by Kellen Squire
A while back, I was acting as the triage nurse in the emergency department I work at. It was an incredibly busy day; not quite a “oh $#@%!” on the busyness scale, but dang close. We had patients piling up in the waiting room, some who’d been there for hours, and it seemed like every time we’d start to make some headway, an ambulance would come in with a patient having a heart attack, or someone would roll in the front door having a massive stroke. At one point, I realized I hadn’t had anything to eat, drink, or even had a chance to pee in ten hours- and then marveled that ten hours had gone by without me realizing.
Y’know. Normal, everyday nurse stuff.
In the course of all this, I was triaging a patient, asking them our normal intake questions; what brought you to the ER, how long have you been feeling poorly, do you have any significant past medical history, etc, etc. All normal questions, all normal answers. Everything was moving smoothly, and I was already mentally starting to run our triage board to determine who to see next, who was next for a bed, and if I needed to cajole our charge nurse to get a couple discharges out the door.
And then I asked a very simple, but essential, question: “Do you have any drug allergies?”
“Oh, yes,” the patient said, confidently. “I’m allergic to Advil.”
“Allergic to ibuprofen, okay,” I said. The patient frowned, clearly annoyed.
“No,” they admonished me, “I’m allergic to Advil. I can take ibuprofen just fine.”
“Err, do you mean maybe you’re allergic to the dye?” I asked, as “normal” Advil-brand ibuprofen is generally dyed with Yellow #6, and some people indeed have allergies to food dyes.
“No, no,” the patient insisted. “Just the Advil part.”
I’ve been in the emergency department for almost ten years now, so I have to deal with that sort of thing on a regular basis. Whether it’s the nineteen year-old young men who come in, shifting uncomfortably from leg to leg, and tell me they just have no idea how they got that infection, to the people who bring in printouts from WebMD and inform you the abdominal pain they’ve had for three hours is metastatic brain cancer, you learn early on to have an unassailable poker face. Roll with it, and move on.
Which is exactly what I did. I paused for a second or two as I felt a few days slip off my life expectancy, and then simply said, “Okay,” and freetexted a note to that effect into the patient’s chart, since our presorted drug allergy window doesn’t differentiate ibuprofen and Advil. The rest of the triage process went without a hitch, and the day for me ended a few hours later.
But when I was driving home, I came back to that interaction, and mulled it over in my mind. It was bothering me for some reason… but I couldn’t quite put my finger on why. It wasn’t until later on, when I was having a mutual bitch session with a Democratic activist from Northern Virginia that the implication of my interaction hit me full-force. We took a break from talking shop and I mentioned in passing the interaction I’d had with the patient. My friend snorted, and asked if I’d corrected the patient’s misunderstanding.
“No,” I said, “I just made a note of it. We were so busy; I had more important things to do.”
My friend laughed. “Well,” she chuckled, “you’re not a very good Democrat, then.”
And then it hit me like a lightning bolt. Because I knew exactly what she meant.
What would a “good Democrat” do? Why, they’d stop everything they were doing- regardless of how many people were waiting, regardless of what the patient’s condition is, regardless of anything else, pat their hand understandingly, and go “Well, ACTUALLY…. if you can take ibuprofen, ibuprofen and Advil are the same thing, you see chemically the FDA requires generic and brand medications to-” on and on for the next twenty minutes.
We have to stop doing that. Yeah, the patient was wrong- but guess what?
It doesn’t matter.
It didn’t matter to why they came to the ER that day- and I’d argue it doesn’t matter for anything, ever. They didn’t think “bleach was bleach” and came in with chemical burns to their head. They didn’t excise their own cancerous growth with a pocket knife because it was “easier”. No, they’re just gonna buy generic ibuprofen when they go to the store. Nod politely and move on.
That patient wasn’t stupid, they just didn’t have the medical background to understand the whole story. So I did exactly what I should have- asked a brief qualifying question, made a quick note in their chart, and moved on to more productive things, things pertinent to the problem at hand and where I could connect with the patient.
