I'm a new grad going into my 4th month floor nursing at a busy trauma 1 cardiac IMC. Despite my expectations from this board, friends, and colleagues, the job is so far not that stressful. In fact, I quite enjoy it. The people I work with are great and I love going to work.
I've had a lot of angry patients, a lot of rude patients, a lot of patients who just seem to lack interpersonal skills, and they've never really bothered me. I've always just figured that they were very, very sick (many of them, clearly dying) and consequently unhappy with their situation, suffering through endless procedures and bad outcomes, etc, etc. And so, I have always put on a kind smile despite whatever dismissive or insulting behavior comes my way.
Yesterday, one particular patient bothered me. A former addict, he complained constantly about his care, and in his complaints, you could see that he was not very intelligent, and didn't understand much. It was strange, because I've had far ruder, far angrier patients... but this one in particular was difficult for me because literally, no explanation would work. I'm not sure if he just has an extremely low IQ or if it's a side effect from the years of illegal IV drugs or a combination of the two. His sister got some device put in her that fixed everything, why can't they do that to him? Why can't they do this faster? What are all these meds for anyway? (This, despite saying "just give them to me and quit talking so much" when I tried to educate him earlier.)
"Why are you interrupting me during my dinner?" (Because I just asked you two minutes ago if it was okay to give your medications while you were eating and you said yes.)
"I suppose I misunderstood you two minutes ago when you said it was okay to come give your medications now."
"Who raised you? Where you from? Japan? Korea? Well, where I was raised we don't interrupt people during dinner. You don't mess with a black man's dinner. Any black man will tell you that. Don't you got any sense of manners?" (No, sir. I don't think I share the same sense of manners as you, and I've had patients, some of whom were African-American, who prefer meds with dinner and have manners quite different from yours.)
"I can come back later?"
"You know what? I'm not even hungry anymore. You made me lose my appetite. Yup. You did that." (I know you're trying to make me feel bad. It's not working.)
"I apologize. I hope you change your mind before dietary comes to collect trays. Let me know if you need your food warmed up again."
Perhaps my disposition only makes it worse though. Some of our patients have made other nurses angry, made them cry, when they're being 'mean'. Sad patients can make me cry---very easily, in fact. Rude patients like him don't make me cry. In fact, I can hardly summon up any feeling except for a cold sort of amusement like "Wow. I can't believe people like you actually exist." For this reason, when other nurses, even the seasoned ones, decline assignments of difficult patients, they often get sent to me. Maybe it could be described as having tough skin, but to be honest, with some rude patients, my initial reaction is just to laugh at how ridiculous people are. I really can't help myself. It's like "Really. You, with little to no education and lacking basic literacy skills---you think you know better than me or the doctor? So why are you here again?" I find myself raising an eyebrow, trying to smile kindly, but really trying very hard not to laugh, and I think sometimes it shows. I know this comes off as really disrespectful, and this is probably what he was sensing. In my head, I can't help thinking, "You are literally so stupid. I can't believe people so stupid manage to live to your age. How?" And I try very hard to retain my politeness, but I think it comes off as passive-aggressive condescension. In the heat of the moment, I can't help myself.
"Man, you don't know anything, do you? And you're a doctor!"
"I told you this morning, I am your nurse. And despite 'not knowing anything', I just explained your plan of care to you, which you seem a little confused about still."
"I just don't understand why I need to be here so long. Explain that!"
"I just explained exactly how long it will take to titrate---to increase---your medications safely."
"But why do I need all these medications and tests anyway?"
"Do you want me to go over all your conditions and the specific medications and tests with you?"
"Nah, man! Nah! I don't got time for that."
"So... you just asked me a question. I just offered to answer it. You just said you don't have time to listen to the answer. What would you like me to do in this situation?" Silence. 1, 2, 3 seconds pass. "Sir?"
"I want to speak to the doctor."
"Then I'll go get him."
It's the best I can do. So maybe it's me. Maybe my lofty attitude toward people like him only perpetuates their frustration and rudeness, but it's not like I can yell at them back and it's not like I can just ignore them (I mean, I have to interact with them to care for them.) I just carry on either expressionless or with a little smile. You know, the one you give to a naive child when you're just appeasing him. Eventually he gets nice again, when his anger subsides and he sees that his abuse has no negative effect on the way I act toward him. But then he gets angry again. The cycle continues. Thankfully, my other patients were sweet and counterbalanced all the negativity, thanking me for giving them a good day, for being "a compassionate person".
I don't often refuse assignments. (Once ever, because a patient was a sweet lady but required a lot of care and I was just horribly exhausted that day and just coming off orientation so I asked for a lighter assignment.) And as I said, I often get assigned people other people don't want. But something in me tells me that if I get assigned this man again, I'll want to refuse him.
It bothers me terribly, because I wish I had more empathy. I wish I found some redeeming quality that helps me to forgive how uncouth he is. I wish I had, somehow, found more love for this man. But I just couldn't. I don't feel bad for him like I do my other patients.
I know what you're thinking. Maybe I have some grudge against addicts, but I don't. I've treated other angry addicts before, no problem. I've even liked some of them, many who are more rough around the edges. I think the difference is they were slightly more intelligent, and I feel like even if we disagreed, they at least understood
me---whereas this man was literally such a fool. To talk to him was to talk to a wall. It makes me feel like an awful person to admit it, but I honestly felt like he is a waste of time. A waste of tax dollars. A waste of space that could be used for someone else. Why are we trying so hard to treat him? What does he add to this world instead of just taking from it? I work hard because I take pride in my work and I'm not going to neglect someone just because I don't particularly like them. But as I work, these thoughts flow through me and it kills me that these are my opinions about someone, about another human being. I never thought I would have such harsh thoughts, such cruel judgments about an almost-stranger. I try to make excuses for him---it's not his fault. He probably had a tough upbringing. It's a little easier that way, to think of him as just a child who had bad parents. But even still. At a certain point, an adult is an adult and he is held to his own words and actions. After all, we don't excuse criminals for 'having it rough as a kid'. But he is a just a mean-spirited little man, not a full-fledged criminal, right? And he probably has someone who cares about him somewhere who wants him around? But I just heard him speaking on the phone with his wife and he's just as rude to her as he is to me. So the argument goes back and forth in my head. It's dizzying. And it disappoints me.
Anyway, if you had the patience to read through all this, thanks for listening.