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Many years ago, I picked up a man having a heart attack. He had all the signs and symptoms of an MI. He told me that his blood pressure was lower than normal.I started to give him nitroglycerin. He started screaming at me, “Jesus fucking Christ! I told you my blood pressure was low, are you trying to fucking kill me? You’re a fucking idiot! I should have driven my self to the hospital! You fucking EMTs don’t know what you’re doing!”I called the medical control doctor, who told him that a blood pressure of 118/80 is not too low to give nitro, that if he valued his life, he would take not only the first dose of nitro, but the two that would follow, the aspirin, and accept the IV.We don’t run into too many patients like him, but I guarantee, if you are that patient, we will talk negatively about you, and you will probably have “combative, uncooperative, belligerent” or similar terms entered in your patient care report.In any job, a customer who is in your face, screaming obscenities is going to get discussed negatively.

I was working in ICU with a new graduate R.N. We both had assigned patients but her patients started to have complications. I went and checked her patient. He was in respiratory distress. She had hidden antibiotics in the trash that she forgot to give to the patient. He had a high fever and had extubated himself. I asked her what his temperature was at the start of shift and she had made up the VSs. (vital signs). She had not assessed the patient or even listened for breath sounds.This was a rural area with not the best of health care. We were working very short-staffed so there was no backup. To say the least, I was flipping out on the inside. I called his doctor and he refused to come in and help the patient.I ordered a chest x-ray even though he said no. The x-ray revealed that the patient had extubated himself and I called the doctor back and told him. He still refused to come in and told me I was in trouble for ordering the x-ray.Meanwhile, the RN whose patient I was taking care of had no idea what she was doing. I called our emergency room and explained to the doctor someone had to re-intubate her patient. The doctor came and took care of that crisis. I reported the nurse to the DON and she was discharged for her inappropriate patient care.The doctor who was responsible for the patient reported me to administration. He had to explain it all to the administrator. I was not reprimanded as the doctor had hoped. The medical director wrote a standing order that anytime a nurse suspected there was a problem she could order an x-ray. The doctor later lost his license a couple years after that incident and went to prison.That was a night from hell. I am grateful that all the patients under that nurse and doctor’s care lived through the night.

Yes, in the 1980s, when a neurosurgeon examined me for persistent pain and a buzzing sensation along the length of my right arm. He diagnosed it as ulnar neuropathy and recommended a surgical fix. Fearing that surgery on the nerves of my right arm was a big deal, I got scared off and hesitated to accept his treatment plan.I ordered up my records and sought a second opinion. The doc had written at the conclusion of the report, “PATIENT RESISTANT TO SURGERY.”I felt the sting of judgment implicit in that phrase. Maybe I would be sorry one day for my rogue behavior.Fortunately, someone I knew had a connection with the physician on call for the Boston Symphony Orchestra. Maybe my problem resembled what happens with violinists whose arms are essential to their musical careers.I met with the doctor, an older man with a patient demeanor. During our lengthy discussion in attempting to discover the cause of my malady, he asked me if I talked a lot on the telephone.Um, yeah, practically all day, on the land line at my law office. Why?And Mrs.Levine, do you hold the phone up to your ear with your right hand?And do you place your elbow on the desk?Yes, all the time.Maybe I wasn't a violinist, but years of assuming this bent elbow position as part of my own vocation had seriously stressed the area.The prescription—stop doing that! Get a telephone with a speaker.He did write a scrip for a fiberglass mold of my arm to wear under my blouse during the daytime and also while sleeping. It felt soooo good to place my arm in the bionic mold and not bend it. After three months, I was “cured” and never had a relapse.It’s not so much that the notation in my medical notes shocked me. But I felt “branded” as a recalcitrant individual and created doubt in my mind, that I was behaving like a disobedient child as well as against my best interests. Couldn’t he have said instead, “Patient exploring non-surgical options?”But that changed quickly when a mature practitioner listened carefully and applied his common sense and experience in practical language. Maybe not a glamorous or profitable recommendation, but an effective one.As Aretha Franklin says, R-E-S-P-E-C-T.Photo courtesy of Pixabay