I. Saw. Red.

Went home intoxicated, with a glimpse of sunlight already on the horizon. Only slept for two hours. Had to force myself out of my bed. My day wasn't starting out right. And from the moment that motorcycle hit my car from behind as I was on my way to work that morning, i knew it would be a horrible day. It just wouldn't be my day.

I know how irrational patients and their relatives can get in times of emergencies... or more often, in times that they mistake for emergencies. Back in 2004, the year of my clinical clerkship, I experienced first hand how a patient's relatives showered utmost hatred towards the medical staff when we failed to revive their relative. Expletives were shouted, and they had the look in their eyes that screamed murder. In times of grief and despair, people tend to become incapable of rational thought. That's human nature, I guess.

There are a number of times that I behaved unprofessionally while at work. I can't help it, so sue me. I work at a government hospital, and although I like the fact that the patients we encounter are those who really need our help, one drawback is that most of these patients and their relatives are uneducated, some may say even uncivilized. They can't understand simple instructions, and they fail to grasp simple reasoning. I'm aware of this fact, and often I can show patience. But the workload can sometimes limit the extent of how this patience can be stretched... especially when these patients don't treat you with the respect that you deserve, I can't help but to retaliate at times. Respect begets respect, one does not need fancy education to grasp such a simple concept.

Often, patients demand to be admitted at the hospital even when they have no basis for admission. They just think they need to be confined at the hospital because of the subjective symptoms that they feel. To be admitted just because you want to be admitted is acceptable at a private hospital, but not in a government hospital wherein we save beds for those who really need to be confined. Most the time all beds are full because the bulk of patients in the general population seek consult at government hospitals. It would be both foolish and impractical to admit patients because they want to. Or how about those patients who go to the emergency room to seek consult for such simple and benign illnesses that could obviously wait until the next day? Do they not understand the meaning of the word "emergency"? It's fine when there are only a few patients. But when we are dealing with a lot of patients, most of whom are really in emergency situations, these patients can really be a waste of time and manpower. And it even gets more irritating when they demand immediate attention, saying they were there first, even when the patient who came after them is already gasping for breath. At times I can't help but shout at these patients. If they refuse to wait, then they better transfer to a private hospital. Their non- emergency complaints along with their money, would be fully appreciated there. It even gets more annoying when they start to namedrop, saying that they know the hospital director, or someone from the government. D-oh, as if those people can really do anything. So what if they are from the government? We can't just discharge patients randomly just so we can admit their patients. Often, all beds are full, all rooms are full. There are even makeshift beds and stretchers along hallways just to accommodate the huge patient load. If those people that they know can add rooms or beds just to accommodate them, then fine. But if they can't, then they better just shut the f*ck up.

There was a time last year when I actually challenged a patient's relatives to a fist fight. Highly unprofessional behavior, i know. There were a lot of patients coming in, and seeing that the patient only had a simple laceration, I asked him to wait. After about an hour, I fully explored the wound, and I saw that a tendon was transected. I couldn't find the proximal part, I had to extend the would longitudinally to find it. A local anesthetic wouldn't be enough. Such a procedure can't be done at the emergency room, and since the operating rooms were full, the patient had to be transferred to another hospital. I called another institution and they were willing to accept the patient. Our ambulance was available, so the patient was ready to be transferred. But then the patient's brother started rapping about making them wait. If I couldn't do something about his brother's condition, I shouldn't have let them wait that long. i explained the situation again, but he refused to listen. I was getting exasperated. I haven't eaten yet, and there were more patients coming in. i couldn't waste any more time explaining. Then I heard an expletive. My patience ran out. I shouted at him. I exclaimed an expletive as well. He answered back. he pointed a finger at my face, and I pushed his hand away. Then I challenged him to a fight outside to settle things. He then said something like what aprofessional I am, challenging him to a fight. I told him that was the way I am and he couldn't so anything about it. I was about to kick his sorry ass when the hospital's security guards grabbed him and brought him outside. Such unreasonable people can really bring out the worst in me, especially when I am stressed.

