Wednesday, December 2, 2009

Big Stuff, Big Words

I have become quite good at reading people within the first few minutes of meeting them. It comes with the job, actually. Thirty patients (and their families) a shift and rest assured, after 16 years in the ER, I have been exposed to many different personalities. I am a poker player of sorts, keeping my personal feelings hidden behind my smile while I measure up the alpha male, the needy daughter, and the nosy neighbor, all begging for more attention than the actual patient.

With all the family dynamics swirling around a patient's room, it is important for me to swiftly figure out the who, what, when, where and how so that I can attend to the patient's illness. You would be amazed how just one person can affect the entire ER experience, either positively or negatively.

And in Room 12, that one person happened to be a father of two boy, ages 10 and 12.

I walked into the room to find the ten year-old boy lying on the treatment cot, his forearm bent in the shape of an "L", obviously broken. The nurse was starting an IV to give him some morphine. Sitting in the corner of the room was this patient's twelve year-old brother, his face tear-stained and agonized, looking as hurt if not more than his younger brother. Pacing nervously alongside the patient's cot was their father.

Nothing really too much out of the ordinary.

Except the tension in the room was explosive. Something wasn't adding up.

And then Dad opened his mouth to speak to the son in the corner and it all made sense.

"I hope you're happy, damn it. Just look at your brother's arm. What the hell is wrong with you?"

Whoa, back up here. As the nurse was starting the IV, she looked up in the middle of Dad's rant to give me "the look," a warning that all was not good in this room. I interrupted Dad to introduce myself.

Dad bit his tongue during the introduction, but as soon as I asked what happened, Dad jumped right back in where he left off.

"He's always causing problems...pain in my ass...doesn't care about anyone but himself..."

His rant against his older son continued and the more he spoke, the more his son's shoulders shook from silent sobbing. The younger son with the broken arm sat silent, his pained expression speaking volumes.

The story played out that the two brothers were in the front yard playing soccer. Soon after, bored from kicking the ball, they started tackling one another. It was then that the older brother tackled his younger brother and, in the midst of the tackle, broke his younger brother's arm.

An accident, pure and simple. I could see it, the nurse could see it, and I know as you read this you see it.

Dad didn't see it. And I was finding it difficult to give him some benefit of doubt during his family's stressful crisis.

After several more hurtful insults, I had had enough.

"Come outside into the hallway with me, Dad. We need to talk."

In the hallway, Dad tried to start all over again with how his older son was a "problem child" and always created conflict in their family, but I halted him. Rarely have I met a "problem child" that didn't have a "problem adult" in his life.

I took a deep breath, not wanting to be anything but professional during this conversation. Deep down, though, my insides were screaming. I wanted to grab this guy and shake him, make him take an outside look at what he was doing to his older son.

"Listen, sir, I understand you're upset. But you have the power to make this a better experience for both of your sons right now. As things stand, your words are only making the situation worse."

"But damn it, he's got..."

I stopped him. "I've heard you already. And so has the nurse. And so have both of your sons. What I am asking of you is to go back in the room, find something nice to say to your older son, and then sit on the cot with your younger son and help him get through this visit. I don't want any more negative talk from you while we help your family, okay?"

I stared at him and he was silent. "Okay?" I asked again, more loudly.

He shook his head yes.

We walked back into the room. I looked at Dad. He was ready to talk to the son in the corner.

"See," the father said, "now you got me in trouble. I hope you're happy with yourself."

I was shocked. And angry. And frustrated with this man who, I felt, was clearly not appreciating the blessings of having children.

He looked at my face and, for once, I failed to hide my emotions. He did not say another word while we fixed his son's fracture.

After successfully reducing the broken arm, we sent the younger son to X-Ray for post-reduction films. We had Dad accompany him. I hung back with the older son.

Over popsicles, we got better acquainted. He shared that his dad said "a lot of mean things" to him. Words "that hurt sometimes." He assured me, though, that this was the extent of his father's unkindness. "He treats me okay most of the time," he added.

"You know this isn't your fault, right?"

He thought I meant his brother's broken arm. "But it is. I shouldn't have tackled him so hard."

"No, but that's not your fault, either. Things like this happen between brothers. I'm talking about the angry words you hear from your dad. Some parents love their kids very much but just don't know how to pick the right words to tell them."

He nodded while he looked down at his sneakers. I continued. "I have no doubt that you are a good son and brother." We talked a few more minutes that culminated with a smile from him.

Dad had calmed down before his son was discharged. Prior to leaving, I had an instinct that he wanted to say something to me--something apologetic, by his expression. But he didn't. A part of me, though, could only hope that he had looked in the mirror and didn't like what he had seen.

