Wow, I'm an asshole

We have all had our moments in life where we surprise ourselves with our own behavior and say, “Wow, I’m an asshole!”  I dare say that doctors may have more of these moments than other people.  Most of us get into this line of work to help people.  We all wrote application essays about our deep empathetic sentiments and benevolent ways.  We probably even honored a class related to “Humanism in Medicine” in medical school (because, yes- in medical school you receive a grade for everything from how much you know about the Krebs cycle to how good of a human you are.)  So appropriately, it comes as quite a surprise to us when we realize that, despite our best efforts and that “honors” on our transcripts, we have become total assholes.  

And there is nothing quite like working in the ER to bring out the asshole in you.  

It was 5 minutes before the end of my incredibly busy shift and things were actually just starting to look good.  I had survived, and my list of patients was shaping up so that I might leave within the next 30 minutes as long as no one else walked in over the next 5 minutes.  With two minutes remaining before the finish line, the new patient popped up on my list.  Chief complaint: SIX MONTHS of weight loss and intermittent abdominal pain- currently pain free.  My train of thought went something like this: “Expletive!  Expletive me! Expletive these expletive-ing patients! Seriously?  At 11:28 at night in the EMERGENCY room with your SIX MONTHS of symptoms that are now resolved?   Seriously.”  But alas, this is the job, and I haven’t left earlier than 2 hours late in over a month anyway so why start now?

  I dragged myself to the patient’s room dying under the weight of this large chip on my shoulder and started getting the patient’s story.  While he explained the intermittent belly pain that he had for six months, that he hadn’t felt in the past three days- all I could do was wait for him to get to the part that would explain why he had chosen tonight, of all nights, 2 minutes before I would have been home free, to finally get this checked out.  He never got there.   So when he was done speaking, I asked, with all of the tact I could muster in my current state of rage, “So...  Did something get worse today that made you decide to come to the ED?”  (Read: why are you doing this to me?)  It turns out that he had actually already seen a doctor for this very issue that morning.  The doctor had appropriately ordered some blood tests to be done and would see the patient later in the week to go over the results.  Turns out, a family member, who had not seen him in several months, visited and became very concerned with his symptoms and insisted that he seek medical attention.  When the primary care doctor did not provide immediate answers, they presented to the emergency department for a more “expedited” workup.  You can imagine my delight.  As much as I wanted to launch into a tyrade about how the emergency room is for emergencies and how anything that has been going on for six months without killing you yet is highly unlikely to be an emergency- this would be bad for PR and I honestly didn’t have the energy.  I figured I would throw him a bone and order some basic blood tests so that I could then discharge him when they inevitably came back normal and have him see his primary care doctor for the rest of this workup. I could be leaving within an hour.  I start to examine the patient as I explain the labs that we will order and the limitations of the emergency department to provide a complete diagnosis in many situations.  As I placed my hands on his abdomen for a cursory exam... “Oh shit.  I am a complete asshole.”  There was a huge, firm, irregular mass under my fingers right in the middle of his abdomen.  I knew immediately- this guy has cancer, and I’m an asshole.   

This is how life works.  As soon as I became too wrapped up in how hard MY night had been, here was this guy’s cancerous belly mass under my fingers to remind me that most of my patients were still having a worse night than I was.  I might be going home 3 hours late, but he was going home with a new cancer diagnosis.  Maybe this is why I think doctors have more of these shameful moments.  We do have a hard job and sacrifice a lot to do what we do like many people do, but we are also constantly surrounded by people that have it far worse than we do; pain, terminal illness, disabilities...  Even the most unsavory of our patients, the drug seekers, the borderline personalities, the needy and anxious, the drunks- I still wouldn’t want to be in their shoes. So all of those inevitable and simply human moments of frustration, exhaustion and self preservation that we experience tend to make us feel like...   well...  assholes.

(please note that details relating to this patient's story have been changed to preserve privacy)