Difficult

When I was 16, I was… difficult. In the way that lots of teenagers are – a little angsty. A little bit of a bitch. A little… stealing shots out of my parents’ liquor cabinet so me and my friends could go dancing downtown. But I was also a difficult patient. At 16, I was injured, and needed a lot of surgeries. And although the patient-facing doctor’s notes described me as an“extremely pleasant girl”... I could tell you, that was a lie. I never did what the doctor ordered. I had “pain out of proportion to injury.” I think I yelled at my doctor once – maybe not, but I definitely wanted to.

But me becoming a difficult patient? Started way before I actually became a patient.

My roots are deep in Appalachian soil. And there’s a saying down in the North Carolina Melungeon community that much of my family is from: Don’t go gettin’ above your raising.

I can remember sitting with my sisters at our kitchen table every afternoon. We deciphered fractions or molded clay into dioramas or read To Kill A Mockingbird for the 7th time, cuz yet another teacher wanted to teach these Poor Southern Children about racism and didn’t check if the teacher last year already did. But then, the back door slammed, & the sharp smell of liquor cut the air.

I didn’t know what my dad was bringing home after his long hours at work – or the bar, if he’d been fired again. But whatever it was, I knew I was the target. Today would he.. hit me on the head with a baseball bat? Maybe he’d hold my elbow over the stovetop, telling me no one would think it was anything but a scrape. Maybe he’d come at me with a knife. And I’d grab my biology book and run out of the house, because, it won’t be safe to come back til he’s asleep, but I need to study.

As a kid, I learned to turn emotions off – cuz we got shit to do. We gotta go huntin for coins in the center console of the family Toyota. Then we gonna walk to the Food Lion, n hopefully we got the money for somethin, cuz if we don’t we ain’t finna eat. While we’re there, I memorize the number printed on the seats of the carts, thoughtfully placed at child height – 1-800-4-A-Child – the national child abuse hotline. One day I told my mom I’d call it. Do it, she said: Do it and then you’ll see.

When I went to school, I learned lessons I already knew. “School resource officers” maced kids; beat them, tore their clothes. There was this one cop – O.D. I don’t know what it stood for. Old Dickbag, maybe. Old Dickbag took a special interest in fucking with us. Between bells, he’d snap his tazer like a cattle prod – trying to get us to go faster. One time, coming out the trailers where I had AP government, I saw O.D. and some cop buddies had pinned 2 little boys to the ground – handcuffed, face down in the dirt. The spiral chain of the tazer was already in their backs, but O.D. yelled – “Do you want some more?” and tazed them again, and again, and again. The other kids and I were wide-eyed, but we kept walking. Violence was our repressed collective memory – best keep your mouth shut. Don’t go gettin’ above your raisin’. 

I didn’t feel lucky then, but in a way, I was. And not just cuz Petey Pablo, the guy who did Freek a Leek, went to my high school, which is lifelong bragging rights. I got spared from a lot of bullshit cuz I was a white kid, and because teachers thought I was “going somewhere.” School was one of my only ways to prove I had worth – and I did. Maybe not to myself -- but enough to attract the attention of some high falutin’ Ivy League motherfuckers. At one interview, one guy told me I’d get in anywhere I wanted, because “no one successful ever comes from where you come from.” Privileged white dudes never know that shit like that is not a compliment. But whatever – you can use me to assuage whatever guilt you got over the shit life gave you – for a price. Cuz some of these schools seemed to think I proved my worth in cash. Full scholarship baby! I had my ticket and I was deucing out – out of town, out of my school, out of my family -- middle fingers up, tits out, guns blazing, riding on top of a sick ass motorcycle shooting flames out of my ass.

But before I could get my ass in the seat, I was ejected from another moving vehicle – I don’t remember it, but I remember my leg doing the wave when I tried to stand on it. And I became a patient.

At first, I was a suuuper easy patient. I’d learned to bottle up my feelings – I didn’t cry, or take too much time. My whole life I’d never learned to advocate for myself – so I did whatever they said. I didn’t ask questions ahead of my first surgery. I took their prescriptions without question and got knocked on my ass by opioids for 24 hours straight.

The doctors fucked up the first surgery. When I didn’t get better, they wouldn’t admit their mistake. I told them I was in pain. They said I wasn’t. I was great at dissociating and dismissing myself – so I just accepted it – and believed them for almost a year.

