“No, you can't have another Percocet prescription because you lost yours.” “No, I won't treat your sprain with Dilaudid.”
The word “no” is crucial to my emergency physician armamentarium. Ten years ago, it might not have rolled off my lips so effortlessly. Now I'm a seasoned EP, which translates to jaded and cynical. How did I go from a fresh-out-of-residency physician who thought she was going to save the world to an untrusting EP who many days thinks she is just contributing to the narcotic epidemic? As Samuel Shem put it in The House of God, “I don't trust anyone. It comes from being vomited on and spit at and yelled at and conned.”
I started dating again after my divorce, and I got a fresh, firsthand look at how distrust develops. The transition from hopeful romantic to cynic in my dating life mirrors the transition to distrust I'd already undergone in my professional life, and it has given me a unique vantage point on how the art of saying no makes its way into our armamentarium. “No, the B.S. is not OK with me.”
For those of you fortunate enough to have not had to date for a while — trust me — dating, much like doctoring, involves sorting through a lot of B.S. The parade of unsuccessful matches punctuated by someone worth going on a second date with resembles the parade of noncritical patients punctuated by real emergencies in the ED. That guy who sleeps with multiple women and then tells you your skepticism is ridiculous is like the patient who hops from ED to ED and tells you your hesitancy to prescribe narcotics is ridiculous. Hindsight in dating is just like the medical differential — all the little behavioral clues we ignore are like the subtle ECG changes we sometimes miss, which become painfully obvious looking back. Each dating encounter is as educational as each patient encounter.
When I plunged back into the dating pool I brought with me all of the behaviors EPs develop to do their jobs:
- EPs have five minutes to discern if someone's life is in danger or just has gas. I'm as decisive about men within a few dates.
- EPs anticipate catastrophe. We know that seemingly-innocuous symptoms could kill someone. Our minds are trained to jump to the worst-case scenario. Neck pain? Meningitis. Belly pain? AAA. Likewise when I date, my mind jumps to, “How is this guy going hurt me?” MIA on a Friday night? He has another girl.
- EPs react. That increase in respiratory rate, that subtle pallor creeping onto a patient's countenance, or those small beads of sweat forming are signs that require intervention. On a date I'm hyper-vigilant about subtle signs, and even when I don't outwardly show a reaction, inwardly I'm reacting and often becoming anxious.
- EPs communicate. We have awkward conversations with patients and families. No topic is off limits. I can dive right into a hard conversation with a guy and tell him whatever I need to.
- EPs advocate assertively for our patients. After arguing with hospitalists and surgeons, I'm not afraid of disagreements with men. One false step and I will address it with the strong-willed advocacy that serves me so well at work.
I optimistically figured dating would be a piece of cake. What happens, however, when you throw a woman with a strong doctor's personality into the dating pool? Suffice it to say, it does not go well. Potential suitors are taken aback by assertiveness and tenacity. The laid-back “we'll see, babe” men or those who want to keep me on the back burner aren't comfortable with me charging in and wanting a decisive disposition. By the third or fourth date, if not before, I'll tell him that he can go or that I like him and want him to stay.
What I learned is that jumping fearlessly into a relationship is equivalent for men to walking into an exam room and going from complete strangers to rectal exam in five minutes. I have had men say I'm overwhelming, and it never seems to work out with the ones I like. Each dating mishap makes me more jaded and distrusting of the next guy the same way I would about the next patient in the ED.
Dating gestalt, like clinical gestalt, is pattern recognition. What my dating experiences have taught me is to recognize patterns of male behavior that lead to me getting burned. I not only recognize those behaviors, I've come to expect them. Crossing that line between accurately identifying and pessimistically expecting dubious behavior is the essence of cynicism. After too many malingerers or players hurt me, even the most idealistic new doctor or new dater becomes cynical, and assumes they're lying if their lips are moving.
We trust our gut instinct in doctoring and in dating, but in periods of cynicism after the sting of negative experiences, is our gut accurate? Can I trust my gestalt about men now or is it skewed to assume the worst? I like to think I'm using healthy skepticism to save society from another unnecessary narcotic prescription or save myself from the players of the dating world, but what if I'm operating with too much cynicism rather than accurate instinct and unfairly withholding necessary pain control or throwing away potentially good relationships? Sometimes people surprise us. Every once in a while a patient says no to Percocet and only wants Tylenol. Recently a few men have come along who cared enough to actually be straight with me, reminding me that not everyone's motives are dubious.
After negative experiences impart negative expectations, our challenge becomes keeping cynicism in check. It's healthy to have some skepticism and learn from experience, but it's a mistake to assume the worst and not be open to letting people prove us wrong. After a decade in emergency medicine, I have perfected the art of saying no. Maybe now the challenge is remembering how to say yes.
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