7 Minute Read
Intern Year, Day 30:
“My dad isn’t taking that f*cking medicine!” I looked up from my computer screen to see a frazzled nurse walk as quickly as she could out of a patient’s room, exasperation splayed across her usually friendly face.
“She is impossible,” the nurse sighed. “I’m done. If he doesn’t want to take his blood pressure medications, FINE. They can have it their way.”
I told the nurse that I would go back into the room and try to convince the patient to change his mind. The nurse gave me a look that said poor little intern… gonna get her feelings hurt. “You can try whatever you want. It will be a miracle to get them to even talk to you; the patient’s daughter has been cursing out everybody that walks into her dad’s room.”
I’ll be completely honest. My motives for attempting to convince the patient to take his medications were not completely pure. I was on long call, meaning I had already been at work from 6AM, and I wasn’t leaving the hospital until 10AM the next day, making for a grand total of 28 hours. 28 hours. It was 9PM, I still had 13 hours to go, and I was looking out for my own best interest. As the intern on call, if anything went downhill with the patients overnight, I would get a page (yes, we still use pagers) and have to put out the fire. An old man in the ICU refusing to take his blood pressure meds sounded like the perfect recipe for a 4AM call about systolic blood pressures in the 200s. NO THANKS.
I pulled the curtain back that separated the patient’s room from the rest of the ICU, and was immediately greeted with a scowl from a pretty brown-skinned woman, seemingly in her late 20s or early 30s, sitting in a chair pulled up to bedside. The patient was a dark elderly man, lying in bed covered in blankets, with his eyes scrunched together as though his head hurt. I put on my brightest smile and prepared for war. “Hi! I’m Dr. Oye-“
“You can save it,” the young woman cut me off. “I’m truly sick of ya’ll’s sh*t. We’re leaving.” She decidedly turned her face downward towards her phone. Her father gave me a half shrug and a mildly apologetic look. I tried to talk again.
“I see that you’re frustrated, miss…” my voice trailed off expectantly, hoping that she would tell me her name.
“I DON’T THINK YOU GET [clap] ME [clap]. So let me make it clear. We. Are. F*cking. Leavi-“
“You’re leaving. I understand.” I interrupted her. “However, until your father leaves, he is still my patient.” I turned to the patient. “Sir, is there a specific reason that you don’t want to take your blood pressure medications?”
“She’s the boss,” he said, with a weak head nod towards his daughter. Her eyes narrowed at me in defiance.
“I see,” I said, looking around the small room for another chair. I sat, noticing her puffy eyes and tear stained cheeks from this new vantage point. “How about this… I will leave the two of you alone as soon as you tell me why you don’t want your father to take his medications.”
She looked over at her dad, and then back at me. Her eyes welled up with tears. “I’m just so frustrated.My dad’s blood pressure is higher than normal right now, and it’s because you all refused to listen to me!”
“What do you mean?” I asked softly.
“I have been telling people to give him his home medications for hours! No one listened to me, no one gave him his medications, and now his blood pressure is high. On top of that, the nurse wants to give him a medication that is different from the one he takes at home! I don’t know how he will react to it!” She started to cry harder now, and her dad reached out to her with his right hand. She took it in hers.
“Let me get you some tissue,” I said as I thought about the situation. Where before I had seen a loud, belligerent woman deliberately causing trouble, I now saw a daddy’s girl, terrified and fighting to make sure he got the best possible care. I immediately thought of how I would feel if it were my typically jovial father, plagued by multiple medical problems, stuck in an ICU, looking and acting unlike himself.
I now understood her frustration – she thought that we had been ignoring her for hours, simply forgetting to give her father his home medications. In reality, we had not forgotten him, but simply had to prioritize. Just a few hours prior, most of the ICU staff had been attending to a patient who needed chest compressions to save his life in the room two doors down. After that, I had personally run down the hallway to stop a sick patient from trying to leave the hospital against medical advice. After that, I had noticed that this patient’s blood pressure was higher than we wanted, examined him briefly, and simply prescribed him a stronger medication than the one he took at home to get his pressure down a little faster. The plan was to re-start all of his home medications in the morning. The problem wasn’t that we weren’t doing our best to give the patient excellent care, the problem was that none of this had been communicated to the patient and his family.
I handed the patient’s daughter a tissue and looked her squarely in her eye. “I am so sorry that you felt ignored. I should have come back into the room to give you an update on the treatment plan, but things got very busy. However, that’s no excuse for not communicating with you, and again, I truly apologize.”
The patient’s daughter sobbed softly for another moment, then sniffled and looked up at me, resigned.
I turned towards the patient. “Daddy’s girl?” I asked, with a small smile.
“Yeah, she takes good care of me,” the patient said proudly.
“I’m a daddy’s girl too,” I said towards the patient’s daughter. “I’m going to make sure we take excellent care of your father.”
“Fine,” she said, without any of the animosity that had previously infected her voice. “But please let me know if there are any additional changes to the plan.”
“I promise,” I said with another smile, before I left the room.
As I returned to my computer screen, I pondered this small victory. I was able to give better care to a patient simply because I had seen my own father in him, and seen myself in his daughter. This patient/family encounter was a great reminder: patients, their families, doctors and nurses alike are human, meaning that sometimes they behave rudely when they are scared, frustrated, or in pain. Often times, you can calm someone down by simply listening to them, understanding what they truly desire from the situation, and showing them kindness despite their bad behavior.
That’s one of the most beautiful things about medicine: seeing patients and their families in their most vulnerable times teaches me so much about humanity, and ultimately myself.