The last time I went on duty, things were going smoothly at first. I've managed to keep that stupid motorcycle driver who scratched my car out of my mind. From morning until the afternoon, the patient load was tolerable. Then that patient with two gunshot wounds to the head came it. He was brought in by the local rescue team. They said they found him by the road, so the exact time of injury was unknown. Both pupils were already dilated. On my assessment, his Glasgow Coma Scale was only 4... definitely not a good sign. But the patient was still alive, so we had to resuscitate him. I inserted an endotracheal tube, started fluid resuscitation, and after a few minutes, his vital signs began to stabilize. The patient was stripped as i searched for other injuries. His pockets were emptied, which had a small bag of marijuana among other things. I knew the outcome wouldn't be favorable, and an operation would be useless, but as per the hospital's protocol, I referred him to a neurosurgeon. Just as I suspected, the prognosis wasn't good. But an immediate CT scan had to be done just to see if an immediate operation would be of benefit. If there was a subdural or epidural hematoma causing a compression or herniation of structures, then immediate craniotomy would be of benefit. If there was none, then a craniotomy would be useless. The location of the bullets had to be known too. If the bullets were only superficially located, they could be excised. If the bullets were located deep in the brain though, excising them would mean dissecting the whole brain, which would only do more harm than good. That was when some relatives came. Since the hospital had no CT scan, the patient had to be transferred temporarily to another hospital. Good thing the relatives had sufficient funds. The CT scan was done immediately. One bullet did not penetrate the skull, but the other was at the center of the brain. There were no subdural nor epidural hematomas, only intraparenchymal hematomas around the bullet's trajectory. Based on my initial assessment, I figured that an operation was useless. The CT scan affirmed my presumption. When I relayed this to the relatives, that was when all hell broke loose. The patient's mother grew hysterical. She demanded that the patient be transferred to a private hospital because we weren't doing anything.(WTF?!) To appease her, I tried to call the hospital where they want to transfer the patient. The physician at that hospital told me that they could not accomodate the patient. The patient's mother grew even more hysterical. She screamed at me and told me that I was a liar. She said the hospital would accept them because money was no object... never mind the fact that that hospital had no available rooms. Obviously, she knew nothing about patient transfer protocols. I let that pass. I knew that she was grieving and she was still in denial. Then they wanted to transport the patient by themselves, which we cannot allow because the patient was intubated. Now the other relatives were also shouting. Why wouldn't we let them go, they ask. Jesus Christ. To appease them, I called another hospital--- one that I was sure had available rooms because of their exorbitant rates. And true enough, they can accomodate the patient. One of the patient's relatives, who was a doctor herself, asked me questions. She understood the fact that transferring the patient to another hospital was useless, that it would only incur additional expenses, and yet she wouldn't help me make her relatives understand. No amount of explaining could make things clear to people in denial. But she could somehow provide the voice of reasoning. When I asked her to explain everything to her relatives--- because maybe they would listen to her... she just remained silent.

Another half hour of crying and screaming. The mother shouting that her son was a good person, he had no enemies, he did not deserve what happened... i just wondered how good he really was, when illicit drugs were found in his pockets. He had two shots in the head, one on each side... a person must really be consumed with anger in order to do that to another human being... More crying. More shouting. It was a madhouse. I was glad when they finally settled their hospital bill. A few more minutes, and we were off. When we arrived at the other hospital, a few more relatives arrived. The patient's brother, who was crying and begging me earlier to let them transfer their patient to another hospital said something that really made my blood boil. He told his relatives that the doctors at our hospital weren't doing anything. He told them that we were stupid and we did not know what we were doing. And the he turned to me and said that all the years i spent in med school was a waste, because look at the way I turned out.

I wanted to punch him in the face.

I was trying so hard to control myself. I knew that they were in grief, and that's why I remained incredibly patient all that time. But to say something like that, to personally attack my and my profession?! That comment was way below the belt. It's bad enough when patients accuse you of not knowing what you are doing--- but when you are 100% sure that everything you've done is correct and they still question your management, it's even more offensive. I know I'm not perfect, and I know I'm not a great doctor. I've made a lot of mistakes in the past, but on that patient's case, I did everything right. I tried so hard to control my temper, simply because I wasn't at my home turf. I was at another hospital. If we were outside and I wasn't on duty, I would challenge him to a fight, punch him in the face, I don't care even if he's bigger than me. We weren't doing anything?! whether they brought the patient to a private or public hospital, it wouldn't have made a difference. We followed resuscitation protocols by the book. The treatment would be the same even if the patient was brought to a private hospital. And he calls us stupid?! They're the ones who can't grasp the reality that their patient was brain dead to begin with, that he wouldn't survive anyway--- and in the unlikely event that he does survive, it would only be in a comatose state. They kept on demanding that the patient undergo operation no matter how hard I explain to them that an operation is useless. If there's anyone stupid in the emergency room, it's their whole family, not us. I wanted to tell him that only a blind person would say that we were not doing anything. Only an imbecile would tell me that i don't know what I was doing. Only a moron would tell me that the things that I did were wrong. But what could i expect from a family that can't grasp the simple fact that their relative has no chance of survival? What could I expect from a family that keeps on insisting on an operation that isn't even needed? Mark my words, if the neurosurgeon at that hospital recommends an operation, he or she would only be milking money from them, knowing very well that an operation is not indicated. But what could I expect from a family that's drowning in denial? What could I expect from a bunch of know-it-alls? Stupidity must really be genetic. Their family is the living proof of that.

But i stayed silent. I tried to symphatize, i tried to understand their situation. But I was really offended, and that feeling rises above all others. It doesn't dissipate... it lingers. I kept all that anger inside, instead of finding a way to release it. And now... two days later, I'm still pissed. Really f*ckin' pissed.

I should've punched that asshole in the face. Who gives a f*ck about consequences. I could deal with all that later. At least punching him would have immediately made me feel better.