Inclination to hate.

I heard the clang of handcuffs jerked against the metal sidebar of a stretcher and gave a knowing look to the officer guarding the door. I entered to meet my next patient, only to be halted by his verbal assault of crude and irate obscenities. I had slept well, and it was early in my day but I immediately felt fatigued. A man in his twenties, Mr Pence was handcuffed to the stretcher and being questioned by a detective. My attention fell to his right leg where a single bullet wound marred an otherwise healthy-looking physique. As I reached out to feel a distal pulse he responded as if my examination was purely motivated by a desire to annoy and prod him for my amusement. In other words, he was not a helpful participant in his care. “What brings you in today, sir?” I asked. “What do you think…I got shot.” “What were you doing?” (In retrospect I don't know why I asked). “Minding my own business.” The detective chimed in, “Fine, I'll tell her. You're not going to avoid people finding out.” I turned to him, my curiosity piqued. “This man was molesting a young girl in his neighborhood this morning when the girl's father came upon the scene. Mr Pence ran and the father shot him in the leg. We apprehended him about a block down because, as you can imagine, his speed was a bit compromised by this hole in his leg.” The story spewed out like vomit, grotesque and unexpected. I couldn't help but step back. I had to make a conscious effort to avoid distorting my face in disgust. Collecting myself, I examined the leg closely and found only a clean entry and exit wound through the lateral thigh. That angry bullet had somehow failed to sever the highway of vital arteries, nerves, veins, and bone that comprise the core of a leg. Three inches to the right could have meant death. I could not be sure exactly where the father was aiming but I felt disappointed that he had missed. I excused myself to form a plan only to find myself paralyzed by a primal abhorrence for Mr Pence and his actions. He seemed a vile, nefarious character with whom I would have preferred no association. I felt repulsed by my responsibility to him. It was my job to ease the suffering of a man who I felt would better deserve to have heaps of hardship and pain loaded onto his life, and now I was supposed to order him morphine. The pain was a reminder of the trauma he had caused to a young girl and I did not want to dull any pain for Mr Pence. I did not go into medicine for this. Being a neophyte in this profession, my medical knowledge of penetrating trauma was in an embryonic state at best so I consulted my colleague, a seasoned nurse named Alice, to teach me how to care for the wound. She gave me the assignment of supporting the leg while she cleansed and dressed the wound. Mr Pence screamed in protest to our manipulation and the entire emergency department was the audience of his next onslaught of cursing. Looking at the tunnel in his leg I thought back on the countless coincidental tragedies I had observed, such as a father who was struck by a car while helping a stranger change a tire or a child who had lost one eye to a congenital cataract, then was rendered blind in his good eye by a freak accident. I marveled at a universe in which this man's leg was the stage upon which a miracle would be played. Anger and disgust swelled in my heart but were quickly interrupted by the nurse's gentle correction, “No, No,” Alice said, adjusting my hands, “Hold here, to minimize the pain.” While I was caught up in my thoughts, Alice was busy cleaning the wound. Every detail of the endeavor was attended to with meticulous care and compassionate resolve. Alice soothed and apologized for the discomfort. She looked Mr Pence in the eye and softly reassured him of a positive outcome. Her job required that she treat the wound but her choice of benevolence dictated the manner in which she carried out her responsibility. As she rolled the clean white gauze around his leg I realized the fortress of my antipathy was no match for her compassion. In my eyes, Alice's actions transformed this man into a human, as deserving of my compassion as every individual should be. Mr Pence was not a good man, but that is certainly not the point. When I looked at him I felt disgust, arrogance, and condemnation: Alice showed me how to feel compassion as well. When I meet the next “Mr Pence” in the emergency department I hope I will follow Alice's path and choose compassion even when it feels most backward to do so. As I make that choice, I hope that others will be watching so that they too can be inspired to reject the inclination to hate. Then compassion will become as infectious as some of the diseases we aim to treat.