Wednesday, June 27, 2007
One side effect of volunteering in an emergency room is that I hear a lot of cursing, either because patients are venting about their conditions or because they're being deliberately nasty to staff. The first category doesn't bother me at all; when patients cover their mouths and apologize for cursing in front of the chaplain, my standard line is, "If God really cared about bad words, we'd all be charcoal briquettes." To my mind, the apology is sufficient evidence that the patient meant no offense.
The second category's trickier. I'm generally inclined to see foul language as evidence of illness (especially when the patient's clearly suffering from a psychiatric disorder, or is under the influence of alcohol or other drugs). In those cases, the language is a symptom. Volunteers being trained to work in the ED are cautioned not to take anything personally, and patient profanity seems to me to be a prime example of that directive.
On one recent shift, we had a young patient (early twenties) who was having a psychotic episode and had been put in four-point restraints. Every other word was "F***!" I felt like I was on an episode of Deadwood. But interspersed with the cursing were poignant pleas -- "Will you sit with me? I'm scared!" -- and complaints about the "leashes." Everyone who entered the room was cursed equally, but the patient's youth and lack of previous history made everyone sympathetic. (Not sympathetic enough to remove the restraints, however.) Later, an anxious relative asked me if the patient had been nasty, and I said, "Well, there was a lot of cursing, but none of us took it personally. We all knew that it was a product of the illness."
Older, more hardbitten patients -- especially frequent fliers -- don't fare so well. I once heard a PA repeatedly telling a homeless alcoholic to stop cursing. The PA became progressively more upset; the patient stayed calm, cheerfully coming out with ever-more-colorful expletives. I wound up getting an earful from the red-faced PA, who was practically spitting in indignation. My response, I'm afraid, was, "Look, it's an emergency room. This kind of stuff comes with the territory." In general, my take on the issue is that people who treasure propriety perhaps shouldn't work in emergency medicine.
But I'm not working twelve-hour shifts, either. What about the nurse who's confided in me several times about how sick she gets of being cursed at, whose morale is being eroded by patients calling her names when she's trying to help them?
I thought about her when I read this news story about Northern Ireland's "zero-tolerance policy" on assault, either physical or verbal, on healthcare workers. One of the nurses interviewed in the article, who's been physically assaulted four times in the past five years -- and is also routinely subjected to verbal abuse -- thought the policy was a nice idea, but questioned how it would work in practical terms.
I don't think there's any question that physical assault should be a matter for the police. But verbal abuse, it seems to me, is a grayer area.
When does foul language cross the line from being a symptom to being a personal attack?
How can it be dealt with effectively?
How can caregivers maintain their morale when subjected to it?