Reflection: What We Deserve
The man had wire-rimmed glasses covering a permanently furled brow as he voiced his deep distrust in the government. He hated almost everything about the Armed Forces except the access to VA cardiologists who “saved his life” multiple times. The previous day, he presented to the VA ER with a few hours of chest pain. His Troponin levels came back elevated, but his EKG displayed no ST-segment elevations. That morning, he had gone to the Cath lab, his 5th visit in as many years, for placement of a stent. We were preparing him for discharge, and it was my job to make sure he knew what to do when he went home. He stated that he did not want to have another heart attack. He had an extensive smoking history, and when I asked if he knew that smoking cessation would decrease his chances of a repeat heart attack, he replied, “Yes, but I’m not going to quit. I need to smoke.” He added, “If I have another heart attack, they’ll just fix me up.” I had grown accustomed to responses like this, but I still never knew how to respond. I asked him if he was willing to change his lifestyle to prevent future attacks, but he said, “Probably not.” His BMI was 38 and he was diabetic, qualifying him as morbidly obese, but he did not want to change his diet, create an exercise routine, or take insulin or any diabetes medications. I was stuck. How was I supposed to help him if he refused to help himself? I struggled to keep my gaze neutral; internally, I was getting frustrated. I asked him what his healthcare goals were, and he replied, “to keep living and not get a heart attack.” My lips had been in the slightest smile, holding hope for his future, but my facial muscles went limp. He felt that the VA should be making him healthy. He had given his life for the country, and he felt the country owed him for his services. He showed up to the VA hospital whenever he had chest pain, but he was unwilling to do anything to prevent recurrences. He was not the first disgruntled patient I encountered at the VA, but he was the most cynical and stubborn. Though I treated him with respect and provided the best care I could, on the inside, I felt angry. I felt like my efforts were for naught. I was providing him with the best care I could, but he would not take any of my advice to help himself. I knew I was supposed to be impartial, but I was tempted to spend less time, less energy on the man in front of me. If medical school has taught me anything, it’s that physicians are expected to love each patient unconditionally, and this love doesn’t always come naturally, sometimes requiring conscious effort, and sometimes not at all.
