patient encounter

I had a rather distressing patient encounter this past Wednesday. Normally, I find myself energized and excited by my meetings with patients. We sit together for an hour or so and they tell me their stories, while I listen and try and find the right questions to ask. The trick seems to be eliciting the one fact that makes all the disparate signs and symptoms come together. It is like solving a puzzle, but better, because finding the answer means that you can help someone regain their health.

Now, I am not the care-giver for the patients I see. I am just another person to talk to. The vast majority of patients are happy to talk to me, even knowing that I can't do anything for them in terms of the medical care. And though it seems pretty one-sided in terms of benefit (in that I am the one learning and taking away from the situation), I do believe that when it goes well, allowing the patient to talk through their situation can be as helpful for them as it is for me.

But this last patient did not seem to want to do anything other than verbally abuse me. Though he told my attending that he did not mind talking to a student, he was hostile and hurtful from the first words. He told me I didn't listen, that I was too stupid to be a doctor, that I would never make it, that I was unattractive, and that I was the worst person for the job. On and on it went. Now, had I been at my best, I like to think I would have been able to address the situation head on, and either figured out a way to have a constructive conversation or left the room. As it was, I had slept only 2 hours the night before, woke up very late, didn't shower and skipped breakfast. Already feeling pretty beaten down and thoroughly worn out, I just kept trying to get the information I needed from the patient to make a semi-decent presentation to my attending. After more than 2 hours of not having my questions answered, I glanced at the clock and realized I was already 30 minutes late to the rounds I was supposed to attend. I shook the patient's hand and thanked him for his time. "No problem," he said.

Because I was so late, I missed rounds, and wasn't able to get any feedback from my attending on what I should have done. Pretty much everyone I talk to says that this will happen again, and on a fairly regular basis.

I wonder if this man simply saw that I was - at the moment - weak. In recognizing that he took advantage of the fact that he was not as powerless in this interaction as he must feel in the majority of his interactions. Being a patient in a hospital is not easy under any circumstances, but when you can't pay for what is being done to you, when you don't have any friends or family visiting, and when you don't understand why you are sick or why the treatment seems worse than the cure, I can see how it would be comforting to have the upper hand.

That said, I sure hope that next week is better than this week. It makes it really, really hard to find the motivation to study from 7am to midnight everyday when the only feedback you get from actual human beings is negative. And, I definitely am in need of some motivation these days.

I am hoping for a sunny, bright, uplifting Easter tomorrow. After church, I plan to drink a celebratory Dr. Pepper, eat a cadbury cream egg, check facebook, take a deep breath, and get back to studying.