How can I help you when I don't even like you?

How do you provide good medical care to someone you don't like? For example the man who smiles at you but calls the nurse a "lazy bitch"...Or the woman who interrupts you with "now you listen to me missy"...Or my worse case yet, the retired and demented sex offender.

How do we normally deal with people we dislike? It's an interesting question and I'm sure you can think of a couple of different ways that you've coped with this problem. Do you avoid the person? Do you ignore them? Do you politely get through the encounter while discrediting in your mind, all that's been said? Do you confront them? Do you let them walk all over you? Do you try and find a medium or a balance that leaves both parties satisfied?

I need to provide equally good medicine to all my patients. I believe I've used all the above techniques at some point to deal with an unpleasant situation, with varying levels of success. And of course what works for some patients may not work for others. But somehow we, as physicians, must learn to push aside our dislikes to evaluate critically what is wrong with the patient and to give them the best possible care, regardless of the negative emotions the person might elicit from us.

I think of all of this today because one of my "toughies", a person I would mentally have to prepare myself for before each and every visit, stopped me today in the hallway. The first time we interacted I was doing a colleague a favour by seeing her. This patient dictated exactly how the encounter was going to go, which made it unpleasant for both of us. She was rude and manipulative, and in retrospect, probably deeply afraid of the coming months. I left the room that day shaking with anger. But I'd also learned some tools on how to work with her in the future. Our next encounter went more smoothly. Near the end I was starting to get wound up so I called it a day. And from that day forward we had established our boundaries. And she opened up to me about her life, her children, her successes and her failures.

She was diagnosed young with ovarian cancer and it is killing her. Today when I saw her her appearance shocked me. By the flash of a younger self, who was startlingly beautiful. By the fact that she is so very obviously now dying. And even more so by my hand on her shoulder and her bringing her hand up to cover mine and to then pull me into a strong hug and a whisper in my ear "I love you".

Having just rediscovered this blog site I'm realizing that my hiatus went from a couple years to nearly half a decade, but here I am, fully graduated and working and thinking of sharing some of the amazing stories I'm so fortunate to witness on a daily basis. Bare with me. Sometimes I leave an encounter with a smile, other times with tears. But each story bares witness to someone's life...so some postings may be happy, others sad, others might share an anecdote or a lesson a patient has taught me. So...let us begin :)

Disclaimer: Confidentiality will be maintained throughout these postings.

I was driving to my Spanish lesson today and thinking about one of the sadder cases I've seen in the past several months working in hospital. My patient is just under twenty and was hit by a car on a freeway. The circumstances of the accident (what we call a peds struck) is shady at best. The poor girl was left with a very traumatic brain injury, a dislocated neck, a broken hip just to give a brief overview. After months in the hospital she was transferred to our facility. I met her today and only one eye can focus on me. She cannot talk, she doesn't have control of her body any more. But that one eye can focus on me, and I like to believe that she could understand me when I spoke, when I touched her arm. She's still quite sick, and unfortunately it may be the result of her brain injury. Which means there's not much we can do other than to try and make her comfortable. There is more to her story, which makes it even sadder, but we'll leave it at this, as the point of my story is different.

I was working with this girl, who shares a room with 3 other people. Another of my patients joined me and put a hand on the head of the girl and told me that they had got to know one another a little over the last several weeks. She could tell me what was wrong, and what she had noticed in the night. She spoke with me as though it was her own daughter in the wheelchair, not a stranger. She asked that I look after her and try and solve the problem that was causing discomfort. All the time she kept her hand on the girls head, stroking what remained of her hair, and talking as though the girl understood.

At the time it didn't strike me, but as I was driving to my lesson today tears came to my eyes. How incredible is it that someone who is a complete stranger, who has never exchanged actual words with this young girl, can stand up and advocate for her health and well being? Most people would be frightened to see her with her tube feeds in her wheelchair, but this patient, who was sick herself, could see past all of that and see the girl who needed someone to stand up for her.