Tuesday, July 13, 2010

Ten Frowns and One Smile

Lately, I have noticed that I don't seem to be all that affected by grumpiness. And this place where I am sitting, immune to another's bad mood, seems to be a very good place to be.

I think as humans, we all go through phases where another fellow being's mood can affect us profoundly. In the ER, especially, the spectrum of moods can vary from unbridled elation to haunting despair. Between the staff, the patients, and their support systems, emotional investments can change on the dime. Another's pain can become your pain, another's happiness your happiness. And, whether we want it to or not, another's foul mood can run rampant among us, it's contagious, sticky fingers grabbing on to us and not letting go.

Sometimes, if we are lucky, the foul mood may slink right off us, heaping itself into a useless pile on the ground. A pile we can kick out of the way or, at a minimum, step over and continue on our way.

Typically, I am an upbeat guy. And recently, despite a crazy work schedule and my daughter heading to Australia and the death of a beloved aunt, I still feel good. Even more so than I would expect. It's hard to beat me down. Maybe it's attitude. Maybe it's being overworked and sleep-deprived to the point where the little shit stays little. Maybe it's getting frequent reminders of compassion and kindness by my fellow man. Maybe it's the sunshine. I don't know, really. What I do know, though, is that I am currently being buffered by all that is negative and I wish I held the secret as to why. Bottle it right up and ship it to the store shelf.

Recently, in the midst of yet another crazy, fast-paced shift in the ER, I felt like maybe I had found the answer. What was it? Simply that my fuel tank could be filled with one, and only one, high octane smile.

That day in the ER, the collective mood of the patients seemed to be that of anger, draped by the curtains of bitterness and frustration. No matter where I looked, I was greeted with the tortured faces of waiting patients. Smiling, it seemed, had been banned. Cots lined the hallways, waiting chairs were filled, and family members paced the hallway as if encouraging us to step into their treatment room. Of course, I'm sure waiting four hours to be seen played some small part. Some of the staff had, unfortunately, been affected by this cloud of misery. Others among us, despite the glaring looks and several obnoxious, open remarks by waiting patients and their families, continued to smile and diligently go forward with providing care.

I walked into Room 20 to see my next patient, a tall fellow in his retirement years, returning to the ER for a second visit in three days. Following one of my partner's discharge instructions, he had returned for worsening abdominal pain. "You're going to like this guy, Jim," his nurse had told me in the nurses' station just minutes earlier.

Walking into the room, I immediately sensed what the nurse had hinted at. I was greeted by the patient's huge heartfelt smile, despite him stoically gripping his abdomen (from pain, I presumed). His wife, sitting in the corner, wore a smile that matched that of her husband's. "Hello, doctor," they both said with a nod of their heads as I introduced myself, "thank you for seeing us." Their appreciation appeared genuine.

The patient, despite his own four hour wait and discomfort, was very gracious in his demeanor. "Doctor," he continued, "I didn't want to come back, but the pain seems to be getting worse. I know you have sicker people than me to deal with, but I appreciate you taking your time to treat me." How can you not like someone like this?

He recapped his abdominal pain complaints for me, from when it started to the present. It was apparent that he was probably having a worsening exacerbation of his diverticulitis. After an exam, we ordered the appropriate tests, including a CT scan of his abdomen. We gave him IV fluids and IV antibiotics as well as some pain medication.

Waiting for the results, with a backlog of filled-rooms and no place to put new patients, I used my rare, spare minutes to recheck several of my patients, saving this patient for last. Finally, walking back into the room, I was greeted with the same big smiles. Although the patient's smile may have been a touch loopier than his last one (from the morphine-derivative), his wife's smile was just as genuine as previously. And contagious. I couldn't help but smile back.

"How can you still be smiling with all that's going on out there?" the wife asked me. I explained that it was much easier to return a smile and kindness when it is shared with you. "Well," she continued, "I hope my son knows how to smile when he is having a day like this, too."

