The Best They Can

I work with a great nurse, an RN with years of ER and OR experience on her resume. She maintains a healthily humorous view of needy patients, exhibiting some of 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 even our most difficult patients, and face to face she always gives them the best of her compassion and kindness.

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 damaged body with a defeated soul, at the end of their rope, whose health and social situation was as depressing as it was desperate  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. 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.' We're all doing the best we can. I guess this is what that looks like for her."

The best they can. Over the succeeding months, she and I 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, within their capacity and experience, try 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, taking the debris of their lives and attempting to refashion something usable, even beautiful?

We all have survival instincts, and many of us are stuck permanently in 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 oxycodone and sedatives every day and living with an abusive man who at least pays her some attention. 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.

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