Eulogy for a Troll

[Names have been changed to protect the innocent (and the guilty)]

troll definition

Jack was an asshole.  A mean, malingering, histrionic jerk who seemed to be placed on this earth purely to torture healthcare workers.  To know him was to loathe him, and boy did we know him well.

With over 200 ER visits under his belt, every doctor, nurse, tech and paramedic had a Jack story.  He had just enough legitimate medical problems that you could never ignore his chief complaints.  He would show up with actual disease just often enough to always keep you on your toes.

His tormenting of the EMS system was the stuff of legend.  He used to find a payphone right at the state line and call 911, knowing full well that it would take the ambulance crew longer to get to the hospital (and thus give him more time to receive IV fentanyl for his 10/10 pain).  One day he pulled that trick, came to the hospital, got worked up and discharged, took a free Medicaid ride back home and went to the same pay phone and called 911 again.  The man had big brass balls.

payphone
Reach out and torment someone.

Nurses would fight over who got stuck taking care of Jack.  His veins were shot.  He was verbally abusive.  He had an insatiable appetite for Dilaudid and turkey sandwiches.  Nurses who heard the familiar medic radio report would hold on to their current patients until Jack had safely arrived and been sent to a different assignment.  I can’t blame them.  As a doc I can walk in and out of the room as I please.  Jack worked that call bell like if he hit it enough times he might win a prize.

ER docs didn’t mind taking care of Jack, but they weren’t particularly looking forward to it.  The tough part wasn’t caring for him in the ED.  The tough part was trying to get consultants to come see him.  You see, the legend of Jack went far beyond the ground floor of the hospital.  Hospitalists, cardiologists and surgeons all associated the name with B.S.  More seasoned ER docs would never reveal Jack’s name when calling a consultant.  “Chest pain rule out, room 8”.  Some gifts are best experienced in person, rather than over the phone.

Docs and nurses talk about our frequent fliers like they’re old battle scars.  There’s a perverse pride that comes from dealing with the steady stream of nonsense.  Sometimes we shake our heads.  Sometimes we laugh to the point of tears.  At no time does anyone say they regret working this job.

It was a cold January night when the medics brought Jack to me looking like death warmed over.  He was febrile, tachycardic and as jaundiced as could be.  “I think I finally did it this time, doc.  I think I fried my liver”.  At that moment I saw something in Jack that I had never seen before:  fear.  In all the times I had attended his performances, I had never seen legitimate fear in his eyes.

icterus

Jack had every right to be afraid.  With a lactate of 17 and a pressure tanking his instincts proved to be right.  After ordering IV fluids and broad spectrum antibiotics I got on the phone with surgery, GI and the ICU.  Every conversation went the same way:  “You’re not going to believe it but Jack is septic and he’s crashing.”  To their credit, each consultant put their biases aside and rushed to the bedside.  They treated Jack as good as they would have treated the CEO of the hospital.  I was proud of my colleagues for rising to the occasion.

Ultimately, their efforts were in vain.  On ER visit #219 Jack was admitted for septic shock and died the next day.  It felt like the hospital should lower its flags to half mast.  At the very least they should have lit a candle next to a turkey sandwich and vial of Dilaudid.  Word spreads quick in the hospital. Within 24 hours everyone had heard the news.  A legend had died.

troll toe tag

A funny thing happens when you’re dead.  All the bad things you’ve done seem to be a little more palatable.  Your redeeming qualities seem to shine a little brighter.  For the past week the doctors and nurses have been retelling Jack stories to each other.  There’s a little something extra in our voices when we tell the stories now.  A mixture of pride and wistfulness gives the stories some extra flavor.

Jack’s obituary was in the paper today.  At no point in any of his 219 visits did anyone see a single friend or family member with him.  For all I know, they never knew he ever set foot in a hospital.  The obituary listed all the friends and family that loved him and missed him.  They described him as kind and generous – the kind of guy that would give you the shirt off his back.  Attached was a photo of him smiling ear to ear wearing a tuxedo.  I don’t know if that was the only picture his family had of him, or if that’s truly how they saw him.

Everyone in healthcare has their trolls.  Some can be mean.  Others can be soul-sucking.  Some trolls wake up in the morning, look in the mirror and ask themselves “who can I torment today?”.  Although they may seem indestructible, all trolls eventually die like the rest of us.  I’m glad I drew the short straw on visit 219.  Seeing Jack in that state reminded me of his humanity as well as my own.

Somewhere out there a bridge is missing its troll, and today – so am I.

Rest in peace, Jack.

What do you think?  Who are the trolls in your life?  When an infamous legend dies, does it change the way you feel about them?  Do you exchange war stories with your colleagues and wear them like badges of honor?  Share your thoughts and comments below.  

 

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14 thoughts on “Eulogy for a Troll

  1. Very powerful post SHS. It is an interesting phenonmeona that death brings when retelling a person’s life. You are right that the bad tends to get pushed under and the good is what is really reminisced about. Interesting dichotomy between his hospital persona and that mentioned in the papers of what his outside friends and family thought of him. I wonder which part of the spectrum he truly laid in.

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    1. People are complicated. I bet he was kind and loving to his family, even if he was a colossal jerk to the rest of us. I’ll give him the benefit of the doubt that his family truly loved him. However, I refuse to believe he wore that tuxedo on a regular basis.

