In lieu of an abstract, here is a brief excerpt of the content:The Transformation:Power in Persistence and PerspectiveTyler BendrickWe've got another meth napper," my resident stated. With an introduction like that, it is hard not to be immediately labeled as a "difficult patient." Being the only Spanish-speaking person on the team, I, a third-year medical student, became the primary point of contact for this severely injured patient. He was an only-Spanish-speaking, 36-year-old male admitted [End Page 7] to our trauma service (...) after he was hit by a truck while riding his bicycle. Unbeknownst to me at the time, the 14 days I spent caring for this man would become one of the most pivotal learning experiences of my medical school career. It changed not only how I understand and approach "difficult patients" but expanded my knowledge of the complexities and challenges of the current healthcare system and how we, as physicians and healthcare providers, can deliver the best care to patients with low health literacy and limited resources.So, what is a "meth napper?" I questioned. "Well, meth is a super stimulant," my resident explained. "When people are frequent meth users, they get used to functioning normally with high levels of stimulants in their body, reducing the normal regulation of wakefulness. When the amphetamine is removed (such as upon admission to the hospital), the body is left to fend for itself, and thus patients oftentimes sleep for 23 hours a day for about 3 to 5 days while their body works to detox and normalize hormones."As predicted, my new friend, "Joe," was napping when I first went to see him. Thinking back, the word "napping" does not accurately describe his level of somnolence. He was virtually unarousable, and I took to a sternal rub to wake him up at 5 a.m. after his traumatic exploratory laparotomy the night before. Once aroused, he was furious. "Estoy bien. Tengo dolor y tengo hambre," he grunted at me. (I am fine, and I am in pain and hungry!). "Ok, Joe," I replied in Spanish, "I am just going to do a quick exam and you can go back to sleep. We will give you medications for your pain. You had a big surgery on your intestines, so you cannot eat or drink right now. If everything goes well in the next couple of days and you start walking around, we can advance your diet." He begrudgingly let me examine him, never opening his eyes, and I left and went about my day.We continued this routine for five days. I would periodically check on him and usually found him sleeping. When awake, he refused to work with physical therapists, get up and walk or go to the bathroom, shower, use his spirometer, or converse with the nursing staff. He seemed completely disinterested in recovery. About day three, we slowly advanced his diet to clear liquids so he could quench his thirst. Sometimes his wife was there, and she would ask for updates, to which I could only reply, "We have to wait until he is more awake or willing to work with us." I was getting frustrated, as it seemed that his noncompliance was becoming his barrier to discharge.But on day six, everything changed. I went to check on Joe, and he was wide awake, vomiting, and irate. He shouted that he was in incredible pain, and his incision was wet. He was also complaining that he had not eaten in five days, and was insisting that we were starving him. Again, I calmly explained (as I had multiple times a day for the past five days) that his major abdominal surgery prevented us from feeding him until his intestines healed. We were giving him fluids and nutrition through his IV lines, so he was not starving to death. I rushed to get my resident to examine his oozing wound, and after a CT scan and an x-ray, we discovered what we feared: His wound had opened down to the fascia, "dehiscence," as it is called. On top of this, he now had a bowel obstruction, causing his vomiting. His lack of mobility for the past five days had slowed his... (shrink)

Abstract:This symposium includes twelve personal narratives from healthcare professionals who have worked with patients whose behavior, attitudes, or life situations make providing care challenging. At the lower end of the estimates, at least 15% of adult patient encounters are with patients described as "difficult" by the treating team, and these encounters often evoke feelings of dread, frustration, and anger in healthcare professionals. Verbal abuse of staff, repeat hospital admissions due to self-injurious behaviors, and negative beliefs about health may make providing (...) care to this group of patients a daily struggle. Despite these challenges, healthcare providers—especially those who work in an in-patient setting—are obligated to treat all comers, sometimes at the expense of their own mental health. This symposium aims to learn from health professionals' stories the kinds of struggles they face, the lessons they draw from those struggles, and the constructive responses they employ to work successfully with challenging patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I Know You Have to Stay … I Wish I Could, I Wish I CouldMegan K. SkaffIn the world of healthcare, I advocate for the scores of youth who have had Adverse Childhood Experiences (ACEs). I work to understand where the child has been so we can learn the extent of the trauma that the child has been through. While working for a facility as the Street Outreach Case (...) Manager, my priority was based mainly on one girl, let us call her Tawny. I knew Tawny was going to be a very difficult client to work with the moment I realized she did not trust anyone in her own life, let alone the facility I worked in. She would not talk to a single staff member. However, being her case manager, it was my job to get her to trust me so I could crack her case and really get down to the problems she was facing. I promised myself the day I met Tawny that I would never cast one judgment upon this girl, and I made good on that promise until this very day.I find it true that we are all raised in different situations. Tawny endured such horrific childhood experiences that she voluntarily entered herself into our organization. My specialty was the homeless and runaway case manager. Hence, the reason she ended up on my caseload. After running many different tests, I learned that her ACEs score was a ten out of ten. To her, everything she had endured that warranted this score was baseline normal; she did not see her experiences as traumatic, she just saw them as a piece of her life. For me as her case manager, looking at this ten was devastating. I wanted to know everything I could that went into this high score. I needed Tawny to learn to trust me so I could understand what was going on in her home life and better understand her and her trust issues.Just a side note, the staff around me strongly hated Tawny. The worst part about this was that she knew it because they vocalized it. The staff [End Page 5] was so horrible that they would not even pretend to her face that they liked her. The one job they had as staff—to make her feel welcomed and loved in an environment full of broken kids—they could not do. There was no question as to why I struggled to build a relationship with my most vulnerable yet strongest client. Tawny would not let anyone see her as vulnerable. She did not want to be vulnerable because to her vulnerability meant weakness.I was determined to build a solid foundation of trust with Tawny. It was difficult, but I did it. At best, this process took weeks, maybe close to over a month. After many days of her asking other staff, "why is this b**** still in here," and her finally, slowly inching closer to me to say, "Sup," and me answering, "Just waiting for you to talk to me." This answer would make her smile, even though she tried hard not to. As much as she did not want it to be true, I was the only person she wanted to hang out with on the floor. She did not want anything to do with the kids or the staff. She knew the kids on the floor were toxic for her, and she wanted a better life for herself. She knew the staff were toxic for her as well.She started to ask daily where I was, so I started making sure I was on the floor every day. I gave her my work cell and wrote it in the call book along with a message that she had permission to call at any time, no matter day or night. Staff hated that. I did not care. Let me tell you, she tested it to its limits. If she called me at 3:00 AM, I would answer. She would say she was calling to say goodnight; when really, she just needed to know someone would be there. She needed to know she could trust me... (shrink)