Hitting a Wall

It's official. I got yelled at for the first time.

About a week into my intern residency, I was taking care of a very pleasant, complicated patient. Unfortunately, as we were getting ready to transfer our patient out to a rehabilitation facility, the wife of the patient became very insistent on getting a particular lab value to "normal" despite the patient being clinically improved. In medicine, we are taught to treat the clinical symptoms and etiologies, not the numbers. Understandably, the patient's wife was very apprehensive and protective because of past complications, and she became very unhappy when we proceeded with discharge plans is what I was told. 

Later in the day, I was contacted by the charge nurse that she needed me to call the wife since they couldn't safely transfer the patient out with the wife very uncomfortable with the process. What ensued was a tirade of angry accusations that we weren't caring for the patient, and we were terrible, uncaring for not even taking the time to understand the patient. 

Indignation, annoyance, frustration, sadness, and fear. Those were the emotions that came to the fore as I sat in my chair listening to the wife's patient yell at me. On an intellectual level, I understood that there was a difference in expectations between the two parties, and the wife was taking out her frustration and anxieties of her husband's illness on me. Emotionally, however, I felt hurt and shocked. I had done everything I could for the patient, and I even took extra time to print out results and explain details per the wife's request. I didn't know how to de-escalate the situation. And I felt like I was accused of something that I didn't do! 

Often, patient's families go through huge changes when the patient has been sick for a long time. The uncertainty and helplessness pushes them into a corner, leaving them clinging to the words of certain specialists. Sometimes, in the moment, that frustration needs to be released and targeted to someone. When the overall medical system has failed them, there needs to be a person to blame. In my unfortunate circumstance, I was the perfect candidate. 

Eventually, we compromised and repleted what the patient's wife wanted us to correct. Then, we sent the patient out as planned. The attending on our team mediated the situation and called up the wife to explain the situation.

What I learned from this experience is that no matter how well we do our jobs, we may still garner dissatisfaction and frustration. It comes from a place of hurt, and often, it's not personal. I've learned that even if I feel like I've done a lot, it may not be enough to the patient's eyes. And that's okay. That's what residency is for. To acquire those interpersonal skills as well as to broaden my fund of knowledge.

In the meantime, I dried my eyes and moved onto the next patient.