The other day I went to see 1 of my patients in the evening. The nursing staff had paged and said this patient was feeling anxious and upset and had asked for me. Me specifically. I had some things to do at Grady and was in the vicinity anyway so decided to just come on in.
A lot has been going on with my patient. A lot. There was fear involved. A lot of fear. And frustration, too. And the thing about fear and frustration is that they can make us behave in ways that aren't always in our character. And since I get that usually I don't take such things personally. I recite the mantra that I tell my students: “This isn't about you.” Because it almost never is.
At, like, 8-something p.m. on a Saturday night, I went to see my patient. I tapped on that door and creaked open the hinge expecting to be met with relief. Or at least some raw emotion and readiness to talk which I could have easily worked with, you know?
Instead, fear flipped an ugly switch on and I walked into a barrage of really unkind words and behaviors. Passive-aggressive. Or rather just sort of nasty-aggressive. Not dangerous or threatening. Just mean, you know? And I've truly grown to care for this patient so not only did those words catch me by surprise--they hurt. My feelings were genuinely hurt.
When the nurses called me, I was sure that the combination of the rapport we'd built so far and the fact that I was up there after visiting hours when the lights get turned down would allay whatever had been going on. I was wrong.
I removed myself from that room and headed out to elevator. I snapped this photo of myself in the vestibule because I wanted to look at it and reflect on how I was feeling. Because my feelings were complicated.
The hospital was so empty at that hour that I stepped onto an empty lift and leaned my head against the wall on the way down. I could feel my pulse quickening and my face getting hot. Next thing I knew, my eyes welled up with tears and, before I could even stop them, I started to cry.
Kind of hard, actually.
I can't fully explain what I was feeling. Some of it was that my feelings were hurt. But that was only part of it. Mostly, I was just sad. Sad for my patient and this fear and this ugly behavior that came with it. Because that kind of thing almost always impedes excellent patient care by robbing even the most well-meaning providers of their empathy. And empathy is a necessary element in quality patient care if you ask me. This patient didn't need anything else to work against all that was already happening.
Not at all.
So right now I'm feeling so sad. Like, every time I even think about the gigantic mountains that so many of my patients like this one are up against I want to steal away over and over again into the quietest elevators to weep into the crook of my white coat--just like I did on Saturday night. With no one looking or hearing or judging. Then, just maybe, even crying out into a vacuous airspace to my God or the Grady gods or any being with powers willing to take this on. Something, anything to defy the suffocating pragmatism and wrestle down the hopelessness I feel in such moments.
Maybe that would make me feel better, you know?
Then, when the doors pop back open, I can shadow box before re-emerging. Pop out of that elevator like a rejuvenated ninja with a new fight and a thicker skin. Believing in the little rays of light that sometimes seep through the darkness faced by so many of my patients, this one included. Or maybe even embracing some lofty idea that I could be that ray of light.
I am realizing that our patients aren't the only vulnerable people in the hospital. We are vulnerable, too. We so very are. Our universal precautions don't protect us from one of the most infectious exposures we face in caring for patients. … love.
On Saturday night, my patient was mean to me. Really mean. And yes, it was about fear but still. I have nothing in my little bag of Internal Medicine tricks to eradicate the effects of all that. I don't.
You know? Sometimes? Sometimes, this job is hard, man.
Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.