Monday, August 22, 2011

Paradigm shift.

"Oh man, I heard you guys got him on your team last night. Oooo weee."

"I think this is my first time taking care of him," I replied.

"Really? Damn, how could that even be possible?  Dude. Everyone has had him before."

This was the exchange I had with a colleague the day after my team admitted this frequently admitted man to our service. Yes, him. He was well known to nearly every physician in our hospital because of his constant revolving door hospitalizations for his underlying--and yes, complicated--medical problems.

But mostly, he was also known for being difficult.  Real, real difficult.

"He will cuss you out and then throw you out." This was what one of the senior nurses had to say about him. She went on to say, "Chile please. . . . I've taken care of him so many times that I don't even take it personally any more. He's just a miserable, miserable little soul." She shook her head and punched in a code into the pixis system.


Him. That difficult guy of legendary status. Challenging enough to grate on the nerves of even the most seasoned Grady nurses--which is pretty difficult to do. Him. Also known as "a miserable, miserable little soul." Guaranteed to either demand that I get out of his room or yell expletives in my direction until I turned red in the face and am rendered completely useless as a clinician. This was the word on the street about him.  Demanding and difficult. Demanding his pain medications. Demanding someone to "cave" in the face of his unruly behavior. And just downright demanding a whole bunch of things.

Yes. This was the rundown that I'd heard.  And no. Nothing about him sounded appealing. At all.

Even one of the nicest people in the entire hospital had this to say:

"Look, there's just no other way to spin it. He's just an asshole." 


An asshole?

Look. We're all grown folks here and sure, I'd like to pretend like every single health care professional is SO professional that he or she would never, ever even go so far as to THINK of a patient as "an asshole"--let alone actually say it. But the reality is. . . .members of health care teams are human. They have feelings and nerves that, despite their altruistic origins, can be stepped on. And deep down inside of every single one of them is that "OH HEEELLLL NAW!" button that some patients just push.  If they can find it.

And this guy? He seemed to know exactly where to find it in every person he encountered.

So the count was now at "oo wee" and "miserable, miserable little soul" and now, "an asshole."

My team had seen him first and I knew they would tell me all about him on rounds. A palpable heaviness came over the entire team as we got closer to his room.

Everyone who had already met him looked so tired. The intern. The resident. Even the bright-eyed bushy-tailed medical student. This man had found their button and pushed it hard. They looked so tired. Which immediately made me feel tired.  And I hadn't even met the dude.

Before I could even get down the corridor in the ward, another person saw us approaching and chimed in their jovial two cents.  With a thumb pointing in the direction of his room, the passerby laughed and said to me sarcastically:

"Wow.  . . . Good times, Dr. M."

This was getting nuts. I offered a half-hearted smile and nodded as I watched the passerby disappear into the neighboring room.


We paused in front of the door and all focused our attention on the intern. The same tired-looking intern who'd been given the distinct pleasure of admitting him to the hospital. Not tired-looking as in I-was-up-all-night-and-might-be-an-assassin. More tired-looking as in this-dude-is-working-my-nerves-so-bad-that-I-am-dangerously-close-to-catching-a-case.

The intern's face was twisted and emotionally exhausted as he reached into his pocket for his notes.. He shifted between his feet and did his best to channel the most empathic part of his psyche. Next, he launched into this patient's story. The same story that seemed to be playing like a broken record all over Grady Hospital.

Suddenly I heard someone hollering from the other side of the door.

"Jest get the f--k out of my room! I ain't doin' none of that! Get the f--k out!"

My intern looked over his shoulder at the door and then down at his shoe laces. Kind of like a child that was being forced to do something he really, really, really didn't want to do.

"Wow," I said wincing as one of the patient techs passed through the door after being kicked out.

"It's bad," my resident said.

"It's awful," the intern cosigned.

"Oo wee"
"Miserable, miserable little soul"

I felt like a person who was waiting for a fight after the school bell. All this build up was just too much for me to stand any more.

"Alright, y'all."  I finally interrupted my own thoughts and the intern's presentation that he'd just resumed. "Let's think about this for a minute."  The whole team paused, almost like they were all being operated by a DVR remote controller. I sighed hard and was honest with my intern. "I'm feeling completely drained by this patient and I haven't even met him yet."

"Dr. M. . .he's difficult. Like. . .so manipulative. . .it's just. . .I don't know. I'm sorry."

