trauma based care

i was just thinking about some things i've seen on social media: white people complaining about being called racists, the apparent "resurgence" of the KKK and neo-nazis, the accusation that the BLM movement is the "same thing."  wondering how it all came to this.

this week i took care of a 90 year old patient who was diagnosed with cancer for the third time.  his family wanted everything done, and then proceeded to verbally shit all over the physicians, nurses, case managers, and social workers involved in his care. they were hostile, pugnacious, and even arguing amongst each other.

i think i get it.  it was really hard to take.  you do what you do hoping to make a positive difference.  all of us are doing our best, navigating a broken system, to provide health for our communities, because we believe it is the right thing to do.  we lose sleep, lose touch with our loved ones, get behind on self-care and life in general, because we believe in it so strongly.  and then to turn  around and get that kind of treatment from the people you are trying to help -- that is difficult to bear.

but, i'm beginning to realize, the moment you make this about yourself, and not the person at hand...you've completely missed the boat.

i have no idea what kind of experiences have led this family to this point today.  poverty, emotional and physical trauma, here, abroad, access to care....i have no idea.  and even if one of them calmed down enough to talk to me, and even if i had the time to listen, i would still have no idea, never truly understand.

that doesn't mean i stop being their physician, and just dump the case. we all keep trying, morning into afternoon into evening into morning, putting on a pleasant face, providing constructive data and options even though we know they will all get shot down immediately.  because there is no other alternative.  because we have to keep trying to work as a team. or things will never get better.

i took care of a 60-year-old woman who was found down in the field and near death from DKA. as she came to and an entire team of people began to piece together her history, it because apparently she had a history of psychiatric illness, polysubstance abuse, and was in a poor/dangerous social situation.  as she became stable and more with it, as part of a cognition evaluation i half-jokingly asked her if she knew who the president was.  "Trump, and i'm glad i voted for him," she said with a smile.

of course, inside i raged, because it was so easy to take personal offense to this.  a person for whom it is become more apparent by the day that she is reliant on public resources, proud to defend a man who is by all accounts a sociopath.  a man who poses a danger to the very systems she relies on just to live her life.  but of course, i have no idea what she's been through to make her feel this way.  our systems ARE fundamentally flawed.  i've heard the struggles first-hand from the patients i took care of through the county clinic during residency, patients who despite living similar traumas are thoughtful, decent, and making the "right" decisions about their health and well-being.... and are still struggling.  the minute i made this about myself, about my own opinions about politics, my own judgements of this woman's life choices, i was blinded by indignant hatred for this lady.  and that is not helpful.

when i see some of my dear acquaintances on social media become consumed with their own outrage, despondence, depression about what is going on in this country, unfriending/unfollowing every dissenting opinion, i get it.  i want to do the same thing.  but, to what end?  to take those feelings and turn around and channel them into hostility towards another, what will that accomplish? we have to work as a team.  or things will never get better.