The nurse planned to arrange follow-up with this family.

Sometimes, despite our best efforts and resources in the ER, life and fate will continue to play out the way they were destined to.

Darn it all.

Next post will be Friday, December 4. See you then...and hats off to the caring nurse who provided more than just good medical care for this family.


R. May said...

*sigh* some people shouldnt have children.

kudos for saying something! even in this day and age there is still too much looking the other way.

Rositta said...

You know I'm glad I don't do your job. I'm just an old cynic but by the time you got part way through your story I pegged the father as an abuser who was responsible for the broken arm. I thought he had his sons under such tight control that they covered for him. Like I said, good thing I don't do your job...ciao

Sheila said...

Bless your heart for dispensing the older 'uninjured' boy some 'good medicine' in your attention and words! Sometimes - often - the wounds no one sees are so much more painful than the visible ones.

rlbates said...

I continue to enjoy your storytelling. Thank you.

Jabulani said...

Stopped by here for the first time today via rlbates (thanks Ramona!). Will be returning on a regular basis.

As a governor at my children's school, I am often involved with the education-side of kids. The parents there are no better than the example this post mentioned. And some folks wonder why their kids don't do better at school. It's so true - education begins at home...sadly, in some cases.

SeaSpray said...

This causes me to wonder what his parenting was like. ?

I could say so very much hear..but.. what I will say is I don't know anything about you personally StorytellERdoc..but I do believe we are absolute kindred spirits in things like this. I truly would've done exactly the same thing and I hope you don't mind ..but you've inspired a post that I will either do soon ..or at some point. (They say emulation is the highest form of flattery ;), I just won't be as eloquent.

Thanks for sharing.

SeaSpray said...

You can delete this but just want to say .. I hope I didn't come across as not appreciating Mr SeaSpray when I said he's not Mr Christmas. (He's not:) and I really am not witchy, pmsyish..just obsessive with the lights and the other things are going on this year. i did leave a response comment. :)

Also ..can I call you a nickname Story? i was gonna call you StD.. but thought better of it. Any preferences?

Anonymous said...

You did handle the situation right. But let me say I've been on the side of the younger brother and lived family dynamic like this with a (then-as-yet-unknown) schizo-affective sibling. Sometimes it really is pretty much all their fault. That does not mean that dad's attitude was right, as that does nothing to improve the situation and can make things much worse. Just sayin' though - I can see it from both sides here if their's was a similar situation. Families and some members learn how to push hot buttoms fast. Otherwise I'd say it appeared that dad is an abuser, but you don't know that for sure.

AtYourCervix said...

Hopefully - fingers crossed here - the older boy will remember your kind words. Hopefully, those kind words will sink in and will overpower the angry, hurtful words that his father must be telling him on a daily basis.

Hopefully, you will have made a difference in that boy's life.

NYCRN said...

I am leary of reading doctor's blogs since i am an ER nurse myself. In your profile, you mention you are a writer and to that i say "Yes you are."

NYCRN said...

I am leary of reading doctor's blogs since i am an ER nurse myself. In your profile, you mention you are a writer and to that i say "Yes you are."

Bongi said...

well done. hats off to you. sometimes the peripheral things around a case are the things that really matter.

Maha said...

It was great how you carved out some time for the older boy as well - too often I see everyone rushed to treat the 'medical emergency at hand' and leave the rest. I can only hope the dad started to change his tone with the older son.

WrightStuff said...

I'm enjoying your blog Mr Storytelling Doctor. Your writing is so captivating. You must see all of life in its many forms on a daily basis - a rich source of material. After reading the Cheetos story, I had to laugh. My parents are the opposite end of the scale - they are too afraid of wasting medical time. That is why my mother's appendix burst (must have been some stomach ache) and Dad had 'indigestion' for 12 hours before it occurred to him to call a doctor and discover he was having a heart attack! Thankfully they are both still with us!

t. said...

I'm never at a loss for amazement when I see that "MD" also means social worker, confidante, sociologist, shoulder-to-cry-on; the list could go on and on.

Thanks for what you do.

Cal said...

The quality of your posts continues to be excellent. Thank you!

Anonymous said...

My thought is wondering how do you chart such an interaction that is equally important as the patient's concern? Isn't it just as valid to document the older brother's psychological affect for prevention of future re-evaluation. For example, the older brother happens to need care in the ER and his past experience is not indicated on the record, thus it is missed as a potential contributing factor to his accident/illness/injury.

Ambrosia Bierce (2014 AD) said...

I wonder where & how they all are, 4.5 years now gone.