I was scrubbed in today for a while, and witnessed the most violent outburst of anger I’ve seen in four years spent around some pretty volatile men. (I say witnessed, because as far as I can tell I wasn’t too close to the center of the target; I’m not sure how much he blames me, but we’ll see about that tomorrow.) My first reaction, besides shock at the amount of cursing, was, “how did he ever get this way? I can’t imagine ever getting to the point of being this angry, or expressing it so openly.”

And then I realized that I’m probably a lot closer to that attending than I would like to think. For instance, the other morning, I had to do several procedures with a nurse who probably qualifies as my least favorite ever. There are some nurses I dislike because I don’t think I can trust their medical advice (ie, they’ll say, “Dr. X would always start z medication now,” whereas in fact Dr. X hates that medication, and anyway it’s not at all indicated at the time); there are others whose opinion I might trust, but I dislike the fact that they are never available to help with problems in their rooms or their neighbors’. This particular nurse qualifies on many levels.

The harder I tried to get all the pieces lined up to get the procedures done in her room, the more ways she seemed to come up with ways to frustrate my efforts (I will allow that she was probably doing this unconsciously, in a sincere attempt to take good care of the patient; nevertheless it added up to thwarting all of my attempts to work efficiently). Finally, I was so angry and tense I would have been happy to throw some trash on the floor, except I knew that would bring our conflict way out in the open, and put an end to any forward momentum at all. As it was, I doubted that I would be able to do the procedure safely, I was so upset.

That morning, I got past it with a few prayers, and some meditations on the insignificance of these procedures to the course of the day, and how it didn’t really matter if I spent an extra fifteen minutes doing them safely.

But I can easily see how, if I had the power to throw things and yell without fear of retribution, and if the procedure I was doing was far more weighty and vital, I might well have chosen that as a method of venting stress, reasoning that it would be better to get it out so I could go on to concentrate on the procedure, rather than trying to keep it politely in, and be so tense that I couldn’t control my hands properly. I can even see how enough of these experiences as a resident, controlling anger, and then watching my role models express it, could make me happy to do the same when I reach that level. (This deliberate choice of a method of stress relief, to get back to the job at hand, would also explain the curiously swift changes of mood of most surgery attendings: they get very angry, then they calm down, and are back to joking and friendly. A few of them don’t let go, and they’re the really scary ones.)

I hope not. I know Paul said “be ye angry, and sin not,” and I’ve got to think that throwing things in the OR, even if only at the floor and not at people, probably counts as sinning while being angry. (Irony there, folks. I know quite well that it’s wrong. Don’t want you to get too concerned about me.)

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