She was a very tiny lady, eighty pounds soaking wet if that. Her fine gray hair was pulled back in a proper bun, her makeup soft and almost non-detectable from a distance. She wore her clothes, obviously expensive but weathered and frayed, in that haphazard way that the once wealthy do. Eighty years old, she had been seeing me for a decade. I had watched her age as she had me, and we laughed and joked about it sometimes.
“You’ll come in to see me one day, and because of your advancing dementia you won’t even remember who I am,” I quipped. “But it won’t matter,” she shot back, “because with your macular degeneration you won’t be able to see my face well enough to tell that it’s me anyway!”
(Before you start to worry, I had had a brief diagnosis of macular degeneration years ago which turned out to be incorrect, but this was very funny in context during that exchange.)
She had long since stopped working as a piano teacher, something she loved to do for years. She lived alone now, dabbling in music still, with some reading and out-the-window gazing filling the rest of her time. She did indeed have an advancing degree of cognitive dysfunction, that was no joke, and it obviously bothered her. I could see some of the telltale signs that this was getting worse, but this visit was different. Something had happened. We continued our small talk a few minutes more, and then I asked my usual questions. Had anything major happened in her life since the last tine I saw her six months before?
There was a flash of red-gold in her eyes that I had never seen before. Her face seemed to contort, the corners of her mouth pulling down as her eyes narrowed. She leaned forward, an uncharacteristic sneer beginning to form, and she almost whispered. “They should never have done that to me, the sons of bitches. They should NEVER have treated me that way, do you hear me?”
I was flabbergasted. I had never heard her utter one single word of profanity in ten years. She was a proper southern lady, through and through.
‘What?” I managed to get out. “What happened?”
Her face reddened, her breathing quickened, and she leaned towards me from across the desk, placing me square in the middle of her emotional gun sights though I did not have a clue why she was so angry. She settled back into the chair, folding her hands, clutching a small plastic bag of her medication bottles. Her voice quickly changed to a soft, let-me-tell-you-a-story whisper. I leaned forward, still typing on my laptop, as one does nowadays, trying to capture this moment in my notes.
“I had a little chest pain. You know I have that from time to time.”
“Yes, ma’am.”
“I waited for it to pass, but it didn’t, and I started to worry. I decided to call 911 for help. “
Soft click of fingers on keys, nothing else from me.
“Only took the ambulance about ten minutes to get there. You know I live right around the corner from the police substation. “
“Yes, ma’am.”
“They came in and assessed me, took my vitals, all that stuff and they said I needed to go to the emergency room. My blood pressure was dangerously high and they thought that I was in danger of having a stroke. Well, it all went okay until I got to that GOD DAMN EMERGENCY ROOM.”
She sprang from her chair, I reflexively sat back in mine, and her eyes were flashing again.
“They got me in there on a gurney, stripped me of all my clothes, STRIPPED ME, DO YOU HEAR ME, an eighty year old woman, and they TORE MY CLOTHES OFF OF ME, and then they started poking and prodding and sticking me with needles. I have never been so humiliated in my life. They did not put the rails up on the gurney, I jerked one way, the bed went the other, and I fell onto the floor. Gown half on, half off, my NAKED ASS IN THE WIND. I have NEVER been so hurt and angry and embarrassed.”
“Oh, my,” I said weakly.
She came closer to the desk, then backed toward the chair again, then raised her right arm and hurled the bag of medication bottles across the room onto the floor. Brightly colored pills danced inside the clear plastic bag.
“I WILL SUE THEM, EVERY GODDAMNED ONE OF THEM. I will sue the ambulance for taking me to that place. I will sue the ER. THEY HAD NO RIGHT, NO RIGHT, do you hear me? I have NEVER in my life been treated that way. “
She was breathing harder now, red-faced, sweating, bobbing and weaving and swaying in the chair. I was truly fearful for her physical safety, as well as my own, even though I tipped the scales at more than twice her weight. Then just as suddenly, her wrath was headed my way again, She stared at me, pointing one delicate but determined finger right at me.
“You will do something to fix this, to help me. You will fix this anger, you will make me better than this, because if you do not, I will GODDAMN WELL go somewhere else and see someone else WHO WILL? DO YOU UNDERSTAND ME? She was screaming at me now.
Training kicks in at times like these. I could not only hear the screaming and see the anger in her eyes, I could feel it. Powerfully. Menacingly. Frighteningly. Stop typing. Head down, avert eyes, no direct or challenging eye contact. Try to deescalate. No physical contact. Assess potential exits for both you and the patient. Get up and leave if needed.
In just that small interval of time that it took me to run through that checklist in my head, it was over. She smoothed her hair, a few wisps of which had fallen over her right eye, smoothed her dress, then got up and picked up the little baggie of pills.
“I am sorry I am so angry, but this incident has shaken me to my core,” she said, through clenched white teeth. You must help me. Tell me what we can do to make this better, please.”
Still internally shaken myself, still feeling the tiny aftershocks from being the target of such raw and savage anger, even if misplaced onto me from elsewhere, I regrouped. I liked this patient very much. She was hurting like I had never seen her hurt before.
We discussed her counseling, her medications, other things that we could do to try our best to make sure that this never happened again. Our time was up, and I rose. She rose. We walked down the long hallway toward the front lobby, then reached the doorway to the front desk. She turned to me, a weak not-quite smile on her lips.
“Thank you for seeing me today. I hope you and your family have a very nice weekend.” And she was gone.
I walked back to my office, and on the way saw nursing and crisis staff coming toward me.
“Are you okay? We heard the loud voice and the screaming and….”
“I’m fine, thanks,” I said, “thanks for checking on me.”
I walked into my office. I closed the door, sat down, finished my visit note, took a deep breath, and regrouped.
My next patient was in the lobby. It was going to be a busy morning,