"No, I hear you." I stared at the card with my notes scrawled all over it and looked over at his door again. "Okay. Let's make a pact. Regardless of how he treats us, we will treat him with kindness and respect. And we won't fight with him. No passive aggressive stuff from us, either." That statement seemed to make my team bristle a bit, so I quickly tried to clean it up. "I mean. . .there is no way that this guy is getting the warm and fuzzy treatment here. No way. I haven't even been in there yet and nearly five people have already made it very clear that being tazed by the Atlanta Police would be far more pleasant than being the person caring for him."

"Tazed?"  one of the medical students asked.

"Yeah, tazed," I repeated. I reached in my pocket for my phone and pretended to jolt him in the arm with it. The team released a bit of much needed nervous laughter. "I'm just saying, guys. How about we just decide right here and right now to throw everyone a curve ball?" I had their attention so kept going. "Look, y'all. Every body was once somebody's baby. This man could not have aspired to be in and out of Grady Hospital infuriating ER staff and ward teams when he was five years old. Like, do you really think he drew himself like this with his crayons when he was in kindergarten? I don't think so." No one said anything. "I know it probably sounds corny but. . . .I say we just try to see that five year old."

Yep. Corny indeed, Dr. Manning.

So in we went. We talked to him as a team and examined him, too. And you know? It wasn't so bad.

I'd be lying if I told you some lovely story of a cosmically heartfelt interaction shared between us. Okay. . .yeah. . .  wouldn't it have been nice if I told you that the heavens opened up and that he'd become wonderfully angelic? Wouldn't a perfect ending have been for us sing kumbayah and all cry together? Yeah.  He was still 100% difficult, 200% unreasonable, and 300% annoying and manipulative.

Yes. I said it. Annoying and manipulative.

But you know what? Sometimes my kids can be annoying and manipulative. And hell, depending upon what's going on with me and my husband, I can be the same way--especially when I'm dealt a hand that I don't like.


Shortly after we saw him that day, someone walked up to our team and made another negative comment about this patient. In unison, we all just sort of looked at each other and didn't really respond. For the rest of his hospitalization, we spoke of him with compassion, paid no attention to references about his prior behavior, and . . .dare I say it? Simply showed him some love.

Cliche, I know.

And you know what happened next?

By the end of his hospitalization, nearly everyone else did, too.

Happy Sunday.

"The greatest healing therapy is friendship and love."  ~ Hubert Humphrey.


  1. Did anyone say, "Bless his heart?"

  2. I love this story. I use that theory often when dealing w a difficult student/family. I tell colleagues, "Yes, so-and-so may be an a**hole. But he's OUR a**hole, and we will see him through." I think it helps. Thanks for sharing.

  3. A good cliche is perfect sometimes.

    Thanks for the reminder -- you absolutely rock.

  4. This is not my first visit to your blog, but my first comment. I came here via lovely Angela. I volunteered at our local hospital for over three years as a Spiritual Care counselor. Because I had more time, I was able to listen to the patients and yes, many of their complaints and gripes. But you know what I found out rather quickly? I found out that people in the hospital mostly want to feel heard and respected and recognized as more that just another diagnosis. I know this is very difficult in the hospital setting as there just isn't enough time to sit and listen to every patients concerns, so some of them become like small, insolent children who throw temper tantrums in order to get the attention that they are in such desperate need of. Seems like you handled the situation perfectly. It's all about expectation as to how someone like this thinks they will be treated and then the staffs response to the patient the more awnry he becomes. Entering the situation with an attitude of pleasantness, love and light won't make everything perfect, but like you implied, it absolutely creates a much better environment for everyone involved. So if even the patient didn't change his attitude very much, everyone else did and that had to have a huge impact on everyone who entered this mans room. The time when an individual could use the most concern and human kindness is probably at a time when it seems as if he/she is the least worthy of it. Therein lies the magic...

    You did a very good thing, Doc, and you taught a very valuable lesson at the same time. That is awesome!


  5. Difficult people are usually scared witless, and the only way they can deal with it is by getting bigger and blustery-er than the fear. And something that always helps me with difficult people is to try and remember that everybody is some womans baby...somewhere in there. deep DEEP down sometimes. lol

    I'd want you and your staff on my side, DrM...

  6. I was reading along and you were building toward the climax of the story and voila! It was a real ending. Not the magic moment of Hollywood but the real life change that comes when one person in the dynamic changes. Thanks for a compelling look at "Mr. 5 year old".


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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