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Defiant, defensive and depressed, he was the highlight of my day.

Fam Pract Manag. 2011;18(3):44

Author disclosure: nothing to disclose.

Simple moments in our professional lives can often turn into life-long memories, giving us the utmost satisfaction and reminding us that our work is not in vain. I experienced one such beautiful moment in my residency practice this morning. It involved a 15-year-old boy (let's call him Casey) who has depression, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and many other diagnoses. His mother had been struggling to keep him out of trouble at school, and she tried to get him counseling but was unsuccessful because of insurance limitations.

So I met with Casey and decided to do some baseline counseling myself. After all, someone had to do it. He had seemed so sad the last time I saw him and had said he hated “everything and everyone.” That comment had left me worried about him for days. I decided to bring him back to make sure he was doing all right. He came in today with his mother.

During the session, he told me that he was enrolled in an emotional support class at school. He did not think it was a useful class. The other day the teacher was explaining different emotions using drawings of faces – happy faces, sad faces, angry faces and so on. Casey felt it was a waste of time, started fidgeting (he has ADHD, after all) and ultimately got into trouble for distracting the class. He was sent to in-school suspension for the day. When I asked him whether he felt bad about it, he said, “No, I helped everyone in that class. They were bored too!”

I almost chuckled when he said this. I commended him for being honest but explained that he has to be respectful to people around him. What his class was discussing could have been helpful to him, I said, explaining that when we understand our emotions and why we have them, that gives us the power to change the way we react to our emotions.

“But I already know them,” Casey replied.

I decided to test him. I asked if he could guess what my emotional state was. “Am I sad? Angry?” I asked him. “You say that you know how to read people's emotions, so tell me, what do you think my emotion is at this time?”

Casey looked into my eyes and without hesitating said, “Caring.” He paused for a very brief moment and then continued, “That's what I think your emotion is.”

My intern and I exchanged surprised yet happy glances. This young patient, who normally responded with defiance and defensiveness, had just paid me a compliment! It gave me a glimmer of hope for his future, and it reminded me that our patients – even the most troubled ones – really do recognize when we care.

Casey's visit was the highlight of my day, one of those moments to be treasured forever. Although these moments are rare and unexpected, they are worth more to me than anything of material value in this world.


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