The train wreck of last week's confirmation hearings is reminiscent of routinely experienced dysfunction in medical practice.
It was an absurd opening day for America watching the circus that was Judge Brett Kavanaugh’s confirmation hearing to become the next justice for the Supreme Court. The train wreck vacillated between grandstanding political theatrics to random, combative outbursts to strange and inaudible shouts related and completely unrelated to the topic at hand – with reports of seventy arrests. As bizarre as the events seemed to most given the context, it reminded me of the vast dysfunction - and humanity - routinely experienced in the practice of medicine.
America just witnessed a day in the life of many medical professionals.
From what has been reported, Judge Kavanaugh’s unfazed expression after hours upon hours of not speaking and enduring the surrounding chaos reflected his measured temperament by some or the product of rigorous mock hearing preparation by others - depending on which side of the aisle they align. No, it is not lost on me the significance and high stakes of such a hearing, especially for those in opposition. But, that’s delving into the mire of the politics of it all which is not the subject I will be addressing.
Any true professional, particularly within medicine, takes out the emotion, mutes the background of often endless distractions and is laser-focused on rapidly identifying and solving the problem. The priority is diagnosing and treating the patient, assuaging their fears and building a trusted, respectful, therapeutic relationship - everything else is extra, to be managed as required. In healthcare especially, this is the resultant goal of the boot camp-like training of residency and fellowships. This is what it means to be a doctor. Kind or nasty, member of the clergy or a convicted criminal, the identity or personality of the patient will not impede the high standard of care delivered by the physician. No matter who you are, how you behave or your location (e.g. airplane, street corner, exam room), excellence in your medical care will be steadfastly attempted and, hopefully, achieved.
People are messy and complicated. There is not one uniform reaction to stress, self-induced, justified or otherwise. Those in possession of their faculties can act as out-of-control if not more than those profoundly impaired. The threshold is the variable and unexpected circumstances can trigger how much it moves. Add sparring families into the mix, the compounding factors of advanced disease or unexpected acute illness, financial woes, recent job loss or a new devastating diagnosis let alone the physical discomfort and vulnerability of it all and it is the perfect storm. Remaining calm as a patient is a challenging task for most of us. The degree of distress can ping-pong in extremes for even the most mild-mannered of individuals.
Consider the emergency room. What haven’t we seen is probably more interesting a question, than what we have. Here are some of the more mundane examples: dodging thrown body fluids, combative and aggressive patients under the influence, others disrobing while wandering halls and performing public masturbation, marital conflict from discovery of affairs (even surprising paternity situations) due to the medical events that brought them in, reviving babies delivered in toilets to parking lots, or removing various foreign objects deliberately to accidentally placed in or through any part or aspect of the body. People are often screaming out of anger for their predicament to writhing in pain or yelling out of annoyance at the perceived loss of control a disease and medical scenario can elicit.
All of it, every single spectrum of the emotional life of the patient gets directed to the health providers responsible for their care, or even the ones adjacent to or in close proximity of it. They are treated constantly with grace, joy, gratitude and appreciation by the countless wonderful population that likely amounts to the vast majority. But, it is the irate, abusive and often toxic minority that tends to imprint in the memory. Fortunately, many of those cases can morph into more serene interactions once inciting events are dealt with and progress is made.
The emergency room isn’t the only medical setting on display for life’s emotional roller coasters. Hospital rooms, surgical suites and pediatric offices are not immune to the drama. Adversarial conditions arise when people demand unethical requests, steal supplies or fight with each other in waiting rooms or hallways, for instance. In pediatrics, for example, during periods of dissolution of families where vitriolic, reactive behavior is born out of hatred of a spouse often trumping the love for a child, messy is an understatement. Denial is quite a powerful coping mechanism. Parents aggressively saying or screaming horrendous things to or about one another in front of the child while insisting they aren’t is, sadly, all too common and pays very poor dividends.
While Judge Kavanaugh’s manner was that of the consummate professional, he is not alone in tolerating, at times withstanding, bedlam in his work environment. Though a likely one-off protracted episode for him, such circumstances, depending on the chosen discipline, occur sporadically to consistently to daily for those in the medical field.