Anger: Friend or foe?

Anger is an energy which can be used in both positive and negative ways.

John D. Kelly IV

While on call several weeks ago, I experienced what orthopedists regularly endure – the “bumped case syndrome.” There I was in the operating room where my innocent, edentulous and frail elderly patient was lying patiently on the gurney about to be transferred to the OR table. I was eager to fix his hip and improve his life. The poor fellow had been waiting for 2 days in pain — the victim of other “urgent cases” receiving higher priority. Suddenly, I received a phone call from anesthesia stating I could not proceed and that another, more urgent, case was to go immediately.

Frustrated, I called anesthesia and pleaded my case to no avail. When I left the OR to compose myself I came upon the other ‘urgent’ case. The patient was resting calmly in the hallway without telemetry, without oxygen and in no distress. Aware of the dishonest transaction which had occurred, I ‘got my Irish up’ and I confronted the other attending surgeon. I expelled some words I am not proud of and was ready to ‘escalate’ the confrontation as I saw necessary (feel free to interpret).

My angry discharge did not resolve the situation. My innocent patient did not get his bipolar hip until about 3 hours later and I was certainly emotionally drained by the whole affair.

In retrospect, I could have handled this whole matter much more constructively.

Anger as an ally

In his book, Make Anger Your Ally, Neil Clark Warren states that anger is a powerful emotion which, when tempered and used appropriately, can help us to effect positive change. Warren explains that anger arises from the activation of three emotions – fear, frustration and hurt. More importantly, he advises that when angry it is best for one to take a step back and ask oneself three questions:

• Why am I angry?
• What do I really want?
• What is the most constructive means of achieving what I want?

Let’s apply Warren’s method for my ordeal.

Why was I so angry?

Clearly I was frustrated. This innocent victim of the ‘system’ had been languishing all weekend, waiting patiently for the care he deserved. Truly I wanted my patient to simply get fixed and be able to eat a good meal. As I contemplate the affair further, I realized I was hurt as well. My grandmother raised me and was the primary caregiver of my childhood. My grandmother and I enjoyed a special closeness and, consequently, I have developed a special affinity for the elderly. I took this whole affair personally because I saw my grandma in this old man’s eyes.

A personal goal I have for my own emotional development is to take stock of what “I bring” to a situation. I am slowly getting to know my emotional triggers and recognize some of my old wounds. In his book Notes to Myself: My Struggle to Become a Person, Hugh Prather, MD, stated that if we want to learn much about ourselves, ask ‘What pushes my buttons?” Usually an old hurt lingers behind situations that cause us to flame up. Perhaps I re-lived an old emotional hurt from a previous authority figure or caregiver who denied my wishes.

Finally, I was somewhat fearful. Perhaps I was afraid this would happen again or maybe the principals involved were taking advantage of my generally good nature.

What did I want?

I wanted to do the case as soon as possible. My patient was medically cleared and the sooner the surgery was performed, the better the outcome.

Believe it or not, emotional discharges rarely serve their intended purpose. Rage causes separation, not mutual solutions. Extreme anger obscures reason and increases anxiety and tension. It promotes the violation of boundaries with respect to civility and respect for the dignity of others. Had I approached the matter assertively but calmly, I suspect a much more positive outcome would have ensued.

How to make anger your friend

Since it is nearly impossible to eliminate anger from our lives, the following are ways to use anger in a positive way:

lIt is OK to be angry. We cannot prevent feelings from occurring. It is what we do with them that matters. Whenever we feel our blood boiling, it is useful to develop awareness of our anger and take a step back and “frame” the situation as Warren describes – the why, what and how.

lTake ownership of what “we bring.” What emotional trigger am I experiencing? What old hurt was just activated? When we own up, we bring our best selves to encounters.

lDropkick judgment whenever you can. When we judge others’ actions it stokes the flames of anger. I judged my colleague as being dishonest and scheming. I didn’t know all the details of his case and didn’t ask for his opinion. I would have been more effective if I had focused on just the facts. Leave judgment at the front door.

lAppeal to others’ “angels.” There is goodness in everyone and had I appealed to my fellow surgeon’s good side, he may have permitted me to proceed with the case. Stating the patient’s age, his delay and the fact that he was already in the OR may have prompted the surgeon to reconsider.

lRespect the dignity of others. When we “name call” and threaten, we are not respecting the dignity of others. We are serving as poor examples for our residents and staff and are only escalating the matter away from resolution. Angry discharges may feel good for a few seconds, but they generate much collateral damage. Likewise, when someone is abusive to us, we are better served by turning the other cheek and focusing on how to achieve what is best for our patients. Most obnoxious behaviors from others are merely a sign of their woundedness or emotional fragility. Do your best to remain calm and not engage in the ‘dance of anger’.

Positive forces

In the final analysis, we are our patients’ most important advocates. We cannot lose sight of what is best for them and how best to achieve it. I am not advocating the stance of emotional wimpishness and letting others walk all over us. I believe we should all strive to be positive forces for those who are entrusted to our care. This requires great strength of character. As one noted theologian stated, “There is great strength in gentleness and great gentleness in strength.” Remember, assertiveness is not aggression.

Next time you get bumped take a step back and decide to act for your patient in the most effective means possible. Anger is energy: We can channel it to create the outcome we want. It does require great discipline, character and awareness.

Take it from me, it does get easier. Make anger your ally … both your patients and your blood pressure will benefit.

Reference:

• Prather H. Notes to Myself: My Struggle to Become a Person. Bantam Books. 1983
• Warren NC. Make Anger Your Ally. Living Books. 1999.

John D. Kelly IV, MD, can be reached at University of Pennsylvania, Dept. of Sports Medicine 235 S. 33rd St., Philadelphia, Pa. 19104-6322; 215-615-4400; e-mail: johndkellyiv@aol.com.