Life’s but a Walking Shadow
…a poor player,
That struts and frets his hour upon the stage,
And then is heard no more;
William Shakespeare, Macbeth
There’s nothing more exasperating than to be caught standing at the nurses’ station fretting over a patient, which is what happened to me earlier this week. Doctors don’t like to be caught fretting, or even come close to gaining a reputation as fretters, not to mention worrywarts, sourpusses or fussbudgets. To lament publicly about a patient creates an aura of frailty that to the casual observer suggests indecisiveness. It infiltrates the air with a mousiness that can lead both peers and patients to surreptitiously raise the appropriate eyebrow (I forget if it is the right or left) signaling a loss of confidence in our leadership. To put it in nautical terms, those who find themselves swept off the deck by a strong wind are not particularly encouraged when they see the crew rending their garments in agony while the life preserver hangs undisturbed. A firm gaze, a strong grip, a voice brimming with dash and daring, a man, a plan, a canal, Panama! - that is what our patients are looking for in their doctors. That is what sends the family back home with a hearty sigh of relief, saying “Thank goodness the doc gave us hope.”
That All-American brand of steadfastness is precisely what I lacked as I deflated over the news contained within the chart before me. The patient I had been asked to see was a young man with left-sided back pain. The pain was due to a pelvic soft tissue mass destroying his ilium. The soft tissue mass, most likely cancer, possibly one of the really bad ones, was the source of my fretfulness. Other than lymphoma, it was difficult to think of a diagnosis in a patient of his age that was going to be encouraging news. I walked down the hall to meet him.
Within the hour I was back at the station, completing my dictated consultation. Even though the hour was late [Translation: He’s got an office full of patients reading copies of Family Circle magazine circa 1983. - Ed.], I lingered over the chart, pondering about this young man’s future and about what I could do to violently yank it off the tracks and place it on a set of rails leading to a more hopeful destination. His nurse approached me to inquire about my plans. I informed her of the need for a biopsy, staging studies and then likely chemotherapy and more.
“You know, he’s so young he’ll have trouble getting insurance because of this,” she said. “The insurance companies reject people like him with pre-existing conditions. Twenty years from now he probably won’t be able to get any health insurance unless he’s with a huge company.”
Somewhere over our heads, away from the stale confines of this brick building, a song of joy fills the spring air. It comes from the smallest of divas who sits high within the green shade of the afternoon, completely hidden from us except for the sprightly melody with which she bathes the sidewalk below. Her voice is a piccolo of nature and perhaps a reminder of a promise made long ago, a promise that those of us in the business of healing have the privilege of helping to keep. Suddenly my anxiety was swept away and I turned toward the nurse and gave her a look like a professional wrestler just before jumping off the top turnbuckle.
“Yes, that would be a huge problem, wouldn’t it? My job is to make sure he’s here twenty years from now to complain about it.”
