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First Person: Connect with Patients, Especially the Crazy Ones

Cotton, Brad MD

doi: 10.1097/01.EEM.0000515690.90720.e3
First Person

Dr. Cotton is an emergency physician at Mt. Carmel, St. Ann's Campus, in Westerville, OH, and an adjunct clinical professor of medicine for the Ohio State University Hospitals. He has served as an EMT-P, ED nurse, and emergency physician for 38 years.

challenging patients

challenging patients



The week between Christmas and New Year's always seems at least one standard deviation away from the mean for raw craziness. Clara was screaming at the cars to hit her. Drinking from a bottle of gin, she was lunging at passing cars on a busy highway. Clara arrived handcuffed to the cart. She said the voices in her head didn't feel good and accepted my offer of an IM “B52.”

One hour later, in came Chuck with rope abrasions around his neck. He tried to convince me that the hanging had gotten the suicide out of his system “for real.” I think he wanted out of the ED because he was thirsty for more 40-ouncers.

The next morning, I saw Ron, who was found in his underwear outside screaming about rattlesnakes. Another “B52,” this one given while Ron was bucking leathers.

The week after Christmas has always been crazy and crazy-busy in every ED where I've ever worked. I think it's because most people are happy with family stuff — except our patients. They are not connected, so they come here to connect with us.

The gangbangers I scraped off the sidewalks as a medic in Cleveland were not connected. They couldn't connect with their baby's mother, couldn't be providers, had no jobs, and no one needed them except the gang. Unconnected, alienated young men are dangerous. They make the best recruits, the true-believer suicide bombers.

Clara from the highway, Chuck with the rope, Ron and his snakes all feel the painful hole more during the holidays. Barbara, my patient after Ron, had developed rapid and painful Pasturella multocida cellulitis twice after being bitten by the same cat. Twice? She has no one else.

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Depersonalization and Burnout

My mother led our family to connect with whatever is out there in the quiet of Quaker meetings. I remember the power of a roomful of worshipful adults listening to the stillness. My father, overworked as a youngster painting and plastering till late after school every day, was a child-set-free for the rest of his life. A natural salesman, he connected with everyone, every gas station attendant, every server in every eatery. Later, from his electric scooter in the nursing facility, he engaged with everyone he couldn't run down. Dad died first; Mom followed seven hours later in the nursing home room they shared. They were connected for 64 years.

I spoke about caregiver burnout to nursing, dental, and allied health students and to the families of body donors at the Ohio State University College of Medicine. Burnout hurts. Burnout is when I think my patient got sicker at the end of my shift or refused to have my presumptive diagnosis or elevated his creatinine to prevent the CT angiogram just to make me go home late. That mom and her kid with the sniffles are wasting my time. I don't see her as a mom working two jobs. Here in the ED at two in the morning is her only way to get her kid help. I became disconnected to my patients. The technical word for this disconnection is “depersonalization.” I don't see myself as a healer or a helper, and it hurts me. It hurts my patients and my nurses too.

Look at it selfishly. To stop my pain, I “re-personalize.” I connect. I introduce myself as “Dr. Cotton — you know, like no polyester and no rayon.” I shake hands. I ask the patient what kind of work he does (everyone likes to chat about their work), and the patient becomes a person, not just a clinical problem. I look at the nurses' Facebook pages and at photos of their kids. I am then less likely to growl when a new nurse asks me a question that I shouldn't have to answer. If I can do this well each shift, I drive home feeling better, and it is easier to go back the next day.

I am honored to have been trusted with this vital work for 40 years and have the unparalleled opportunity to connect with so many people, including Clara, Chuck, and Ron.

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