Copy That?

I just drove home through a stormy Pacific Northwest highway from a long, crummy ER shift, and I feel like I've been stuck in a washing machine full of clogs all day. Not only did I have no idea what was wrong with most of my patients, but nearly every client resisted my advice to one degree or another. Too much of that kind of stuff builds momentum towards medical nihilism, so I was glad to chill out to a carefully curated playlist of Ethiopian Soul music on the local jazz radio station.

Normally, I take pride in my ability to communicate under difficult circumstances, but I may as well have been speaking Elvish for all the good it did today. I don't think most of my clients picked up what I was putting down.

My armchair-psychologizing guess is that they didn't like the news being delivered. A crude translation would be your animal's prognosis is dogs**t. It's an understandably difficult pill to swallow when there's very little hope of a happy outcome. But it's not a lot of fun trying to pry open mouths and force the bitter news down their throat.

There are some things people won't accept. In government, it's called the Overton Window: the range of policies palatable enough to be discussed publicly. We probably all have our own individual Overton Windows (for example, I will not hear any praise of Sammy Hagar-era Van Halen), but for many of my clients nowadays, the ultimate mortality of their pet seems solidly outside this realm. No matter how many times I stated that the prognosis was bad, it wasn't likely to get better, and the available economic resources weren't sufficient to move the needle very far, I was met with the same answer "We want to give them a chance".

I totally get that, but it's not the way I see it. I get it if you're a naive pet owner who has built up a story in their head about how they owe their pet a fighting chance, because that seems like something you'd see in a movie. But failing organs have never seen Rudy. If you're in a veterinary clinic for advice, it might be worthwhile to have your ears open.

Some people are unwilling, unready, or unmotivated to listen. They can't. It's not their fault. The concept that they have an Overton Window might actually be outside their Overton Window. But I can only do so much to explain the harsh reality of life to someone with closed ears. Eventually, after answering the same question half a dozen times, I need to move one.

In John Steinbeck's The Log from the Sea of Cortez, a travelogue with his friend Ed Ricketts, he tells a story of how Ricketts got off a train in Indianapolis and started walking south. He just wanted to walk south. He was a weird guy. But he'd stop in for lunch at some hamburger joint along the way, and some friendly townsperson would ask him what he was doing, and when he answered honestly ("Just walking south, no reason") they nearly always kicked him out for being a lunatic. Eventually he learned to tell say that he had lost a bet instead, which was always met with a chuckle and some hospitable gesture.

You can't get through to everyone. Some people really don't want to hear the truth. There are plenty of people looking for a life of blissful ignorance, preferring to take the blue pill and eat steak for the rest of their life. But medicine (and every other attempt to solve problems in the world) requires an acceptance of the truth. That's your starting point. You open your ears, and your eyes, and your ampullae of Lorenzini (if you're a shark), and start to take it all in.

It's all good. In part or in whole, we'll keep on trucking. We've been doing it for 4 billion years.