You Don’t Say: Knowing When to Just Listen to Patients, Families Trying to Cope

I knew it within the first moments of meeting her. As soon as she crossed her arms against her chest, rolled her eyes, and said, “You’re 2 minutes late.” I knew that nothing we said was likely to make a difference. Her mind was made up before we arrived. Meeting with us was an exercise in futility but one we had to undertake, like dotting the i’s and crossing the t’s, so to speak.

Mary Jane was the Guardian of the Galaxy with super hero powers to protect her sister. But she was mean. Cranky. Argumentative. I don’t like to be warned about difficult patients or families. I prefer to form my own impressions. But Mary Jane had a legend of a reputation. The history and physical for her sister included the following: “Patient’s sister Mary Jane is extremely confrontational.” No one could take her on and win. The truth was, in spite of what I heard or read about her I don’t think I would have liked her anyway. I know I’m not supposed to say that. I honestly tried to give her a chance, tried to look past her demeaning tone, past her outright verbal challenges — no one knows what they are doing in this hospital, if I weren’t here there’s no telling what would be missed. But her eye rolling did me in. It was the final insult. Truth is, I had a difficult time not taking it personally.

CASE

In spite of her negative energy and dismissive tone, Mary Jane had agreed to meet with us. The patient was confused and unable to participate. Although she consented to meet with us, she maintained her disagreeable attitude throughout our conversation. The first 10 minutes were spent with her disgorging the details of the many medical things she felt had not been done correctly. She wasn’t satisfied just complaining about the current hospitalization, she went far back in time, to encounters we had no part in.

Throughout her discourse she managed to incorporate personal verbal jabs: “I don’t trust anyone taking care of her. No one knows what they’re doing, including all of you.” “My sister isn’t in pain, it’s only that the nurses who work here are too stupid to figure out what she needs.” I watched her as she spoke, how she moved her hands in the air, how she shook her head with each statement. She upset me. We had so much to offer, if she would only let us. And her sister needed us, she really did. When she finally stopped talking, our palliative care physician started by reviewing the current situation.