I am consistently in awe at the succinct beauty of C.S. Lewis' writings. Something I recently read by him raised this point,
"...we must hate the bad man's actions, but not hate the bad man. For a long time I used to think this a silly, straw-splitting distinction: how could you hate what a man did and not hate the man? But years later it occurred to me that there was one man to whom I had been doing this all my life--namely myself. However much I might dislike my own cowardice or conceit or greed, I went on loving myself. There had never been the slightest difficulty about it. In fact the very reason I hated these things was that I loved the man. Just because I loved myself, I was sorry to find that I was the sort of man who did those things..."
It has caused me to reflect on a recent incident from a few nights ago has been gnawing at me. I keep coming back to it in my mind, seeing myself react more quickly, with more confidence and ease, with strength. Like those times when you think of a really good comeback or joke but the moment is long past and you're just left to burn and smolder in your thoughts of inadequacy.
This 30 something woman in tight jeans, heels, and handbag has been coming in for her late night dose of IV therapy. She's suffering from a case of pyelonephritis. I am sure it is unpleasant and irritating to be sick to have to drag yourself to the hospital thrice daily, (two times to Ambulatory Care during the day, and once to the ED late at night) but I believe that this does not excuse her behavior in the slightest.
Each night when she comes in she harasses the nurse who must work at a slow jog to keep up with the IV therapies, the evening meds of the admitted patients, the call bells, the pukers, the criers, the poopers. It is the 'non-acute' side of the department which means you can forget a break all night and you can also forget getting to do anything fun (like assisting with reductions, sedations, intubations, chest tubes, etc). This woman will complain about the fact that she has to sit in a chair (a chair that just happens to go into full recline but I guess that is beside the point), because really she "deserves a bed". She demands blankets. No, HOT blankets. She needs juice. She needs a new IV site because this one is really bothering her.
One night the nurse actually accommodated the early site change and thus subjected the entire department to the womans wails, screams, and sobs while the new IV was put in. And I mean SOBS. There were tears rolling down her cheeks I-kid-you-not. I even went over to see what was going on and to see why one of my colleagues had clearly snapped and decided to shove bamboo slivers under someones nails that evening instead doing her job.
But no. It was just our little pyelo getting a #22G catheter in the arm.
So I am on the dreaded 'pit' side the other night. And I am dealing with the usual 10-pt-per-nurse ratio and I go to flush her IV with normal saline while we wait for her repeat blood work to come back to see what the plan for the next day will be. While I am hooking up the syringe she points to how badly her skin is doing, how the site is clearly not working and that it needed to be changed. Since 250mls of cipro had just gone into that supposedly "non working site" I was unconvinced but assessed the area anyway. Her skin was slightly puckered from the op-site but looked pink, healthy, and non-infiltrated underneath. I explained that it was the taping job and not the signs of a faulty site.
When I went to flush the line she almost knocked me over as she reached around to grab her hand in pain, screeching. The saline was going in with no resistance and again I noted no signs of infiltration or an interstitial loss. She demanded that it be taken out otherwise she wouldn't sleep that night.
Remembering back to the antics the night before I told her that since we'd been having such a hard time getting IV's in her I was less than willing to pull out a perfectly good site. I added that I was certain it would not go over well when she returned the next day without a saline lock in place (I was really trying to save this faceless RN unknown to me at the ADC program that kind of a start to her day...faceless RN if you ever read this blog you can thank me anytime).
I wrapped her hand up and went to tend to the patients in the department that were actually quite sick and in need of attention (in a non-pathological way). Like, for example, the woman in bed 6 with gross hematuria and the guy in 5 with hepatic encephalopathy.
As I am on the other side of a curtain nearby doing a quick EKG on a patient that had seemed to have vagaled but just wasn't coming around in a timely enough fashion for my liking, I had to listen to pyelo ranting at a just-below-yelling-decibel-level:
...yeah they have me in a hucking chair in the middle of the hucking department...no I am NOT in a hucking bed I am sitting here in a chair! Yeah I told her to take it out and she wouldn't...because it is so hard to start a hucking IV on me!! Yeah, they are so hucking brutal down here...they are waaay hucking better in ADC...I just cannot believe the hucking treatment I am getting....I don't even hucking know what the huck I am waiting for...this stupid hucking antibiotic isn't hucking working anyway!....
And on and on and on she went in a similar fashion. I could feel the anger rising in me. I felt my face beginning to flush and my heart rate starting to rise.
Why was she allowed to pollute our emergency department with her sense of entitlement, her anger and her foul language? Why was I feeling so incredibly offended by her mouth? I used to be a basketball referee for crying out loud! I've been called every name in the book in front of hundreds of people and I had never taken it this personally.
Why was the person who was the least in need of emergency care in the entire department allowed to rudely and inappropriately disturb patients and family members with dissatisfaction over her care?
Because I didn't do a thing about it.
Ugh. It makes my stomach turn a flip every time I think back to it.
Why didn't I walk over to her and say, "please turn off your cell phone, as you can see there are signs everywhere restricting their use. Also, please refrain from using such offensive language. If you are not happy with your care here please feel free to be seen at XYZ emergency which is about a 10 minute drive away. Thank you and good night".
I am so angry with myself for cowering away from the confrontation that would have spared my other patients, family members, and colleagues from her ridiculous (and totally unreasonable) ranting.
And I am also unhappy with myself for hating this woman who was sick and clearly has other issues than her pyelo or she wouldn't be acting out in the way that she did.
I have been thinking of ways I will deal with these things in the future, how I will handle them more pro-actively. How I will learn to "hate the bad man's actions but not hate the bad man". How I can try to see those poor qualities in myself and change them; the sense of entitlement, the impatience, the desire for attention.
And how I will let go of this, move on , regrow that thick skin I once had, and keep smiling.