This is a very short story about a baby bird, a yoga mom and a hawk. I tell it because it made me think about the disordered way we frame healthcare decisions.
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The neighborhood is one of old brick houses, cracked cement sidewalks and tall trees. What was once a suburb is now a city neighborhood. What was once a community of older folks is now one of young couples and children. There is money here. There is education here. This is not the 1% but maybe the 2.4%.
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The fit young mother dressed in yoga pants and a bright-colored top was pushing a jogging stroller with two children. A typical image in the land of the educated and tall trees and brick houses.
It was a peaceful morning walk when the baby bird appeared next to the sidewalk with cracks. The mom stopped and swiveled the stroller so her offspring could bear witness to the cuteness. It was a zoo moment. It was tranquil.
Then it happened.
The hawk was big and brown and muscular. She came from nowhere. Her talons were sharp and effective. Though strong, the hawk struggled against gravity to elevate with the extra weight.
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The delay was an opportunity.
It was the moment in which the woman with the stroller and colored top and yoga pants tried to intervene. Surely she, of the influential 2.4%, could change the course of the event—of nature. Here was a wrong that must be righted. The baby bird’s punctured lung and viscera could be un-done. The talons removed, the hawk reprimanded, the innocent baby restored to its former self. Nature controlled.
But of course it could not.
Another neighbor later told me that the human mother was worried that her children might be scarred. Scarred not just by the death of the cute baby bird but also the mother’s lack of influence over nature. She tried to stop the hawk, help the bird, but she had failed.
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You see the (construct) problem?
What is it about human beings in 2014 that think we exert this much control over nature? Why the fantasy over expectations?
A mother is no more able to undo the behavior of a hawk than she is to make her surgery go perfectly, or a hospital staffer not to roughly roll an old man almost out of bed (my experience with my grandfather), or a cardiologist not to be influenced by effective marketing and fee-for-service incentives. Such are fantasy constructs, ones of deeply disordered expectations, of perfection and control.
But nature is not like this. Neither is healthcare.
Mistakes are not abnormal. Medical errors are indeed part of medical practice. Death is not abnormal. Death is damn normal.
And no matter how hard the healthcare system tries, with its protocols, work-hour restrictions of resident doctors, multiple layers of timeouts, armies of plaintiff lawyers, institutes of safety measures, and even public reporting of how well doctors check boxes, hawks will still kill, baby birds will still die, and no treatment will be free of risk or conferring of immortality.
We, patients and doctors, should collectively buck up and face our own hubris.
Control is an illusion. Perfection is fantasy. Errors are nature.
Imagine the improvement in medical decision-making if both patients and doctors stopped thinking we could save baby birds from hawks. Imagine if our construct was more modest.
JMM
