We’ve all been there — that patient whose circumstance, behavior or personality really makes us question our career choice. Perhaps it is a belligerent, intoxicated, homeless person or a very demanding, loud and aggressive person with a seemingly minor complaint. I’ll admit, there are times that I just want to walk away. It is easy to get angry. Expeditious to be dismissive. The challenge for me is to find a way forward and not react to a seemingly “bad” patient.
I’m reminded of my own experiences. At one of the hospitals I worked at, we frequently were visited by “Mike”, a severe alcoholic. He would come in, too intoxicated to stand and invariably covered in urine and feces — a consequence of being too drunk to walk. Often he was aggressive and belligerent. We knew him well.
On this particular evening, he came, more or less carried by the police, with a large scalp laceration. He was cussing up a storm but settled down enough for us to get an exam and put him the CT scanner. Later I attended to his wounds. As I quietly worked on repairing his laceration while blocking the assault on my olfactory senses — I became angry that, once again, he was in the ED consuming resources. Suddenly, in as clear speech as I had ever heard him say, he told me, “I don’t like being a drunk.” He proceeded to tell me he had two masters degrees and spoke three different languages. He had worked in some industry where his skills were in demand. He lived in a nice home and had all the trappings of a good middle class life. He started drinking about a decade before when he caught his wife cheating on him in their bed. He told me about the innumerable times he had tried to quit drinking, but invariably the vodka always won. He was desperate to quit, but, he said, had resigned himself to a life and ultimately a death, with the bottle. I never saw him after that — I moved on to a different hospital. I was struck how similar he and I were. Both professionals, both with hopes and dreams, but for a few circumstances and choices.
Atul Gawande is a surgeon and a writer for the New Yorker Magazine. He’s won a myriad of awards for his writing about medicine and society in the United States and has long been a favorite of mine. This past Friday, he delivered the commencement address to the UCLA Medical School. I wanted to share his speech with you, as published in the New Yorker. As I read it, I am reminded me that despite our vast differences, my patients and I share the same, core reality: our humanity. We all have fears, motivations and desires. Dr. Gawande reminded me this morning that sometimes, caring for challenging patients can be aided by seeking their humanity. And I was reminded of Mike.
Read the speech here: Curiosity and What Equality Really Means
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