Near the end of an interview: “I didn’t like you as soon as you walked through that door. I just don’t like you, I don’t know why.” A brief pause, and I reply “You don’t have to like me; I will do my best to treat you anyway.”
He had been sullenly difficult throughout our conversation, and a tiny part of me felt no sympathy for this nearly 400-lb man with so much coronary artery disease that he had no viable placements for stents. It was the end of my cardiology month, and I'd become jaded by the sheer number of morbidly obese patients with 30+ pack year smoking histories I’ve seen in my evaluations of acute coronary syndrome.
At that point, all I could do was complete the physical exam; I had silently agreed with his own assessment that there was nothing we could do for him. I half hoped he would leave AMA (against medical advice), as he had blithely told me: “I can just walk out any time.” I checked the charts and saw that he did indeed leave AMA during his last admission.
Several hours later, halfway through rounds, our attending got a page for this patient. “He left AMA, didn’t he?” I asked. “No, he’s having extreme bradycardia and has a lot of chest pain right now.” I warned her that the patient was not very pleasant.
To my surprise, the patient was in tears when we arrived. He apologized profusely to me “for being an asshole,” and I was very much taken aback. The attending, bemused, cut his apology short to explain to him that he needed a temporary pacemaker. Immediately. There was a back and forth between the attending and the patient’s wife, who said that the patient really did not want any more procedures but she thought he should have it. The attending looked expectantly at the patient.
To my surprise, he looked at me. “What do you think I should do?”
The attending started, “I think you should get a temporary -”
“No, what do YOU think?” He continued looking directly at me. “I want your opinion. I trust you.”
Flustered, I tried to muster a confident reply when I was really just parroting my attending’s words. He agreed to it.
I never expect patients to apologize to me for poor behavior; as a future psychiatrist, I have encountered abysmal behavior and I come to expect it whenever I steel myself to talk to a psych patient. I did not in the inpatient medicine setting, and I thought I had handled him poorly. His misplaced but genuine trust moved me, and it was humbling to talk to him afterwards when everyone had left. “You were kind to me when I didn’t deserve it,” he said.
It had only been a few weeks since I had started my cardiology rotation, and I was shocked to realize how quickly I had forgotten that patients are genuinely fearful when they think they are dying of a heart attack. It’s easy for me to casually look them over and write them off as atypical chest pain, stable for discharge from a cardiac standpoint, but it would’ve been equally easy to spend a minute to genuinely hear them out. For some reason, I take off my psychiatry hat when I’m on the medicine floors and focus only on their medical concerns. This rotation flew by, but I hope I’ll take his lesson with me when I’m back on the floors.
