I settle into the bent-wicker chair on my lanai and try to relax. It’s a perfect island day, the temperature warm, the breeze cool, and I gaze out over the pool to the tops of the coastal mangroves. I’ve just come home from a shift at the local free clinic, and my mind is occupied by the work we did today. My fourth-year medical students encountered some difficult patients, and we struggled to get them the care they needed. In particular, I spent twenty minutes talking down an angry man with suicidal and homicidal ideation, and as I sink deeper into the fluffy tropical print cushions, I am wondering why I was not afraid. I would have been years ago, I think. I should have been today.
My mind buzzes with minutia. The dog needs a bath. The sheets and towels need washing. I must get to the grocery store. I have two stories I should write. I should go walk on the beach. As a pelican soars overhead, I say to my mind: freeze-frame.
- A still image in a cinematic work made by showing a series of identical frames or by stopping a film or video at one desired frame, usually representing the suspension of action or time.
- A vivid, motionless scene or image.
I began saying this phrase to myself during the last year I had with my father. I would be someplace with him — a ballgame, the pool, a restaurant — and I would realize that we were nearing the end of our time together. I would be overwhelmed with the thought of my life without him. “Freeze-frame” was a way to deal with all the emotion that I felt. I would clear my mind and simply experience that moment, savoring everything about it, embedding it my memory. The breeze on my face. The smooth feel of my father’s wrinkled skin where I touched his arm. The way he breathed while he slept in the sun. I pushed out my fear of his death and focused only on him; I stopped time, if only for an instant.
I found myself doing the same thing today in the clinic. My student told me about his patient, a man with multiple problems and no resources to deal with them. He was unemployed, homeless, and in pain. We tried to gather medical information about this man by looking through old records; all of his problems seemed chronic and unsolvable. Why was he here at the medical clinic?
“He’s so angry,” said the student uncomfortably. “He’s saying some concerning things, and I don’t know what to do.”
“Well, let’s go see him,” I say. “I’ll think of something.”
We return to the room, and I pull up a stool at eye level with the patient and sit close, touching his arm. This is not my usual approach, but the man is clearly in distress. My student is leaning against the sink, wide-eyed at my physical nearness to this dangerous man. He is indeed angry, cursing his life, the system, society, and everyone in it. Responsibility is pushing in on me: for my safety, the student’s education, the patient’s mental health. I want to run away, leave the room, call the cops, do what I had always done in the ER, but I don’t. I freeze the frame.
I concentrate on the other two people in the cramped exam room. The patient, whose problems are both real and overwhelming, and my student, who needs to see compassion and empathy modeled in my approach. I must show him how to care for the unlikeable, the dangerous, the other. At the same time, I need to assess the level of threat this man poses for us and for our clinic. For a moment, I can place all these thoughts aside and listen.
The man tells me his story, and I offer no excuses, no explanations for what has happened to him. I don’t judge the validity of what he tells me. I sympathize, I confirm, I encourage. At first, he is still angry, threatening to jump off a bridge or shoot the next person who annoys him. But gradually, quietly, we have a conversation. I am able to ask him about his statements, and come to an understanding of what his intentions might be. And I see a way out of this situation as he gradually looks me in the eye.
“Will you do me a favor?” I ask. The man looks startled, but nods. We then begin to negotiate details of a visit to the local walk-in mental health clinic. At first, he is adamant in his refusal, but eventually agrees some help with the stress and anger might be beneficial. He promises to come back in a week and let me know how he is doing. I tell him that even if I can’t help with his problems, I can still care about him. And I do, in this moment of frozen time. Earlier in my career, under other circumstances, I didn’t have this ability to conjure mindfulness in the midst of chaos, to freeze-frame an encounter, to exist outside myself.
Later, after the man has gone, my student says, “He really opened up to you. He was a lot less scary.” We focus on the “doctoring,” talking about safety and never being alone in the room, how to inquire about suicidal and homicidal ideation, when to quit and when to persevere. The student saw a way to take an unpleasant situation and prevent it from deteriorating to the point where all therapeutic value is lost. And I learned something vital about myself: how to work through my own fear.
At home now, I freeze another frame. I savor the salty air, the warm sun on my forearm, my beautiful home. Great white egrets and parakeets fly past. The water sparkles. I let my responsibilities fade from thought. I did a good thing today, and I thank my father for the gift of freeze-frame, through which I can find peace.
Maureen Hirthler is an emergency physician.
Image credit: Shutterstock.com