"My first inclination was to hit him in the mouth"

April 11, 2003

Honorable Mention 2002 Doctors' Writing Contest

Honorable Mention

2002 Doctors' Writing Contest

"My first inclination was to hit him in the mouth"

A nurse's crass remark about his dying grandfather made this FP realize how cynical he, too, had become.

By Charles P. Vega, MD
Family Physician/Orange, CA

Oh, no, I thought, as my legs somehow got me across the room. Oh, dear God, no. This couldn't be. My aunt had screamed my name only seconds before, and I could see from across the room that my grandfather was ashen and losing consciousness. My family as well as my very-soon-to-be-bride's family and our friends were all just finishing our wedding rehearsal dinner when my aunt shrieked.

I ripped open my grandfather's shirt and started CPR. With the help of several physician friends, we managed to get him transferred to the local ED. We all knew the chance of recovery was slim.

Stunned, I sat outside the ED suite while the doctor and nurses worked on my grandfather. A young nurse approached me, visibly excited by all the action involved with trying to save this dying man. I suppose that he didn't recognize me as a family member, although sitting there with tears in my eyes, I'm not sure who he thought I might be.

He had a cocky smile. "Hey, you're a doc, right? If you want to go in there and play around, go ahead," he beamed.

My first inclination was to hit him in the mouth. But then I remembered what it was like when I worked in the ED.

The callous remark frightened me

I remembered the "frequent fliers" with their myriad social problems, and how we learned to practice medicine by rote. I remembered the addicts injecting failure, depression, and abuse through the same syringe as their heroin. And was it all that different in my own primary care clinic? No, it was the same lineup of patients needing our help.

Who were we physicians? Young, confident, and trying to do the best we could. Unfortunately, our best was frequently not enough, so we employed the defenses we had learned in medical school: derision, detachment, and depersonalization. The woman whose terrible, obsessive dietary habits had made her blood sugars soar became the object of ridicule in the back office. The man hopelessly hooked on prescription painkillers was treated with open contempt. The woman whose cancer we could not cure became simply another medical record number in a long, sad parade.

So, my initial outrage vanished; instead this nurse and his crude statement left me frightened. I could see part of me reflected in him. I could see his attitude in the students and residents I trained with, as well as in the residents and faculty in the residency program where I'm currently associate director. Even the fresh-faced interns quickly become cynical, coached by the experienced senior residents and, too often, me.

We must battle the culture of cynicism

As the ED physician attempted, unsuccessfully, to cajole my grandfather's heart back to a regular rhythm, I realized that it wasn't proper coding, or expanding into a second office, or nailing the right stock on the dip that made me happy or made a difference in the world.

That night, I reconnected with the ideals that led me into medicine in the first place. Even in the most recalcitrant patient, there is honor, and sometimes even joy, in the attempt to make that person better.

I made a promise to my grandfather that night that I would emulate his generosity, caring, and even some of his stubbornness in my medical practice. In his prime, my grandfather would return from long hours as a bricklayer only to spend his evenings shoring up the houses of the community's seniors. During a tough winter when lack of work threatened the family Christmas, he went into debt to buy presents for his kids.

Now, I take the time to listen to why my diabetic patients are substituting food for something missing in their lives. I work harder to find a program that will pay for medications for my indigent patients. By embracing my grandfather's best qualities, I have given hope to some of my toughest patients.

Equally as important, I feel as if I have made a small difference in the culture of cynicism in which we sometimes practice, and I will strive to teach this change to each group of residents who enter our program.

 

Charles Vega. "My first inclination was to hit him in the mouth". Medical Economics 2003;7:70.