Lip smacks, insults and f-bombs

Some days, dealing with patients feels like a boxing match.


I'd been taking care of some patients over the last few days who hadn't been very nice to me. On this particular day, one of them flat out told me to “Go away, dammit!” when I tried to perform my examination on rounds. She swatted my hands off of her and shooed me out of the room, for no reason that I could think of.

Kimberly Manning FACP
Kimberly Manning, FACP

It was a day when I was tired from working over the weekend, from my son Zachary waking up repeatedly in the night then whining while getting dressed, from my other son Isaiah crying before getting on the bus, and from driving between Grady Hospital and Emory University in the middle of the day for what felt like the five trillionth time that month. So honestly? I just wasn't in the mood. At. All.

Round one

I was alone. There were no medical students or residents with me, or even a nurse overlooking. I was super-tempted to put my hand on my hip, jut out my hip, and curl my lips. I was ultra-tempted to grab up my cantankerous patient by the gown, stare at her nose-to-nose, and growl, “I WILL NOT go away. You WILL sit up and you WILL let me examine you and I will NOT be putting up with this TODAY! GOT THAT, LADY?!”

But I didn't.

Instead I just did what I could in between her exaggerated lip smacks and throaty insults, laying my quivering stethoscope any place that could possibly give me some answers instead of a hand slap. I'll admit that I was seething and had a rather funky attitude as I quietly told her the plan and halfheartedly asked if she had questions.

She did have one question: “Can you please just go A-WAY?” She then smacked her lips very hard and turned her back to me in a way so exaggerated that it looked planned and blocked by a director for a medical drama. “GO A-WAY!” she repeated.

I wish I could tell you that I said something poignant that allowed us to connect and then sing kumbaya. Nope. Not at all. I was tired. And I wasn't in the mood to be gracious.

So I did what she wanted. I went away.

Round two

After that patient, I went to see another patient who had decided early in his hospitalization that being nice to me or anyone else was not a priority. He had gone from screaming and spitting mad, to eerily calm, to angry f-bombs, back to scary docile—all over a four-day period. I had no idea what to expect this day, and truthfully? I wasn't in the mood to find out.

Turns out that day was Sarcasm Day.

“Hey there…it's Dr. Manning.”

“Well, well, well! If it isn't DOC-ta Manning!”

“Hi sir. How are you feeling today?”

“Awesome! Just awesome! In fact, I could not be better!”

I cleared my throat and rubbed my neck. “Umm, okay. Any pain today?”

“Let's see…pain. Um yeah! Everyone here is a pain in the ass! Does that count?” He gave me a saccharine-sweet smile.

I pursed my lips and blew outward. Not. In. The. Mood. “Sir, are you moving your bowels okay?”

“I sure am! But I'm not sure how since I barely eat this ridiculously disgusting diet! It's an absolute, f—ing joke. But, hey, I am still AWESOME. Totally AWESOME.”

I did my best to acknowledge the psychiatric aspects of his behavior. But it was hard today. And I won't even lie—all I could feel was annoyed. I felt myself crumbling.

“Look, sir. This isn't helping anything. And I'm not about to stand here and listen to your profanity. I'm not. Not today, I'm not.”

“Is THAT RIGHT?” he chided in an even more horribly cynical sing-song tone.

He was totally pushing my buttons.

“That's RIGHT.”

“Oh, well NEWS FLASH! I do what I WANT TO F—ING DO, ALRIGHT?”

I pressed my lips together and sighed hard. “You know what?” I started and then stopped. It was the kind of “you know what” that precedes somebody getting cussed out on the corner or after dealing with a rude cashier. I wanted to go straight L.A.—no, straight INGLEWOOD—on him, giving him back exactly what he was giving. I closed my eyes, gripped the bed rail, and tapped my foot to release the mounting frustration.

Jesus. Help me to be more like you. Whew.

I looked at his tray and the clear liquid diet that his condition required him to eat. I glanced at the tubes and IV lines coming from every limb of his body. His youngish face was twisted and frustrated. His eyes narrowed and I braced myself for the venom that I saw him preparing to spew in my direction.

As I examined him, expletives whizzed past my cheeks and punched my shoulders. The worst ones you can think of. I've written much about my many tender moments at Grady, but there was nothing tender about this at all.

In between f-bombs and grating sarcasm, I did my best to repeat the plan to him that my team had discussed earlier that morning.

“I will speak to the specialists,” I said with every drop of exhaustion that I was feeling evident in my voice. “As soon as they tell me what they recommend, someone from our team will be back to review that with you.”

“GREAT, Dr. Manning! AWESOME! Tell you what? I'll see you back in what, like, FIVE BILLION hours?!” He let out a cackle and squeezed his eyes shut.

I just stood there staring at him. I could feel my blood boiling.

I couldn't take it anymore. I walked out to the nurses' station, sat down and just put my head down on the desk. I was tired. I was sick of hearing it. I closed my eyes and did my best to channel something…anything…to get me in a better place.

Regaining control

That's when, all of a sudden, this image of eighteen-year-old Janet Jackson followed by the word “CONTROL” underneath it popped into my head like a giant TV caption.

Ah hah.

Kind of like Janet sang about in her hit song, that's really what we all want to some degree. It's why Zachary was crying this morning when I wouldn't let him wear his big red rain boots to school, and why Isaiah was giving me the business about wanting to be “a walker” to school and not a “bus rider.” It's why I was so aggravated by my patients' being so difficult. Control.

The profanity? The refusal to cooperate? All ways to regain control for people whose unfortunate medical, social and psychiatric conditions had left them with virtually none. These two patients were frustrated with minds and bodies that had turned their backs on them—which, truthfully, had little to do with me or anyone else.

I finally admitted to myself that I was bent out of shape because I couldn't bend them in the direction I wanted them to go. No amount of kind words or soft intonation was working. These are things that usually work for me to control a situation.

So the next day, despite what someone else might think was the right approach, I stopped trying. I went back in to see those two patients again, this time making up my mind that I wouldn't make it about me. Because it wasn't. On that day, I decided to let my patients have the control that they, too, craved by simply controlling me—even if it meant getting pelted with the shrapnel of profanity, hostile remarks, and extraordinarily rude sarcasm—and even if giving it to them was at the expense of just a little bit (okay, a lot) of my own pride.

Funny. Once I looked at it that way, I somehow felt better about it all. And more in control.