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One of our nurses had an encounter with a patient today.  The patient was in custody, suicidal and very angry.  She called our nurse a ‘White Trash Bitch.’  She also said she hoped the nurse’s children would die. Nice.  Nurse A and I laughed it off, but I know it stung. Especially the part about her kids. Like most moms, she adores her children ‘to the moon and back.’  When she told me about it I congratulated her on her new title. WTB.  We laughed and moved on with our day.

I remember a patient at my first job out of residency.  He was a bad alcoholic.  He was in the ED weekly, asking for help for abdominal pain or for narcotics.  He threatened to kill all of us at one point or another.  Some days he was a delight.

This is life in medicine, especially emergency medicine.  But it’s also life…in life.  Life on earth. Life among human beings.  Life for centuries and millennia and ages past. Life in civilizations long gone.  Life in tribes.  Life in families.  Humans are hard cases.

Many times I’ll see online comments from my colleagues around the country who are shocked and scandalized when they see patients who are lewd, base, hateful, sexist, bigoted, racist, homophobic and all the rest.  And admittedly, it can be unpleasant.  But I think perhaps it’s especially disturbing when we come from a background of civility and gentility.  There’s a selection bias here, in a way.  Physicians and nurses are often raised in families that encourage education; by people who care for them.  (There are obviously exceptions and I mean no disrespect to anyone’s trials.)

We are frequently nurtured in an environment where it is expected that we show manners and proper respect for others.  Not only so, those traits are important to being accepted into professional training programs for physicians, PAs, nurses and nurse practitioners.  Open hostility, disdain for others, these things bubble to the top and it’s hard to hide them.

But more to the point, even as we think of America as a place of rampant hatred and cruelty, of systematic intolerance and oppression, the reality on the ground in much of the country is quite different.  In the heartland, in the ‘flyover’ country, people are often remarkably…nice.  Just nice.  And patient and kind.  And so, when people aren’t, and when they direct their venom at those of us who are stable and patient, then it can seem shocking.

I know this all too well. I was raised in a very devout Christian home. My grandparents were all devout.  And  my father was a pastor.  Profanity was, in our home, a little scandalous.  Divorces and affairs were the stuff of gossip.  Alcohol was nowhere to be found.  Drugs?  As if…

When I went off to medical school to learn to help and heal my fellow man (and woman), I was a bit of a wide-eyed innocent.  Medical school changed all that; and residency confirmed what I had already seen.  Because medicine immerses its disciples in the swamp of human life (and holds them under for about 7 to 12 years), then dries them off in the fires of human suffering…often their own.

Not everyone learns the lesson and it can be a shocking cognitive exercise to think of humans as all nice and sweet and kind, only to discover that they can be those things, as well as vile, murderous, abusive, cruel, hateful, vengeful, dishonest, manipulative and any number of other adjectives.

I’ll say this.  That experience of humanity, the one that continues every day of my life in emergency medicine, was one of the greatest things ever.  Coupled with my own several (and remarkable) character flaws and personal sins, I’ve come to a place where I’m not really shocked by people.  I’m sometimes offended, and often defensive of my co-workers.  But I am unscathed by the most impressive (and poetic) use of profanity.  I am nonplussed by any of a variety of sexual escapades as described by my patients.  I take their assorted substance abuses in stride, and with no small amount of technical curiosity.  ‘So you use crack for pain, but think weed is too strong.  Fascinating.’  I am still very disturbed when people harm or abuse the vulnerable; children and the elderly, the weak, anyone powerless.  But even still, I am not surprised.  I am just, maybe amazed is the right word.  Maybe saddened.

Of course, I now have to circle back to a question of Christian faith because it sustains me in my work.  Some people reject faith because they say humans are simply evidence that there’s too much evil in the world for God to be real, for belief to matter.  Years of working with humans has taken me in another direction.  The level of evil in the world suggests to me how very much people need to be loved in the midst of their cruelty, vengence, hatred, violence, addiction, abuse and all the rest.

The evil, the dangerous, these are not abberations. They are the ages old backdrop of human behavior and interaction!  The more fundamental reader can take it to the garden and the fall.  Others can say it’s all about survival and evolution. Some of us are squarely somewhere in the middle of all that.  Whatever.  But Christianity says to me, ‘go and help them.  Go and try to change them for Christ.  Go and show them redemption.’  It also reminds me that they won’t always like it or want it.  Or like or want me.

The Bible is crystal clear on this.  So maybe it’s why, despite being sheltered as a young person, I have no delusions about people.  I believe we’re all sinners in need of grace.   Maybe that’s why I’m not the least bit surprised that my nurse was called ‘white trash bitch.’  Because the one who called her that is wounded and hurting too.  And God loves both of them. Equally.  Talk about feeling conflicted!

The Great Commission of Jesus was ‘Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you.  And surely I am with you always, to the very end of the age.’  Matthew 28:  19-20.

What he said there, ‘all nations,’ also means all places. And it means all people.  It especially doesn’t mean, ‘the world is full of nice people so go and agree with them and sing songs.’  It means dive in.  The water is fetid.  And full of biting things.  But this is your pond.  It means, by implication, that there are people who need to be transformed.  Thus, there are icky, difficult people.

Physicians struggle with this because we think our educations and dedications make us better.  That’s false. We can be as mean, petty, ugly, cruel and (particularly) arrogant as anyone on earth.  We’re capable of every evil.

Christians, from nice Christian homes, also struggle with this.  Because we sometimes imagine that our outreach will be in heroic places where people will throng to our message and where we can have victories and come home to tell tear-filled stories of lives transformed. That sometimes happens. God is powerful.

But sometimes, the place he puts is a place where people aren’t interested in our ideas, hate our guts, just want another hit of heroin, are one conviction from life in prison, and where our only possible reach is a prayer for them across the room as they punch the wall and get handcuffed.

Sometimes, he puts us in places where we’re called names.  White Trash Bitch comes to mind.

That’s tough.  But it’s no surprise.  And if that’s the mission field at hand, then it is.

So deal with it people.  Humans aren’t nice.  But all of them, all of us, need our wounds bandaged, our mistakes forgotten, our sisn forgiven.

We have a long way to go.

Edwin