What I learnt this week: Understanding the patients who may make you angry #WILTW

This is the 44th #WILTW

“I couldn’t see my next patient after we had stopped resuscitating a dead-on-arrival four month old. It wasn’t because I was too upset, too emotionally drained or too busy. It wasn’t even because I had to clean up the resus room; persistently re-tidying the cannula tray because it gives you something to do to switch off from the parents crying. 

It was because I was angry.

I had actually been seeing the fourteen year old with “appendicitis” before the priority one call came over the Emergency Department loudspeaker. I’d taken a history and examined the boy brought in by his worried mother. I had explained he didn’t have a compatible history, didn’t have a fever and didn’t have any right iliac fossa tenderness. I had been patient when mum explained that he had a huge pain threshold. I had been sympathetic that he had ‘always’ only ever opened his bowels every four days. I had compassionately discussed that the mass of stool in the left side of his abdomen showed he needed some kind of laxative. His Mother got angry with me saying that he ‘must’ have appendicitis and what kind of Doctor was I to diagnose constipation in a teenager! I demand to see a surgeon, she said, “They know what they are talking about.”

The priority call went off then and I made my apologies. 

The unfortunate child arrived moments later in the resus room. Found in his cot he was white, pulseless but not yet stiff. In front of his hysterical mother we performed the necessary resuscitative measures. The room was silent save for the voices of those asking how long the child had been in the department? How many rounds of adrenaline had we used? And a whispered, “ When are we going to stop?”. With mother’s consent we ceased resuscitating and left the parents, father only arriving from work seconds earlier, to grieve an unimaginable loss.

I am not sure if I felt their pain, I hope I never will, but I did feel sick. All I could see was a furious mother looking as if I had cursed her child with the words, “constipation”. I was angry that she wanted her child to have a severe illness not just a socially unacceptable inconvenience. Who is she to want her child to have the risk of anaesthetic, surgery, infective complications when the parents of the other child would have given anything that morning to have a child, albeit one with constipation?

The mother of the the child said thank you too me. Whether the mother of the teenager said thank you to the surgeon who discharged him with a diagnosis of constipation, I am not sure. Am I too harsh on a parent who probably devotedly cares for her son or justifiably perturbed at a society that doesn’t see the real picture? In the cold light of day I see the overreaction in my thinking but hope I will never wish a diagnosis on anyone ever again.

I wrote the above as part of a reflection in 2005. The experience, subtly altered to protect confidentiality has always remained with me. This week as part of a Consultant CPD session we discussed a paper by Alys Cole-King on Compassion. Compassion has become a buzzword in the NHS. I hope that this doesn’t devalue its meaning – the paper I think brilliantly explains how compassion is more than than just a singular approach but a set values which go beyond simply being kind. The paper discusses the attributes of compassion: Sensitivity, Sympathy, Distress Tolerance, Empathy, Care for Wellbeing and Non-judgment. The last, Non-judgment, defined as:

Not judging a persons pain or distress, but simply validating their experience. Compassion involves also being non-judgemental in the sense of not condemning. 

I have always considered myself compassionate but do I deliver of compassion? Since those events in 2005 I have endeavoured to question my emotional responses to the families that I see. This paper reminded me of the constant need, however busy, whatever circumstance, to continue to do this.

What have you learnt this week? #WILTW

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