And to Survive, She Became a Shark

      She presented to the hospital feeling tired and with burning when she urinated, and she was found to have an increase in her creatinine. The patient was found to have a urinary tract infection and was started on intravenous antibiotics. As part of her initial workup, a resident in the emergency department performed a bedside renal ultrasound that revealed a mass along her left kidney. A formal ultrasound confirmed the findings. It was not clear from the ultrasound whether the mass was a cyst in her kidney or a structure adjacent to the kidney. She knew it could potentially mean something serious and was awaiting computed tomography (CT) imaging to further clarify.
      It stunned me, then, to find her in the morning braiding her hair into a bun and watching a documentary on her computer. She smiled and waved when I came in. The patient asked me, “Did you know sharks pee through their skin?” I did not, and I also did not know what relevance this had. “I was reminded by this show,” she said. “Isn't it an interesting fact?” Well, yes, but . . . She said, “I collect them for my niece. All the animal facts I can get my hands on.” How interesting. That left me wondering. She offered, “My niece has taught me plenty, too. There are enough to go around. Would you like some? I'll teach you, too.”
      Finding myself ahead of schedule on rounds, and always with time to make for patients who may need an extra moment, I pulled a chair up to the bedside of a woman who seemed so at ease even though the CT scan was not performed yet. In such scenarios I am used to patients with their hands knotted into the blankets and a flinch that settles into their shoulders at every small sound, and not to a woman with a mouth full of laughter at something funny in the documentary. She closed the laptop and left it on her lap. The patient told me about her niece, who was now a woman in college but who had collected animal facts since childhood. “Okay,” the patient said. “What animal should we start with?” I admitted I have a fondness for wolves. “My niece could tell you everything about wolves,” she said. “Even the number and length of their teeth.” She chose to tell me about wolves in love, that they mate for life and are known to flirt and show affection toward one another. They also form friendships and nurture their injured pack members. Wolves don't abandon one another. She set aside the laptop and sighed, the breath falling quietly to her lap. “If only humans could learn to do that.”
      It's personal, she told me, because years ago her niece was a little girl with messy hair and with legs that were always running, fast feet that carried her into the backyard to throw autumn leaves into the air and hands that grabbed for hot chocolate in the winter and for rain boots in the spring to stomp in puddles and, in the summer, met up with her friends on the lawn green as the world that can be if children are not left with faded purple bruises by the people who are supposed to love them. “But things changed when my sister became a single mother,” she explained. The little girl's father left their family, and every look at her daughter reminded her mother of what had happened. Then, a few months later, the little girl was a little too tired and a little too fussy and spent most of the day curled up on her bed. Her own mother did nothing, content to spend her days out with new men that she hoped would replace the man who left. “I was the one who took her to a clinic,” the patient told me. “Turns out her kidneys had some sort of a problem.” They tried to give her medications, but they couldn't reverse the course quickly enough. She ended up needing dialysis in the short term. “Her mother didn't want to be bothered with taking her,” she said. “I went with her instead to the appointments and to the dialysis sessions.”
      It was difficult, at first, to keep a little girl sitting still for long dialysis sessions. And she was scared of the machines, her mouth closed and her voice quiet while the dialysis took place. “Then I had an idea,” she said. “I started bringing her books.” Pictures books with glossy photographs and drawings. Books on animals, books that kept her hands flipping through the pages, books she tucked carefully into her memories. The little girl started wearing a hat decorated with a shark fin. Sharks pee through their skin. Dialysis is like that, isn't it? For a child, the technicality of a catheter would hardly stop her from announcing to every stranger that she was a shark. “That was how it started,” she explained. “Now she grabs every fact on animals she can hold on to. The animals give her strength. They make her feel that everything will turn out okay.”
      The talk of bruises worried me, but the patient reminded me all of that happened years ago. “Her kidneys got better. My sister never did.” She explained that she adopted her niece, and her sister was happy when she did. “That little girl is a grown woman now, but she still looks for those facts that helped get her through. And that's what helps me.” She opened up her laptop and set it back down on her lap. A documentary about sharks. Now I better understood. She said, “I don't know what that scan will show. But I know that it'll be okay.”
      The CT scan later resulted with a simple renal cyst. But I remember what she told me without knowing that result, sharks are survivors. She taught me that sharks were around with the dinosaurs, and they were able to survive. They're saltwater fish, but put a bull shark into freshwater and it will survive. Break the tooth of a great white shark, and there's already a corresponding tooth waiting to take its place to allow it to survive. Sharks survive no matter what—and people, too, find their own ways to survive.