OK, it happened a while back, but it’s still a fun story!

I’LL EAT YOUR HEAD, AND I MEAN IT!

Storming into the emergency department, one of the physicians on staff at our hospital held his hands out as if asking a question, then launched into a series of angry accusations directed at me.  Next, in his excellent but slightly accented English, he proclaimed “When I see your face in my mind today, I want to swallow your head!”  Swallow my head?  I’ve been threatened before.  You know, the standard “I know where you live and I’m going to kill you”, or the more mundane “You’ll hear from my lawyer”.  These were from patients. I expect them to threaten me.  But I can’t ever remember hearing anything quite like this from a fellow physician.  And frankly, my head isn’t that small.

It all stemmed from an interaction the night before that turned out badly in the light of day.  You know how it goes.  I think a patient should be cared for one way, the consultant doesn’t.   Looking back, I probably could have handled it differently.  If I had, I could have allowed my fellow staff member to avoid the frustration of what I can only assume is a failure of the English language to describe something very clearly understood in his native tongue.  But disagreements and conflicts happen.  And sometimes, someone just wants to swallow your head.

I hate conflict.  I always have.  I don’t like to yell or argue with anyone.  Not with my children, not with my wife, not with my parents and certainly not with my fellow physicians.  Arguments make my muscles quiver and my stomach shake.  They rob me of my ability to say anything witty or urbane.  They leave me saying things like, “fine” or “whatever”.  The sort of things that angry teenagers say to parents.

On the other hand, even at my worst, I don’t plunge into screaming tirades or break innocent, inanimate objects.  I don’t go home and pace or write angry letters.   Occasionally I fall back on the well-entrenched passive aggression that I learned from my family down the years.  Generally, I simply let conflict go when I leave for home.

But this conflict was different.  This whole “head swallowing” thing actually made me mad.  I felt testosterone surge through my body, resulting in a sort of terrible serenity.  And so, when my sparring partner explained for a second time that he wanted to consume my cranium, I responded more like a South Carolina redneck than a professional.  “Do we need to take this to the parking lot?”  Did I really say that?  Did I really respond to a professional conflict like a drunken college student on Saturday night?  Yep, I really did.

Now mind you, I’m telling all of this as a sort of confession.  I’m not proud that I said it.  Looking back, I seem to recall that a number of nurses stopped what they were doing and looked around about the time those words came out of my lips.  Of course, they had been looking obliquely at the whole thing for the 30 minutes or so that it dragged on.  They knew that my head was in danger of being digested.   They just didn’t expect me to counter the gracious offer of consumption with my own offer of a roll around the asphalt.  I think I was feeling anger because I didn’t believe I was entirely in the wrong, and also because I had been awake all night, so that my inner control mechanisms were off-line.

Truthfully, I didn’t really mean it.  But when someone twice, in one loud conversation, offers to digest your calvarium, it starts to sound serious.  I think that saying “do you want to go to the parking lot” was kind of a distraction.  I think it surprised my colleague, who finally laughed in the midst of a tirade that would have made an auctioneer proud.  “No, No!”  He laughed again.  The nearest nurse seemed to breathe a sigh of relief.  Fortunately, we didn’t go to the parking lot.  We just stood there and kept yelling at each other.  Finally, it all cooled down.  I apologized for not handling things differently. He apologized too.  We shook hands, we miraculously stopped talking, and I ended the shift with my head still attached to my body.  I left town for the weekend soon after and spent several days feeling badly.  I hope that he and I can come to some sort of amicable working relationship from now on.  I think I may have to apologize again when I go back home and see him.  Even now, I’m haunted by my distaste for conflict.

Like every physician, I’ve had my share of battles.  I’ve been treated like a simpleton by an out of town Ob-gyn who wanted me to send his patient to him immediately so he could treat her reflux, when she was actually suffering from HELLP Syndrome.  I’ve been lectured on the necessity of ordering liver function tests on a schizophrenic patient before sending her to a psychiatric hospital.  Over the years I have been slyly insulted, openly insulted, talked down to and ignored.  I’ve had degrading conversations with sarcastic physicians and been treated like a hick by physicians at nearby tertiary care centers.   I guess it comes with the turf.

In the process of such treatments, I have expressed my anger a few other times.  I once told someone they should move out of our area and practice somewhere else if they didn’t want to take care of patients.  I think, in a minor flurry of “negative energy”,  that I asked a physician if he had actually gone to medical school.  I know that I occasionally slam down phones.  I offered to get a portable phone for a patient so that he could call his attorney, as he threatened he would, at 3:00 AM.  I could go on, but then no one would hire me if I ever needed another job.  I have never struck anyone in anger (not since 5th grade, and Mike was asking for it).  I have not, since residency, used profanity toward a patient.  (I was suffering from an unfortunate moral lapse that night in Indianapolis).  And I have never threatened a patient or staff member.  All in all, anger really isn’t a problem for me.

Unfortunately conflict is a problem for all of us.  Because somewhere along the line, physicians seem to learn that if you’re angry enough, then you can say whatever you want to another physician or to a nurse.  I hear stories.  Stories of screaming fits, stories of instruments thrown down, clipboards flung across rooms.  I hear stories of nurses left in tears, of doctors cursed thoroughly by other doctors.  I have never understood any of this, except to say that the way in which we deal with our anger reflects a great deal about our professionalism, but even more about our maturity.  My children throw tantrums sometimes.  My daughter, 2 1/2 years old, is an artist, and rage is her medium.  I expect it from her.  I have learned that ignoring her is the deepest cut, and usually ends her outbursts.  I guess ignoring some of the tantrums we see in hospitals may be the best tack as well.

I can’t imagine working in a place where such anger was commonplace.  I work in a community hospital and truly unpleasant encounters are unusual.  We live near each other.  Some of our kids go to school together.  We need one another professionally and socially.  Feuds, though they still occur, are generally impractical.  And fits of rage make the rounds in about two hours.  By the time I came back to work the day after my little “incident”, people were asking me “did you almost get into a fight?”  They all know me well enough to realize that I wouldn’t have gotten into a fight.  But just the thought made a good story.  And by now, it’s one that does not make me proud.  It does make me laugh, though, that someone might say, “that doctor Leap is a little bit crazy”.  After all, the night shift doctor needs that sort of publicity sometimes.

In the end it was a lesson to me.  It was several lessons, actually.  The first was that most conflicts can be pre-empted before they need to be resolved.  And as a physician, it’s my job to keep things moving calmly and smoothly for the sake of everyone.  I need to avoid unnecessary battles for the sake of the patients who need me, and also for the physicians who are just as tired and frustrated as I am.  The second lesson was that sometimes my indignation is actually righteous.  It isn’t wrong to stand for what I believe, as long as I’m willing, when the smoke clears, to accept that I might also have been wrong. And the third is that when someone threatens to eat part of your body, they generally don’t mean it.  I think.

Edwin

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