I don’t have time to list all the reasons someone is wrong to them. I have an infinite problem– healing people- and finite resources with which to accomplish it. So I need to find the most productive way to get that done that’ll make the biggest impact to the most people. Instead of sitting there telling the patient they’re wrong, I need to find out where common ground exists and how to reach this patient on as deep a level as I can. Because my job, every single day, is to engage people on things they don’t understand or don’t really want to do– enlist them as a part of their own care team- so I can help heal them.
Try convincing a patient suffering from hypertension- who may have no symptoms other than me telling him the machine says his blood pressure is high- that he needs to take this pill every day for the rest of his life. Oh, and it’s not cheap, you might pass out after taking it the first few times, you’re going to wake up five times in the middle of the night to pee, you’re not going to be able to have sex with your partner, etc, etc. As you might imagine, this doesn’t usually go over so well. I know full well how deleterious high blood pressure is to someone’s health, but they just can’t comprehend it- especially since they can discern anything bad is going on!
Sure, I could tell the patient “Hey, well, if you don’t take the meds, you’ll be in a nursing home for the twenty years after your stroke getting spoon-fed and sponge bathed,” and then shrug helplessly when the patient storms out after throwing away his prescription. I mean, I told them the truth- right? I tried. If they don’t want to help themselves, it ain’t my problem; I tried to help them, after all, didn’t I?
But it is my problem. It’s all of our problem. Because we all bear the cost for when those things go wrong.
This is readily applicable to the political realm, where the most pressing issues of ours time- things like climate change, healthcare reform, the rise of authoritarianism, et cetera- are often oblique and hard to visualize for the majority of people, unless it’s had a direct impact on them personally. “Two degrees warmer? So it’ll be 60 instead of 58 in spring? Whoopity doo. Eh, all politicians are crooked, stuff like this has happened before. They’re not going to come for me. Both sides are bad.” Etc.
Which is where storytelling comes in. Relating issues to people at a kitchen table level. Letting them know you understand where they’re coming. Giving them examples applicable to their lives, and their experiences, of both the problem and the solution. Listening to them- really listening, and not just waiting for your turn to talk.
People don’t need it dumbed down; they’re not stupid. They just need it in a frame of reference that makes sense to their lives if you want to make the biggest impact. And this is key, because evidence shows that even the wonkiest of wonks among us tend to vote with their hearts instead of their heads.
People like Senator Elizabeth Warren, Congresswoman Lauren Underwood (a nurse herself), rural activist Sarah Smarsh, Mayor Pete Buttigieg, or former Congressman Tom Perriello, and you’ll see they get this implicitly. If you want an example from right here in the Commonwealth, I can think of no better person than Delegate Sam Rasoul of Roanoke. A self-described “brown kid from Roanoke with a funny name” I joked to him once that I needed to nominate him as an honorary redneck because of the ease he interacted with and built a rapport with “everyone from NOVA to ROVA-” the Rest of Virginia (which, yes, we should “bother” to go to).
Though in listening to all of them, and having met her in person, I’d say Senator Warren probably does it better than anyone. She gets the need for storytelling as her primary “method of attack”, and also recognizes that while she could probably ignore policy, she’s going to show she can do storytelling and wonk. I’d imagine this is why she’s had the most heat from the Trump folks because they understand this dynamic, too. It’s what Donald Trump’s candidacy was built on. Stories made to connect with just enough voters to push him over the edge in the electoral college, but with no substance whatsoever.
We need to take that dynamic and use it for good, instead of evil.
That’s what I want to see at all levels, whether you’re running for school board to state senate, District attorney, Lieutenant Governor, or President. We don’t need immaculately groomed candidates with focus grouped talking points and perfectly coifed hair, ready to leap into the center and engage in “both sides-ism” and take their place as another “Solomon Politician”, ready to cut the baby in half and declare it equal for everyone. We need good folks who’ll undertake the arduous and thankless task of relating values and fighting unapologetically for working Virginia families in every corner of the Commonwealth.
Kellen Squire is an emergency department nurse from Barboursville, VA, and former candidate for the Virginia House of Delegates. He’s not running for anything in 2019, but there are plenty of good folks here in Virginia who are! Here’s a link to our House of Delegates candidates, State Senate candidates, and local candidates up for election this year. Help us keep the Blue Wave moving onward!