily upon the right words to convey complexity to patients.  He had also developed, though unbeknownst to him at the time, a proclivity of parceling out his brain.  A mechanism of coping, if you will.  The ability to run emotions in the background and he had plenty of those, while his ears still heard and his brain still recorded and interpreted what the patient said. 
     And that falcon caught and held his attention.  Such a beautiful bird of prey.  Was it a peregrine falcon?  His eyes had faded enough with age, or the thick window distorted the waves of light enough to prevent him from discerning the identity of the bird.  It glided and drifted with the updrafts, it's keen eyes constantly scanning the park below for signs of prey.  Such purposeful flight.  He envied the bird.  A falcon is a predator and no question remains to its nature.  He was not so lucky.  His nature had been upended in more ways than he cared to consider.  That lack of purpose made it progressively more arduous to continue to see patients. 
     Or perhaps, it was the confusion of purpose.  The image of the bird of prey brought to mind the tale of Prometheus who stole fire from the gods and was rewarded with having an eagle eat his liver day after day, only to have the liver grow back again.  Yes, he could empathize with Prometheus, while he continued to record the patient's story.  He had learned how to treat the most difficult of pain, how to care for the most emotionally difficult patient, how to help someone die, and he was rewarded with having his guts devoured daily, at least figuratively, if not literally judging from the feelings of a growing pit in his stomach. 
     While he continued to watch the falcon, the patient concluded their story and looked expectantly at him.  "Let me do a brief physical and see what we see," he told the elderly man. 
     "First, let me see you walk across the room," the patient gave him a bit of a smart assed scoff as if to wonder at the knowledge level of the medical student. 
     "Now, walk like me," he said, demonstrating the heel-toe-heel drunk walk that cops often use to assess field sobriety.  The patient went from skepticism to surprise as he couldn't do it.  At all.  The falcon had floated from the field of view offered by the wide window.  It disappointed him and left him wanting.  He wanted one more good glimpse at the bird.
     "Now, hop on the table and let me look at your reflexes."  The patient just about came off the table.  He performed a few more relevant neurologic assessments, just to be thorough, but the fore brain was starting to demand more attention from his consciousness.  The emotions which ran in the background, had to shut off, at least for the benefit of the patient.  But did they, he wondered?  He had subsided his pain so many times before, he wondered what would happen if he no longer put the patient up first.  After all, there was a doctor here to follow up on him.  To make sure he didn't miss anything.  What would it hurt?
     In the end, his pride figured into the equation.  He wanted to find something the doctor didn't.  And nothing trivial, either.  This patient likely had cervical myelopathy.  And in the end, he genuinely did wish to help the patient despite the upsetting of that delicate balance between his emotions and his cognition. It seemed so very fragile.  A line in the sand was drawn, separating his well-being from the patient's well-being, and whether it was the 100th or 10,000th time, it didn't seem to matter anymore.  He couldn't possibly let this patient walk out with a missed diagnosis of cervical myelopathy. 
     Turning his back on the window and the now absent hawk, he left the room and told the attending doc his suspicions.  The attending listened and looked at him quizzically.  Did the attending believe him?  The attending believed enough to verify the findings.  "Let me see your reflex hammer," as surgeons they don't ask, they demand.  When the patient gave a repeat performance, the attending looked at the medical student with an arched eyebrow.  The attending was impressed, he could tell.  Would that newly earned respect still be there if it was known that below the surface, he struggled daily to keep himself together?  That every time he saw someone with cancer, with pain, with a deadly illness, his already broken heart and psyche fell apart that much more?  But he didn't really care what attendings thought anymore.  He had done right by the patient and he had done right by himself.  That was all that mattered and now it was time for the emotions to regain their grip on his thoughts. 

1 comment:

Abe said...

A tad bit autobiographical?