Mark vs Cancer

Wednesday, August 26, 2009

The Best They Can

I work with a great nurse, an RN with many years of ER and OR experience on her resume. She maintains a healthily cynical, darkly humorous view of needy patients, exhibiting the hardened exterior that most of us health care workers eventually develop out of experience and necessity. But beneath the tough veneer, she has a gigantic heart and displays gentle acceptance of our most difficult patients, and face to face, she always gives them the best of her compassion and kindness.

Several months ago, on the very first day we worked together, she came out of a room with a patient who was, to put it mildly, a train wreck, a sorry, pathetic person at the end of their rope whose health and social situation was as depressing as it was precarious. She came into my office, put the chart in front of me, and said with a sigh, "Dr. Foster, they're a mess. But you know what? They're doing the best they can."

I looked at her for an explanation, and she continued, "You know, they didn't wake up this morning and say, 'I want to fail at life today, so I'm going to ruin my health and my relationships and do bad things that hurt other people.'"

The best they can. Over the succeeding eight months, we have repeated this phrase like a mantra when dealing with our challenging patients. (However, we have decided that there are exceptions, and that some of our patients are indeed not doing the best they can, and in fact are intentionally failing out of the school of life. But these are rare exceptions.)

By and large, it holds true. At the least, this mantra forces me to perceive needy patients in a more compassionate light. Isn't it true, I tell myself? Don't most people try, within their capacity and experience, to succeed at life? The narcotic addicts, the hypochondriacs, the borderline personalities, the depressed and defeated: isn't the fact that they're breathing, sitting in the doctor's office and seeking help--doesn't that mean they're trying to get better, to do better, to be better people, taking the detritus of their lives and attempting to refashion something usable, even beautiful?

We all have survival instincts, and a very many of us are stuck permanently on survival mode. The frantic, abrasive mother who slaps at her children as she begs for pain meds may be tough to deal with, but after all, she's a single mom, abused herself as a child, and she is trying in some dysfunctional way to carve something better out of her life for her and her children. She's seeking love, safety, acceptance, and peace on very basic levels, and when these appear too elusive she turns desperately to unhealthy avenues to fulfill her needs, like stoning herself with vicodin and sedatives every day and living with an abusive man who at least pays her some attention. But this probably represents the best way that she can figure out how to cope. She's doing the best she can. And sadly, so is he.

The best they can. I keep repeating it to myself as she slaps at her two year old again and becomes more insistent of her absolute necessity for narcotics. She needs them like she needs air. She might die without them. On a scale of one to ten, her pain is, like, a bazillion.

I'm not sure I believe it, but luckily I've got a nurse who reminds me to look at her with compassion, even if I refuse to enable her addictions. Maybe with time I'll learn to be more naturally accepting and kind.

So forgive me if I'm not there yet. I'm doing the best I can.


princess jen said...

That was beautiful. You are such a talented writer and a gifted thinker. I love reading your perspective. Thank you.

Matthew said...

This is one of the most profound things I've ever read by you, Mark. Well done. We all should try to keep the general idea in mind.

One thing that bugs me about the whole health care "debate" is when people say "I don't want to pay for health care for **insert some disdained group of people**" To me, that's just a non-starter.

What kind of society are we? That's the question. No system or society is perfect. Are we doing the best we can?

Dianne said...

Your nurse is a wonder. A powerful spiritual presence in your universe. "The best they can." It's what we all think we try for everyday. Most of us fall short every day. I look at my life and often say "I did the best I could" but in reality that's not true, it's a convenient and self soothing lie. I like to think I do the best I can in each moment. If I'm completely honest I know that I could have tried just a tiny bit more, been a little bit more patient, kept the exasperation out of my voice, not rolled my eyes.

If this then, is the best I actually do, how fair is it to hold anyone at all (even myself) to any other standard?

It isn't fair of course. And that is where compassion and kindliness enter the picture. Your nurse knows this. May God bless her richly.

Seth Jenson said...

Thanks for sharing. I can only imagine how difficult it would be to have patients like that and to try and be compassionate and empathetic. The temptation to be judgmental and one-dimensional in my thinking about that person would be overwhelming!