Finally, a wood-paneled mobile MRI trailer proved my pain. As they fixed their mistakes, I was in and out of surgeries and crutches and wheelchairs for 2 years.  I felt like I had no control over my body or my life. It felt like I wasn’t being seen as a person, or seen at all. And so, I became “difficult.” I stopped hiding that I was upset with the situation. I never did the PT, I talked back, I stopped going.

Then, I needed a surgery. As a small part of it, the surgeon recommended they lengthen some tendons in my leg. It wasn’t absolutely necessary, and I didn’t want it. And I made that very clear. I thought we were on the same page. I can remember after the surgery waking up – sorta groggy, my eyes halfway open – and 2 figures coming into focus. It was my mom and my doctor. “You don’t have to tell her,” After listening a bit, I realized that my doctor had lengthened my tendons anyways – and she was trying to get my mom in on hiding it. “Oh, I’m gonna tell her.” My mom said. But it wouldn’t have mattered – the scars would have told me.

And I’m a difficult patient, right? You might think I’d scream or yell, or at least cry – but I didn’t have any fight left. Cuz I realized I had just taken too long to learn a lesson I already knew.  Affirmed over and over at home, at school, in the medical system. No one will protect you. Nothing is safe. You are alone. And you will never be enough.

Shockingly, this deep-seated inner monologue doesn’t exactly set one up to thrive. Trauma is a cycle, and my early adulthood played out just like the textbooks said it would. But I had more resources. So I ended up in therapy – and I did what the Freudians call “sublimating” – and I became a trauma and violence researcher. And I learned a lot about myself – like, my go-to response to negative emotions is to not have them. A foolproof plan – until they explode out of your body in the form of migraines and muscle tension and depression. With trauma, they say the body keeps the score, and the body is kind of a bitch about it. If I get reeeally sad, I can get these intense, shooting nerve pains, and when I’m super stressed, sometimes I measurably lose my hearing. I know it’s coming because my ears will hurt and everything starts sounding like autotune – I call it pain and T-Pain.

And I’ve accepted the corny truth that healing is a lifelong journey. But also, that kinda sucks. Sometimes I think – the things I could do if I didn’t to work so hard to get above my raising.

But what am I complaining. I’m in medical school! And as a med student, I’ve seen how quickly patients get labeled as “difficult” by healthcare providers. And to be honest, I see the utility of it. It’s a heuristic. Doctors are short on time and energy, and it’s a quick way to communicate about a patient or what’s going on in a room. At its worst, it’s a dismissal – a refusal to learn more. But even in those moments, I think many doctors are just sad and frustrated that they can’t help someone, when that’s why they got into the whole business. It’s easier to move on and feel better if that person is just difficult.

But I’ve seen that willful ignorance have terrible consequences for patients. And as a med student, what I lack in knowledge and skills, I make up for in time – and so I’m in this amazing position where I can learn the stories of my patients. I’ve also been learning therapy – as a therapist! – in a child PTSD clinic. I prop up my shitty little leg on a wedge pillow behind the camera and I invite the children into my Zoom room. And I have this one patient, She’d been in therapy for years and never really opened up. But working with her, I felt like the silences in our sessions were more tense. Sessions seemed to be moving faster – there were more questions, stuff felt more urgent.  I could sense it – It was time for that shit to be free. She told us her story – flat at first, staring at the ground. But the more she’s shared, she has bloomed. She is laughing, joking, cursing even. Do you know how incredible it is to hear a teenage girl let herself call her abuser an asshat for the first time? When she had space to share her sadness, and anger, and shame, she had so much joy waiting underneath. 

Working with these kids, I mostly just feel proud. But sometimes, I get to reflecting – with the prompting of my own therapist, I’m not gonna lie – I think about me, as a kid. Because I can remember what it was like for me – feeling like my feelings were too much, and pushing them down because I had no safe space to put them. But they’d boil over and I’d lash out at the smallest things, and I’d hate myself for it – and I’d think about how damaged and broken and difficult I was.

And I wonder if people could read it on me as easy as I read it on these kids. They might try to hide it. They might act tough, or lash out. But they are dying to be seen. I wonder if labeling patients as difficult prevents us from looking further – from seeing them. I wonder how care would be different if whenever we thought a patient was difficult, instead we asked “why”?

Now that I’m on wards, I see that same urgency – that same dyingness to be seen – in so many of the patients I see. And I WANT to see them – and to make them feel seen. To give them a safe place to put big feelings that they deserve. Because you have been through shit. Maybe you’re still going through shit. Because there is no “too much” of you that you could give me. Because you aren’t damaged or broken or difficult. Because if you say it enough, it starts to feel true: you are safe now. I am with you. And you have always been enough.