A Fragile and Delicate thing

On the gen med floor, we take care of adults.  We get used to extensive questioning during intake histories, shared decision making for our care plans, daily updates of progress and explaining test results.

Ryan is definitely not our usual.  Because he can’t talk to us, we are forced to make do with reports from caregivers to understand when each symptom developed, to rely on numbers to figure out if what we are doing is making him better or worse.

His bedside staff has the most difficult job – even for folks who are skilled in the arts of cajoling, compromising and winning the trust of a person in pain.  But trust is a poor word for what allows our patients to let strangers do incredibly personal and invasive things to their body knowing they are acting in good faith.

Ryan’s trust is an incredibly fragile thing – gone in a moment, displaced by older and more primal emotions.  Worse, you only figure out the trust is gone when the shouting or hitting starts.

It’s hard to see scared through loud and unpredictable and not your usual.

“Careful, he likes to grab.”  Everyone was warned to hide badges, stethoscopes.   I adhered to the warnings, but forgot the necklace one day.

Tiny silver links with filigree crosses.   Long.  Long enough to grab easily, strong adult fingers wrapping around it in a moment.

The fact that I managed to lean in instead of jerking away is something I’m still grateful for.  To respond with gentle chiding “Ryan, you know that’s not nice” instead of raised voice or clipped tones.   I credit the amazing colleagues who taught me how to interact with folks whose brains work in ways different from what we’re used to.

Because when I leaned in, I saw the eyes of my two year old looking back at me.   The one who gets frustrated and bangs on a table because he can’t put words to “My world is ending because you gave me the green plate when I wanted the blue one”   The one who is morally obligated to do the opposite of what you tell them to do because testing boundaries is an appropriate developmental milestone.

And so I kept leaning in.  Held hands whenever I could.

It would have taken no effort for either of us to break that chain, to sever the attachment instead of deepening it.

The most rewarding breakthroughs I’ve made with my children, my patients, my residents were the times that I moved closer to the off-putting person or behavior instead of away.   It’s a leap of faith in a fellow human when you force yourself to get to the root of anger and see the hurt, guilt or fear.

 In this instance, we both took the leap.  We each had something to hang on to, as insubstantial and transient as that link was.

So now I have a tangible reminder of that moment, something to wear when I need to appreciate the fundamental truth of my practice.

Our test scores, our data, our outcomes and guidelines mean exactly squat without the connections we make.

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