Rebel without a Gauze

It had been one of those busy but rewarding mornings where nothing could throw off my groove. I'd reassured one patient about a scary test result, eased another's shoulder pain with a cortisone injection, and provided the open ear that a third needed. So when the first patient of the afternoon took my hand with a smirk and squeezed it hard, I wasn't fazed. But it wasn't one of those firm but friendly handshakes. This one felt mean.

I wondered if I'd done something. I was five minutes late but I'd apologized. John Stroup plunked himself down and stared at the floor. He was fifty-four, muscular and compact. His Adam's apple jutted from his neck like a sharp rock.

"How are you today," I said, affecting a bright tone. "It's been awhile since you saw a doctor here." He shrugged. I peered at my computer. The note from his last physical was brief and unremarkable—nothing about this seeming hostility. "Looks like it's been almost two years."

"So why're you asking? You have it right there."

I exhaled silently and tried a more professional tone. "What brings you here today?"

"Got a letter." Presumably, he was referring to a computer-generated letter sent to patients who hadn't been to the clinic in a while.

"Do you have any concerns about your health?"

"Nope."

I inquired about his work.

"Drive a truck."

"What do you transport?"

"Don't know, don't care." His muscular upper arms strained against the short sleeves of his black T-shirt.

If only I'd remembered what we teach our medical students to do when a patient cries, or is angry, or expresses some other kind of emotion. You don't ignore the elephant in the room: you address it. But it was too late. My patients were usually respectful and pleasant. I wasn't used to this.

Somebody knocked on the door. Need you for a second, the nurse's raised eyebrows said. "I'll be right back," I said and closed the door behind me.

After answering the nurse's question about another patient's blood pressure, I knocked and opened the door. Mr. Stroup was shutting a cabinet drawer. My mind went blank. At first I thought he was impatiently sliding the drawer in and out. But then I saw his handful of gauze pads. I drew my breath in sharply. "What are you doing?" I heard myself asking, my heart beating fast.

"Taking some gauze," he said. His upper lip curled like he had a bad taste in his mouth. "You want me to put it back?"

I looked at him, tongue-tied. I could see taking one gauze pad from an open drawer if he needed it. But opening a closed drawer and helping himself to a handful? Flustered, I tried to give him the benefit of the doubt. "Do you have a cut? Do you cut yourself at work?"

Stroup was silent. He stared at his sneakers like a sullen kid, determined, it seemed, to flaunt his defiance. I felt the blood rise to my face. I was uneasy confronting him, but he'd brazenly stolen the gauze in what seemed an intentional effort to provoke me.

"You might have asked me if you needed some." I sounded like a parent who'd lost her temper. I didn't like it.

A doctor's power goes without saying—we're the ones who make our patients wait, tell them to undress, elicit personal information, give advice, and prescribe treatment. But I don't push my agenda. I follow my patient's lead. And yet a mutual dependence is at play, like two people on a seesaw. Both parties must cooperate, adjusting as needed to keep balance, or nobody benefits.

Mr. Stroup had jumped off the seesaw and was letting it bang down hard, again and again.

All I wanted was to get this visit over with. I asked him to sit on the exam table and remove his shirt, and, eyes fixed on the wall, he yanked it over his...