Terms of Engagement

by Jinryu

“You know what game I like to play sometimes while I’m here?” I asked Cindy.


“You see that lady there?  She’s been on our case for 30 minutes there, standing in the hallway, just staring at me.  She’s been in that room for an hour because she thinks that we’re not treating her kid fairly.”

“Of course.”

“Well, when she stares, I like to stare right back.”

Last night, I got into an argument with some lady.  I think it’s a common feeling among the parents’ of patients that it’s alright to shit on coordinators, orderlies and nurses, basically anyone in a hospital, because we’re not doctors.  I mean, doctors get their fair share of attitude problems as well, but for the most part, as soon as a doctor shows up, patients’ parents start getting all chummy– and up to that point, they treat the rest of us like shit.

And while it’s certainly to be expected, and dare I say, part of my job to deal with it, there are lines to cross.  These lines depend entirely on what time of day it is and how far into my shift I am.  The line is a lot closer, for example, at the end of my shift at 12:25 AM (I finish at 12:30AM) because at that point, if you start an argument with me, I don’t fucking care– I don’t have to deal with you anymore in 5 minutes, so I will tell you off.

The problem is that when I’m tired, I get irritible, and when I get irritible, like, really pissed off, I don’t think as well.  I mean, usually someone’s pissing me off because I’ve got a system to things, in the sense that I’m seldom wrong so long as I stick to it, and since I usually do, I’m usually not wrong.  But the problem with me getting pissed off is that I have more difficulty expressing myself and tend to just intimidate people with the power of my emotion rather than my reasoning.  And that gets nowhere fast.

It’s sorta a lesser tactic I guess.

This woman was basically accusing me of not having her child seen by a doctor.  I don’t need to tell you how the triage system works.  Her kid’s case was deemed non-urgent.  We had one doctor working from 11pm and on, and he was being assisted by a second doctor was already 2 hours overtime because we had two simultaneous crash room cases, one of which was so serious that it required intubation. Crash room cases usually mean that everything else in the emergency department grinds a halt– it usually takes up a fair number of your doctors, nurses and orderlies.

Which I was trying to explain to her, very politely (so politely like you wouldn’t believe!) for about forty five minutes since I put her and her son in an examination room.

Anyway, long story short, she continually comes into the administrative area and just starts shit about how she’s not getting seen.  And I understand that for parents to be parents, it involves a lot of worrying and making sure that everything is being done for the sake of your child.  But this woman, well…

At some point she gave me a lecture about how she shouldn’t have to wait and how it was unfair for her to be passed ahead of by other patients.  I cut in and started switching to “I don’t give a fuck anymore mode” as far as manners go, I tried to lay it out simply for her.

“Ma’am, I understand you’ve been waiting a long time.  What I can I do to help you?”

“When is the doctor going to come?”

“As soon as he can.  He’s busy right now.  As I already told you. Next question.”

“You said he was going to be here in 10 minutes.”

“You said he’s going to be here in 10 minutes.  I never tell people the doctor’s going to come in 10 minutes.  That wasn’t a question.  Would you like to try again?”

“I keep seeing people in the waiting room passing in front of me!  That’s not fair!”

“I’ve explained to you ma’am that there are surgical cases as well as medical cases, and that there are different categories of triage.  Your case is deemed less urgent.  If you’d like me to explain it again, I can, but you refuse to understand, so I’ve got nothing to say.  Next?”

“I want to speak with a doctor!”

“Ma’am, I have a list of 24 other people here who want the same thing, and you’re already next in line.  What do you think I can I do for you?”

“So where is the doctor?”

“The doctor is in the crash room and will see you as soon as he’s got the time.  He’s working as fast as he can.”

She inches to look around me.

“If you take another step ma’am, I’ll have security escort you outside.”

“This is [!@#*!(@# swearing in another language].  Give me my card.  I’m leaving.  This hospital is stupid and you people don’t do what you’re supposed to do!”

“Ma’am, this isn’t my obligation,” cuts in Cindy, “but I suggest that you wait a little longer.  You’re already next.”

“I’m never coming back here!  Give me my card.”

“Alright,” I say, breaking eye contact with a “fuck this” attutide.  “You know what, fine.  You want to go?  Are you sure?”

“Give me my card!”

I go and get her son’s card. And I think that this is something important to point out– her son looks fine.  Visual check, which is an accepted hospital technique, says that if the kid is standing, if his complexion is good, and his nurse-triaged code is 4 or 5, then they can wait.  The important thing is that it’s her SON’s card, not HER card.  Because she’s making this into a hospital vs her thing, which is besides the point– we’re here to cater to her son’s needs not hers.

I give her her son’s card, and she starts down the hallway.

At that point, Dr. [E] comes out of the crashroom, with almost stupendous timing, and yells out as he always does: “Do we have any patients in rooms?” because that woman was the only one loaded.  At night, when there’s only one doctor, we only load one patient at a time so that they don’t keep popping their heads out of the examination room to harass us.

