Stuck in My Craw

One of the things I was taught in medical school: common things are common. 

These things have been more common lately. I know I’m starting the grumpy old man phase of my blogging life, but good grief, people. Really?!?


No direct eye contact. No acknowledgement, verbal or otherwise, when greeted with a cheery good morning. Annoying behaviors designed, quite consciously, to actively annoy and derail the time in the office. Texting, typing, talking and playing games on phones in the office when active input would be appreciated! Ignoring questions outright or refusing to answer. 

Sullen mood: 

No, I’m not talking about serious depression or active psychosis. I’m talking about deliberately hostile, staring, scowling, defiant presentations designed to minimize communication. Really?

Lack of responsibility: 

“I don’t know why I had to come here.”

“I’m not sure how that gun/knife/weapon got in my gym bag, but it’s the kid’s fault that found it and turned me in that I got in trouble.”

“My teachers suck. They don’t know how to teach. They’re stupid.”

“Because I don’t like to do chores, that’s why.”

“I just don’t do the work. I don’t feel like it. No, I never turn my homework in.” 

“They can’t do this! They can’t take away my iPhone/iPad/Gameboy/PlayStation/XBox/flat screen TV just because I have four Fs and a D!”


It’s the teacher’s/principal’s/parents’/other kids’/government’s/doctor’s fault.

Anger for anger’s sake.

Refusal to problem solve or to see anything positive at all in a situation. 

Adversarial stance (kids and parents both!)

“Fix me!”

“We’ve tried everything and nothing works for him.”

“Nothing you can do will help.”
This was a week, friends. 

This is not entirely a mental health crisis. 

This is a crisis of investment in parenting, house rules, expectations, empowerment, upbringing, respect for elders, and establishment of normalcy in childhood. 

Enjoy your weekend. 

Next week, we all have more work to do. 

Danger Field

“I don’t get no respect!”

Rodney Dangerfield


He was a little guy, munching on the taco lunch that his mother had brought into my office for him, his younger sister and herself. I was a little miffed, I won’t lie, that the family knew they had an appointment with me right after lunch, but they decided to make the appointment itself lunch. I tried to concentrate on my interview questions and assessment, shredded lettuce and ground beef flying onto the floor as I did so. I could overlook the need to vacuum my office after the visit.

What I could not overlook, at least not easily, was the outright, in-my-face, vitriolic and vocal disrespect that was shown to me by my pint-sized patient. After trying to engage him for several minutes, only to have the conversation default to mother, who was trying her best to ignore his outrageous behavior, I got this answer from him as I tried to ask one more softball question.

What I need from you right now is for you to stop talking!”

Really? That’s what I get from a latency age patient after being in the profession for thirty years? Really?

It struck me as I thought about this scenario later in the day and for several days after this that we are, as a culture, rapidly losing any sense of what appropriate displays of respect are. It happens in my office. It happens when I am seeing folks in emergency rooms around the state. It happens in homes across the country, as children disrespect their parents. It happens in schools, as kids think that bringing weapons to school in outright defiance of rules or talking back to teachers and principals is acceptable behavior.

It happens when citizens do not respect police officers or EMS workers. It happens to the office of the President of the United States. Now, I don’t know about you, but I was always taught that I should respect the office of the Presidency no matter who held it, for he could be removed for wrong doing or could be voted out after his term if he had not done a good job, but the office would remain. Nowadays, it appears that we have lost our way and no longer prescribe to this idea either.

What has happened? What is happening?

Why do we no longer respect ourselves, our institutions such as schools, churches, marriage, and others? 

It seems to me that several things are adrift here, with mooring lines long since cut and nothing to hold us safely in the harbor. 

Respect is not being modeled in the home. 

Respect is not being taught in the schools.

Respect is not being demanded as a prerequisite to moving forward in life.

Respect is not being earned, whether at the local level or at the highest levels of government and industry. 

I would challenge each of us to think hard about this.

How do we get back to teaching respect from the very beginning in the home, then have this lesson continued in the schools, and then modeled further in the workplace and beyond?

A single session when a troubled child is scattering lettuce on my floor and telling me to shut up is one thing. Training kicks in to deal with these minor frustrations. 

Losing respect for each other, our government, our religious institutions, our governing documents, our social norms, and our mutually accepted ways of moving together through society is much more serious, and may have far reaching effects if we don’t act now to turn things around.

As always, I welcome your comments.



Sock It To Me

Call me crazy. Call me old. Call me a dinosaur. I don’t care.

I feel that after all my years of education and training and experience that I deserve a little respect from my patients. There. I said it. I will wait for the collective gasp from all of you. Okay, may we move on now?

I have seen the gamut of suffering souls in the emergency departments of South Carolina in the past week or two. Short ones, tall ones, fat ones, skinny ones, depressed ones, manic ones, drugged  ones, inebriated ones. Psychotic ones, aggressive ones, agitated ones, quiet ones. Hands uplifted to Heaven and eyes downcast toward the floor. The sweet words of a child and the foul-mouthed derogatory rantings of a narcissistic drug addict.

What makes me keep doing this? What makes me go back to seeing patients, sixteen-hour-Monday after sixteen-hour-Monday? Sixteen hours is a long shift. You can process a lot of pain in sixteen hours. You can become an angst-absorbing sponge in two-thirds of a day.

Well, there’s the satisfaction of helping people. There’s the feeling that maybe I can pick up on something that somebody else missed. There’s that blessed feeling of taking away medications instead of adding just one more drug because we really don’t know what’s going on here anyway so why don’t we just snow him and see what happens.

And then, there’s that one sweet patient, that one who has just done something heinous, something awful, something that nobody would have expected. That patient, who because of the ravages of time and illness has been robbed of intellect and reasoning and normal cognitive processing. The patient who still maintains, deep down in the depths of their tormented soul, that part of themselves that is civil and decent and human enough to extend common courtesies to the doctor who is trying to help them.

“May I continue, Doctor?” (Note the capital “D”. It’s there. Make no mistake.)

“I’m sorry, Doctor, but I don’t usually look like this. They gave me some medicine, and I was asleep and they woke me up to come talk to you. I’m sorry for my appearance…”

“I’m sorry, Doctor, but this is important. May I start back at the beginning? Do you have time for me to tell you about this?”

Okay, okay, my false sense of importance and the need to harvest respect from the fields of misery is not exactly what this post is about, is it? You read me. You know how I think. You knew I was setting you up way back there at I don’t care.

It’s not about the respect I get from my patients. Not really. It’s nice, yes, to have someone treat me nicely and call me Doctor with an audible capital D. It’s nice to have one’s education and experience acknowledged once in a while. It’s nice to score a diagnostic coup. All those things are nice.

The most important thing I learned in my sixteen hour work day yesterday was that even in the midst of terrible suffering, a story is a story.

Even when a blood alcohol level is four times legal, I’m sorry can come through loud and clear.

Even when someone is cursing me for everything but making the sun come up in the morning, pain comes through loud and clear as pain.

I’m having a long, hard day.

You’re having maybe the very worst day of your entire life. One that brought you to the emergency department of a hospital. One that has you talking to me, trying to make sense of it all.

I don’t need your respect.

I need your trust.

I can take it.

Let’s work this through. Together.

Sock it to me.