      I wonder who will read our obits one day and think “I can’t believe people loved that jerk!”

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  2. Powerful story SHS. Even those that annoy us the most are human beings and it is our duty to treat all who walk in through the hospital doors with respect and dignity. The post makes me proud of our profession and I’m glad to be called doctor. Great post!

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    1. I never know where I’m going to get an idea for the next post. When I saw Jack’s obituary in the paper it slapped me in the face.

      I too am proud of our profession and the compassion my fellow docs demonstrate in even the toughest of circumstances.

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  3. Enjoyed this post very much.
    In my profession the ‘troll’ would be that one student who pushes your buttons. But it’s not quite the same – we see kids nearly every day so we see their good days as well as their bad.
    RIP Jack.

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    1. My wife taught 8th grade special ed for 13 years. She had her share of “trolls” as well. You’re right – seeing them day in and day out gives you a better appreciation of their highs and lows.

      I’m not cut out for teaching kids. I’ll take the chaos of the ER any day.

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  4. “A funny thing happens when you’re dead. All the bad things you’ve done seem to be a little more palatable.”

    You see death way more than I do of course, but I never thought of it that way. Very interesting observation….

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    1. Usually I’m the guy standing at the foot of the bed while the dead guy’s loved ones are saying goodbye and reminiscing. I’ve never once heard someone say “good riddance! That S.O.B. Is finally gone!”

      You know there had to be at least a few jerks in the bunch. Seeing the deceased rendered powerless somehow absolves them of their sins.

      Liked by 1 person

  5. Thanks for this post, SHS. It’s a perfect Memento Mori.

    All ER docs know more than our share of Jacks, but I’ve also known gentle trolls.

    My favorite was a homeless man of sweet demeanor, a benign and slightly enigmatic presence who checked in almost daily for the duration of my residency with the same nonspecific chief complaint and always felt “better” after half an hour in the hallway. Never caused rancor and never asked for meals or favors. As a result, he received meals and favors in abundance from our staff, who felt it their job to look out for his well-being.

    A friend once got a psych consult on him, revealing a delusional belief that the air in the ED was therapeutic or curative, as if our department were Warm Springs, Georgia and he was a paralyzed FDR.

    He taught me to seek more than I was given. On each successive visit I’d try to learn one new detail about him. Where he grew up, the number of siblings he had, his prior employment, what this particular tattoo meant. This once helped me detect and treat a dental abscess I might otherwise have missed. More importantly, it helped me understood I could not take his immortality for granted.

    On my final shift before graduating, he walked through the door. I asked him if we might take a photo together so I could remember what he’d taught me about becoming a physician, and he grinned widely and obliged.

    Years later I’d hear about a cancer diagnosis and eventual death from a former attending.

    These days I try to perpetuate his delusion a little bit longer – that my ER is a place where sometimes the only healing thing I can offer is air (words), comfort, and connection to another human being.

    Your piece brings it back, and for that I thank you, SHS. Rest in peace, Jack.

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    1. The gentle giants are some of the most interesting trolls of them all. We had one such troll who had a chronic abdominal wound but suffered from short term memory loss. Every time he discovered the wound he panicked and called 911.

      Aside from having no recollection of his wound, he also had no recollection of ever being in the hospital or meeting any of us.

      At some point I gave up trying to convince him we had met before. Instead I would just ask him about the time in his life he could remember. Eventually I found out that he used to live in my childhood neighborhood several hours away. I wonder how many times I was his troll riding my bike through his yard. Life is funny sometimes.

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  6. Between SHS and Crispy Doc I’m getting all teary eyed.

    One of the things I like about being a pediatrician is that nearly everyone gets better. Most children are healthy and if a child was healthy before getting sick and admitted then they are going to leave healthy.

    Knowing this makes caring for sickh kids a bit easier.

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  7. This was a great post SHS. Every specialty has its flavour of trolls.

    In the ICU, a sick troll is pretty easy to deal with. They are genuinely so sick and fragile that it is easy to have empathy for them. They also don’t talk much on a ventilator. It’s more commonly the troll families that come out from under the bridge that wear on us. It is like they were all grown from the same material. It can happen – I remember that from my younger hack & slash Dungeons & Dragons days. I am not talkinq about the folks that are just genuinely grieving and have anger as a part of that. Some people are just nasty and manipulative. Either way, we have to be empathic professionals or they pounce on any moment of weakness.

    In D&D, trolls were best dealt with using fire. I think the Financial Independence and RE-focusing aspects of FIRE are useful here also. I remember struggling to handle trolls when I was more stressed and needed to work whether I wanted to or not. It is much easier when you aren’t burnt out and have an escape option if desired.

    -LD

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  8. One of the services during my internship had a patient like this. If I remember correctly he was an asthmatic with cocaine and opiate addiction. I admitted him10 times in a two month rotation. I never left his room without having to fight off a request for a PCA or just a small dose of dilaudid. I heard he died a few months later. I knew many people who died that year but I only remember a few and he was one of them. He knew you knew he was full of it but served his addiction over his emotional intelligence. He is a symbol of humanity that I carry with me many years later.

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