Wednesday, August 10, 2011

You make a grown man cry.

"You make a grown man cry. . . ."

~ Mick Jagger in "Start me up."

That first day you went off on me and everyone else.

"I'm in pain!" you yelled in no particular direction.

"I will work on your pain," I said back to you, my voice decidedly softer than yours.

"Yeah, right." That's what you retorted. Phtooo. Take that.

The next day I ask you, "How do you feel?"

Again you light me up, this time threatening to kick me out altogether.  "Worse! Worse! I'm in pain! Y'all got my medicines all confused and I'm still in pain!"

And see, you have a reason to be in pain. This is not some "soft call" where you have a little ache in your back or a visit from Arthur-itis.  No, this pain is legit. And this analgesia you're calling out for is warranted.

I take your venom and withstand your anger because I know it's really at the pain and not me. And, seeing as you're a born-at-Grady elder who happens to be old enough to remember the segregated "Gradys", then that gives you license to go off whenever you feel ready.

"Okay, let me compare your home medications to what we are doing here," I reply.  "Were your home medications helping at all?"

"They were working better than what y'all doing! This don't even seem like it's as much as what I was getting at home and I thought I was s'posed to be getting my pain medicines worked out. This is some bullshit."

"Sir. . .I'm sorry. Please. . .let me look at--"

"Get out, please. Just get out. I need some rest. I'm tired and my body is hurting. Just go."

"Okay. I'm going to put you back on your home medicines and then move up from there. Okay, I'll leave now."

"And turn my television that YOU shut off back on 'fore you go."

"Yes, sir."

"And get that bright ass light, too."

I click it off on the way out and leave with my tail between my legs.

As a team we carefully reconcile your home medicines with your hospital medicines. Looks like we were a few milligrams under what you'd been getting, and we bring it all to speed by changing the orders.

The third day I come in to see you and your back is to me.

"Hey there, sir. I'm making my rounds and I'm here to see about you."

No answer.

"How are you feeling?"




"The medicines aren't taking the edge off?"

"It helped a little bit, but now I feel sick to my stomach. My bowels are loose, too."  Your voice is quiet and defeated. This is different. . . and it scares me.

"We put you back on what you were getting at home and--"

"I know that. Soon as you said that yesterday I started. But now all I feel is sick."

"I'm sorry. . . what do you mean by 'as soon as I said that?' Do you mean the nurses told you it was a new dose?"


"The medicines. You said you started as soon as I said something? That part confused me. Just wanted to get clear."

You reach under the bed and pull out a plastic Kroger bag full of pills. "No, I'm talking about my home medicines that you said to get back on. These here."

Wait, huh?

"Sir. . .wait. You're taking. . .hold up. . . you're taking these . . . and the ones we're prescribing in the hospital?"

"I did what you said." You point straight at me. You are talking about ME. Not my intern. Not my resident.

"What I said? You mean you are opening these bottles and taking these pills in the hospital?"

"Just the pain pills. Just those like you was talking about." You pull out a bottle and show me. "I took two of these here."

I look and then read the bottle. You have just shown me some Reglan to help with digestion. This is not a pain medicine at all. "This is what you took, sir?"

"Yes, I took my pain pills from home. That's what you said!"  Your voice is rising higher and cracking a bit. Your repeat yourself. "You said to get back on my pills from home!"

Briefly, I'm relieved that you didn't take double the amount of narcotic pain medicine, but that is only fleeting.  I squeeze my eyes and rub my forehead with the heel of my hand and sigh. "Sirrrr. . ." My voice sounds scolding, even though I don't mean for it to sound that way. "Noooo. .  .noooo. . . .you're never supposed to take your pills from home when you're in the hospital. This could really--"

That was it. That was the straw that broke the camel's back.

Your face melted into frustration and tears began shooting out of your crinkled eyes. You shriek out, "I DON'T KNOW!!! I DON'T KNOW!!!  I DON'T UNDERSTAND THIS! I DON'T UNDERSTAND THESE MEDICINES!!!"  Your body is limp and your shoulders slump. And you weep. An exhausted, exasperated, tired weep.  "I'm tired of the pain. I just want to stop my body from hurting. This illness going all through my body. . . I know it ain't a cure but they said. . . you said you would help my pain. Please, please. . . .help me."

