The Asshole

“Why are people assholes? Just need to get that off my chest.”
– Emergency physician on closed internet forum

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Stepping back from the stretcher, I used my sleeve to clear the sweat from my forehead and then strengthened the grip on my needle driver. My patient had been in a bar fight, and I only needed to place a few stitches to stop the bleeding from his scalp.  Unfortunately, that simple task had already stolen twenty minutes from my night and I had made no progress.

Taking a deep breath, I approached again, leading my needle to the anesthetized skin on the back of his head. Once again, he lifted his head off the stretcher.

“Dude, you have to stop moving.”

“I’m sorry,” he slurred drunkenly. 

“Sorry? You’ve said ‘sorry’ fifteen times already.  But you keep moving. STOP. MOVING.”

Hearing my raised voice, a nurse, Ron, stepped into the room to ask if I was okay.  “Yeah, this guy is…” I stopped myself.  Ron knowingly shook his head as he rolled his eyes. “Squad just brought in a chest pain to room 15.” Tossing the needle driver onto a table, I left the room to hear a paramedic tell the story of the 85-year-old male he had transported with crushing chest pain.

Hearing a “thank you” from the elderly man as I left his room, I returned, frustrated, to close the wound.  This patient didn’t appreciate me or respect my other, sicker patients that evening, and he was detracting me from their care.  It was no surprise that he had been in a bar fight. I haphazardly and aggressively threw in a few stitches – it wasn’t pretty, but he didn’t deserve anything better.  He’d lost his chance.  I flung my gloves in the trash and left the room annoyed.

Shortly after my patient returned from his CT scan, his fiancée entered the room.   He had only one drink at the bar and he never acted like this, she explained.  I told her he must have had more while she wasn’t looking, because he was clearly drunk.  She turned livid as she began to lecture him.  I remember smiling as I walked towards my computer to open the radiologist’s interpretation of his CT scan.

“Small subdural hematoma with scattered subarachnoid blood.  No midline shift.”  Bleeding in and around his brain was causing him to act that way. My smile vanished.

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Technically, I had provided my patient with sound medical treatment, but I had failed to care for him. He was a typical drunk and must have provoked an assault.  He was the guy who was intentionally ruining my night by moving despite my instruction, mocking me with his apologies.  He was the guy who lied to his girlfriend about how much he was drinking.

I was wrong about everything.  I was the guy who ignored his signals, mocked him, and lied to his girlfriend. He was the guy with the traumatic head injury. And I was the asshole.

It was not the first or last time reality would contradict my perception.  Earlier today, I was at a stoplight, and I turned my head to my right.  A woman, also stopped, was looking down at her cell phone.  I grew upset – why wasn’t she paying attention to the road?  How irresponsible.  My anger turned to laughter as I realized I had broken eye contact with my own phone to look at her.  We all tend to notice and judge others’ behaviors, while easily forgiving or ignoring our own.

I probably would have ignored this episode as well, except a memory remained fresh in my mind.  A week prior, Ron, the nurse from that night, had approached me after a difficult patient encounter.  “Dr. Sanjay, do you ever get mad?”  Smiling proudly, I told him there was a time in my life when my emotions would control me, but I had learned to recognize them and choose a better course of action.  With fresh embarrassment on this night, I told Ron he was wrong about me and I explained what had happened.  “It was a natural response. You had no other choice,” was his answer.  I was placed in an uncomfortable, difficult situation, where it was impossible to be my best self.

If I had to choose words to describe an emergency department, uncomfortable and difficult would top the list. I remember the maelstrom of the trauma center during med school – I knew a lot about what was happening, and it was still scary. As if the inherent discomfort of their illness was not enough, our patients face the added discomfort of new people, new places, new procedures every time they come to the emergency department. How can we expect anything but a “natural response?” We can’t expect them to be at their best. If we do, we are guaranteed to be disappointed.

I am not perfect, but I am focused on improving. In healthcare and life, perhaps a better question to ask than “why are people assholes” would be “why is this person being an asshole right now?” Looking for and listening to the answer will undoubtedly help our sanity. And if there are no answers, try being creative and forgiving with a potential explanation – the world becomes a better place. I could only assume that the girl next to me at the stoplight today had lost her dog to illness two years ago, and had just received an email that she was accepted to a prestigious veterinary school in California.

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“There is so much good in the worst of us, and so much bad in the best of us, that it ill behooves any of us to find fault with the rest of us.”
– James Truslow Adams