"What does your son do, maam?" I asked.

"Oh, he's an ER physician in Alabama. I can only hope," she continued, "that we raised him right and he remembers to smile when he is having a chaotic day. It's funny, but whenever I picture him working, it's always in a slow-paced, clean, brightly-lit ER. Not anything like the day your ER seems to be having today."

I assured her that, for the most part, our days are not typically this chaotic. And, I thought to myself, if smiles were genetic, then there was no way in hell that this couple's son would do anything but smile when facing a stressful day.

I talked a few minutes longer with the both of them, filling up my energy tank off their smiles and good-naturedness. Prior to excusing myself from their company, the husband briefly dozed off. Remarkably, he was still smiling in his sleep. "How the heck does he do that?" I asked his wife.

She shook her head and laughed. "He smiles all the time. If he isn't smiling, something is seriously wrong. His calm nature and smiles are the reason I said "yes" to him forty years ago." I thought back to how he had greeted me, despite having obvious pain, with that big smile of his.

As I walked out of their room, I looked up the hallway. Scowling faces greeted me in the waiting chairs. I looked down the hallway. Scowling faces greeted me from the cots lining the wall. I looked intently at the face of the nurse passing me as I stepped into the hallway. Her frustrations were obvious. I turned and looked back into the room I had just stepped out of. The patient was still napping. And still smiling. His wife was watching me watching her, a small wave of her hand accompanying her continued smile.

I smiled back. And I felt the needle of my gas tank pass "full".

What makes some people react to a situation with misery versus reacting with a smile and good energy? Eternal smilers, so to speak? Yes, I recognize that for some patients in the ER, the misery is understandable and situational and unique--whether from pain or frustration or impatience. Heck, even we get frustrated and impatient from the emergency department's flow, despite giving it our all. And yes, I know the answer to my question is not simple and is individual. I know the answer may be complex and multi-faceted. Even recently, though, at several local graduation parties, I was able to observe how happy, laughing, optimistic people tend to gravitate towards one another, while non-smiling, serious or pessimistic people tend to "sit at the same table".

Which table are you sitting at? And why? And are you happy with your seating arrangements?

Me? Well, you can give me ten frowns and one smile and, like Wonder Woman with her deflecting bracelets, the frowns will bounce off me. The smile, however, will be absorbed, internally feeding my soul.

Keep the ten frowns. And give me one big smile.

As always, big thanks for reading. Emma update--day 8 of 17 in Australia and loving every minute of it. Just jumped a plane from Sydney to Darwin where amazing wildlife and nature beckon her. Thank you to all who sent your well-wishes and prayers to Emma and our family. Next post will be Thursday or Friday...


radioactive girl said...

I am laughing because I just posted something about me always finding the funny in things and annoying people because they think I'm not taking things seriously enough.

In my opinion it is just as easy to smile as it is to frown and it feels much better too.

Empress Bee (of the High Sea) said...

i try to smile every day at someone. some days are easier than others. but i do have one question. if you had to wait in line for something for four hours (not even hurting or a loved one hurting) would you be smiling? maybe so. but it might not be easy! ha ha

smiles, bee

Kate said...

Sending you a smile from South Dakota.

Have Myelin? said...

Wow. This is difficult.

But things can and do go wrong in the ER. I was in Colorado and my daughter was in Texas. I don't know if I'd be smiling to be honest.

I knew my daughter was very ill and no one was paying attention. I think it was because they (ER) was overwhelmed that day.

My daughter was at ER for 9 hours waiting. Just waiting. I asked her to go outside and call 911 so she could be admitted that way. Would it have worked? I don't know. She refused. It was chaotic at the teaching hospital she was at.

ER was FULL of people with sniffles, kids needing stitches and the like. You know.

When she finally got in, she was admitted and it was very late at night.

Only 3-4 hours later she crashed... and was put on a ventilator. She went into multiple organ failure and died ten days later.