Your hands are shaking and your lips are quivering. Each word is punctuated by your throaty cry. That cry sounded like it had been bottled up for all seven of your decades and I had just rubbed it out just like some kind of genie. It rose out into the hallway, first slithering around my head and strangling my neck.

I stood there dumbfounded.  My face felt like it was on fire and my eyes blinked like some kind of involuntary tick to fight back the rapidly forming tears. I dared not talk. I had done enough.

I reached down and patted the bed, looking at you for permission to sit beside you. You nod, still crying. . . now trickling off into restrained manly crying instead.

And so I sat next to you in silence. I held your hand and wiped your cheek with some paper towel since it was the only thing sitting on your tray table. Then, when you were ready, we started over. Going through each medicine one by one. . . opening the bottles, pouring out each pill, and making it more concrete.

You told me that sometimes it's hard to see the words on the pill bottles and that even when you can, sometimes it's hard to read them depending on the words involved.  I tell you I should have asked that and I apologize for what feels like the one hundred-trillionth time.

Then, eventually we get somewhere.  I excuse myself with your permission and share this with the other members of our team. The intern, the resident, the pharmacist, the students. I let them see how ashamed I feel and how much it hurt my heart to see you cry. Yes, you. A grown man. Their faces look sorry, too, and I say nothing to blow it over or shrug it off because you being confused and in pain and frustrated just isn't acceptable. So together, we vow to do better.

And so we do.

On the fourth day you were smiling. A big beautiful, nearly toothless smile. . . lighting up the room and even the hallway.

"How do you feel today?"




Happy Wednesday.


  1. Ah man. My husband lives with chronic pain. I feel this post.

  2. No one can understand pain until they are in it. This made me cry.

  3. What a job you have -- and you are an impressive role model: strong and caring and patient.

  4. I don't feel so much for you (sorry, you know what I mean) as just TRIUMPH for this man. I'm glad he got it and you did too! My mom carries a ziploc full of bottles too and I worry how she can keep it all straight, especially when she doesn't always seem as clear on simple things as she used to.


    AKA in ATL

  5. I have been away from your reading almost all blogs and then I read this. I am humbled once again. By your patients that you treat and by you. The ending was indeed spectacular!

  6. Ahhh . . . the Grady elders! In tears over that one.

  7. I've been in that kind of pain and that confused when I was sick. Thank you for taking the time to work him out of it.

  8. I read this and tears came to my eyes. I get so frustrated when those I work with cannot empathize with the fear/confusion/pain of our patients. You give me hope that I'm not entering a profession empty of compassion and patience.

  9. I am in tears too. That was reinforcement that we have to be oh so careful to check that what we said was what they heard. Glad he didn't double the pain meds!

  10. I get it...I finally am starting to understand this love you have for this place and the people in it. I just began my medicine rotation at Grady last week...and I'm starting to get it.

    Low key...I want to be just like you when I grow up!

    ~Morehouse School of Medicine M3

  11. Bless his heart...and yours for *really* caring.

  12. You made me cry too, but in a good way, with this post. You made me want to sit at your patient's bedside, to hold his hand, even hug him, and wipe his tears away... If I can be half the doctor you are when I "grow up" in medicine...

  13. My husband lives with chronic neuropathic pain, too. It's very, very hard, and I know what it can do to your quality of life. Glad this man had a physician who cares.

  14. You made me cry and thank you for taking the time with this man. I am an RN at Grady - and I am often humbled when I hear back what my patients heard me say, and realize I did not explain something or check to see if they got it. Most recent: "so, what is birth control exactly, does it just keep you from getting pregnant?" Actually had a nice chat - I could see how "birth control" sounds like it is more about birth than not. Lesson learned.
    Anyhoo Thank you for writing so honestly about this patient!


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

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