“No problem, Dr. E, I’m loading one right now,” and I pick up the speakerphone to call in a fresh patient.

Suddenly, that woman comes running back in.

“Is that the doctor?” she demands.


“That man!  Is he the doctor?”

“He’s the doctor tonight, yes,” I reply, and then ignore her, sorting through the papers to see how backlogged we are with patients.

“I want to see that doctor.”

“You’ll have to wait like everyone else, ma’am.  I just took you out of the system.  You said you wanted to leave.  The exit is that way.  You can go through triage like everybody else.”

“Why didn’t you tell me the doctor was coming?”

“Ma’am, I did.  You weren’t listening. Excuse me, for one moment please.”

Another patient and his father comes in, and I direct them to their room.

I think what gets to me most is that people have no humility.  I don’t think it’s a prerequisite for being cared for at a hospital, but in a certain sense, it should be.  If you come to us for help, you have to acknowledge that you’re here because you can’t do it on your own.  That means that you shut the fuck up and do as you’re told.

This doesn’t mean that you shouldn’t take an active role in the wellbeing of you and your family.  But it does mean that when it comes to attitude, you need to understand that we know what we’re doing and if you try to fuck with us, you’re not going to get any better results.  And, if you really push all our buttons, we can decide to really fuck you up and it would be by the books.

You know, that lady and her son?  They’d been waiting in the waiting room for three hours, and they’d been in an examination room for about an hour.  That’s actually really decent.  It’s not uncommon in Montreal to have waiting times of over 6 hours just to get a room.  But, I don’t expect patients to know that.  Their job is to come in when called, and be patient.

My job is to faciliatate them getting seen.

There should be no favors.

But I crossed that line yesterday because I did a kid a favor, just to spite his mom.

“Listen to me, and listen closely,” I said, and now, I was looking her straight in the eyes the way I was taught as a child never to do to my elders, because it’s disrespectful.  “This is a hospital.  I work here because I believe in my job, and because I want to help.  I do not lie to families.  I do not treat favorites.  If you ask me a question, if I don’t give you an answer it’s because I can’t.  You can ask me all night when you’re going to be seen and I won’t tell you, and it’s not because I want to withhold information from you.  Do you understand what I’m saying?  I’m on your side.  Now, I don’t care if you ever come back.  If your son is sick, bring him to me.  But I don’t need you here because your attitude is no good, you hear me? NO GOOD.”

“We have been waiting four hours here and…”

“And I have been here for 12 hours, and this is my job, and you are the only one in the last tweleve hours who doesn’t understand this.  I DON’T NEED THIS.  And when you go to another hospital, they don’t need this either.  YOU need to learn to control yourself because the only one who suffers out of this is your son.  You realize that you’ve already told me you’ve left, and that legally, I can make you wait another 7 hours before you see a doctor.  Do you know why?”

“I want to see a doctor.”

“No, because you are getting so caught up with making me the bad guy that you’re not looking at your son, or all the other sick children here.  This isn’t about you.  Do you want your son to see a doctor?”

“Yes, I want to see a doctor.”

“You asked me… no, you told me, that you were going to leave, that you wanted your card back, and that you’d never come back.  Do you want to leave or do you want to see a doctor?”

“I want to see a doctor!”

“Go back to your room, and wait.”

“When will he come? Last time you said he’d be here in 10 minutes.”

“If you want to be seen, you go back to your room, and you wait.  I’ve got nothing more to tell you.”

The thing about working in hospitals is that…

… you find moments of inspiration.  You meet a kid and he’s especially cute.  They’re amazing in so many ways.

But in the real world, inspiration isn’t everything.  Not everyone has insurance.  There are parents out there who abuse their children.  Kids come in with stab wounds, or because of motor vehicle accidents.  It’s a job for us, and as inspired as anyone who does their job is, there’s a certain amount of it that becomes mechanical simply because that’s what  you do at times to put bread on the table.  And it’s easy to forget why you’re doing all this when the kid is shorter than the counter and all you can see is their asshole parent.

Yesterday night, I almost just told them to fuckoff. Sorry!  You said you were leaving!

Would it have mattered? There are only a finite amount of patients that can be seen during one night shift.  The space they freed up would instantly be gobbled up by the next family.  Life would go on.  The procedure book actually tells me, too bad.  They decided to leave.  There are no mulligans, there’s no 10 second rule.

But I did them a favor.

And the truth was, it wasn’t because I cared about the boy.

It’s because I wanted to spite the mother.  You need our help, I thought. No, you need my help, and now you’ve come crawling back.

There’s this saying in the bushido tradition that mercy is a greater virtue than power…

…however, I don’t think the person who came up with that idea ever realized how pettily mercy could be used.