I want to return and scream. Not smile.

I do see your point. I do. But if I am ever in the ER with my son I will not be so patient...forgive me....

Heather said...

I want to be at your table too!

I had a professor who once told us to have empathy and not sympathy...he also told us that if we couldn't walk in to each and every patient's room and truly want to be there, we were choosing the wrong profession.

I'm smiling with you.

Katie said...

I will admit, I'm one of those pessimistic, frowning people. In the last year or so, I've become more aware of it and the words that leave my mouth. More recently, I've seen the ripples a smile makes and try to put one on when things aren't going so well.

Over the weekend, I was standing in the front row of a concert. The sun was beating down on my cowboy hat, the worship leader praising God twenty feet in front of me, and my arms were raised. I opened my eyes just long enough to see the photographer's lens pointed straight at me. I smiled (bigger?). God hit me. "Why are you only smiling because the camera's pointed at you? There are hundreds of people around, some of them watching you. Smile."

Glad to hear Emma's enjoying herself.
<>< Katie

Cal said...

I am an upbeat person who tends to smile a lot (in fact I just smiled at the woman who bumped into my car twice today; she was old and I felt bad for her), but I am extremely vulnerable to moods in the room. If someone is angry, upset, distant or whatever bad emotion is showing I pick it up immediately and it brings me right down too. I hate it, as it can make my life hard, especially when you have to work with chronically miserable or, worse, anxious and stressed people. So, I would be bad at your job... I am terrible at deflecting!
Hope you daughter is having a great time in Australia. It is brave of you guys to let her go, but she will appreciate it greatly and demonstrate doubled responsibility.

DrSnit said...

I am so glad you posted this! It is always a good wake up call to remember to be kind and generous with each other! I have many stories of times when people's smiles (or kind words) have bolstered me in some way... Thank you for sharing yours! Cheers!

MLee said...

lovely post, I smile all the time, yet my co-workers always think I am up to something, which most of the time I am:)it makes the day go by faster

coulrophobic agnostic said...

I was waiting for some horrible pancreatic cancer diagnosis. Thank god what he's got is treatable!

Kawaii-Ne said...

Hi Dr Grumpy!

Just wanted to say how lovely all of your posts are, i have been reading your blog for a while now and have loved every one of them. But what got me out of the closet today to post a comment was that i actually live right here in Darwin, Northern Territory, Australia! =D I had no idea that Emma's school trip would include a trip to the Top End (most people stick to down south) and was very excited to hear that she is now up here! I hope she has the time of her life while in Australia and enjoys my beautiful part of the world too =]

Heather said...

i'm a smiler. always. you wouldn't believe the things i've laughed about... well, given your job, you probably would... LOL but i came across a quote when asher was a baby, and i've clung to it ever since:

"oughtn't we to be prepared for the best, too? it's just as likely to happen as the worst." (LM Montgomery)

it gets me through just about anything. :) thanks for another great post!

Kawaii-Ne said...

Oops, SO sorry, Storytellerdoc, i had Dr Grumpy open on another page and got confused!! Im so sorry!! XD

Tanya said...

I'm glad you had a cheerful patient on an otherwise gloomy day. Your post reminds me of an incident that happened to me many years ago-I had a job that I truly hated, managing a small gas station. I was having a horrible day and I was truly miserable, until a car pulled in that was loaded with several kids laughing and playing in the car. Suddenly all their heads ducked down and when they came back up they were all wearing purple pom pom noses and dangling earrings! It still makes me laugh.

SeaSpray said...

I'm with you ..the eternal smiler.

It's my nature. Even when things are difficult.

My mentor was like that too. But she told me once that some people don't trust people that always smile. Don't know if that's true ..but interesting.

Great ..uplifting post.

You made me smile.,, even right now ..smiling. :)

Karen said...

I always sit at the smiley table :)

sunseasurf said...

every happy family is alike, every unhappy family is miserable in it's own way... tolstoy.