My first experience administering injections involved sitting in an ICU room, ten years old, drinking bitter diet Shasta colas and watching thrillers from the 90s starring Sandra Bullock. The nurses started me on oranges. Easy as pie — I could stab away, practicing insulin injections with saline and fruit. The oranges practically squealed with delight upon puncture, rewarding me with the scent of citrus and a plume of juice — no blood, no outcry.
This week, I watched an intern I highly admire follow one patient in particular over an increasingly lengthy hospital course. It was disheartening to watch her return to the workroom after spending long visits at his bedside only to single-handedly bear the brunt of this patient’s anger — maybe at the medical system, maybe at his own illness, maybe at a host of experiences I’ll never imagine — as a regular part of her day.
Despite her ability to articulate possible reasons why he might have been upset at each encounter, she still bore the emotional burden of feeling punished for her efforts to help. The task of caring for people is emotionally complex. For many providers, we gain our own fulfillment by fulfilling the needs of our patients. When it is clear that we cannot fulfill a patient’s needs with our limited tools or connect with a patient on a positive emotional level, we leave the encounter feeling drained rather than energized.
It is easy to recognize what we have diplomatically come to call a “challenging patient,” because his label as such is meant to describe the emotions they invoke in us as providers. At the end of an encounter, we feel angry, frustrated, or exhausted.
This patient in particular was needle-phobic and had fought a long campaign for a peripherally inserted central catheter (PICC) to be placed in lieu of blood draws. The risk of the procedure, especially when he was only several days away from reaching therapeutic levels of his medication, was absurdly high — at least from a medical standpoint. If we obliged his request, we could be risking his life for his very short-term comfort.
As a first year medical student, I remember those rare circumstances when my preceptors were reamed by their patients, and I, the student, was spared; even then, those patients made me glad I wasn’t yet the doctor. Now, as I begin taking a more prominent role in the care of these patients, I don’t get to hide behind the real doctors when things get sticky.
As I near the beginning of my own residency, I have begun to realize that we are emotionally responsible for our patients up to a certain point, though our skills for managing emotions are largely taught by observation. Monkey see, monkey do. One day, I will be teaching by my own example, and likely standing between a vulnerable, angry patient and a bewildered, naïve medical student who only wanted to change the world as they knew it, and I will be tasked with teaching empathy and patience amidst strong emotions. I hope I can do it as gracefully as my colleagues and mentors who demonstrated it to me.
Remember: We wanted the sometimes smelly, fluid-filled encounters with physical illness; we wanted the vulnerability of patients whose emotional lives are linked more tightly to their physical well-being than they realize. We wanted the challenges that accompany blood and outcry. We wanted patients, not oranges.
Heather Alva is a medical student. This article
