I could hear the cussing from inside the room and noted the awkward glances of nearby nurses and staff who turned to look and gawk. Even though I only sat a few feet outside the door, I ignored the increasingly loud litany of expletives and deliberately focused on the screen in front of me. He was my patient and I was doing my best to concentrate on his rapidly evolving list of medical problems, the electronic progress note already ballooning in front of me as I tried to prioritize multiple terminal conditions competing for attention. I scrolled through pages of old notes that were littered with repeating instances of phrases such as “lost to follow up,” “did not comply with therapy,” “uncooperative,” and the ever favored, “signed out against medical advice.” I paused and watched as a freshly berated specialist walked out of the room, sat down at a nearby computer, and dictated into his own note the word “belligerent.” The diction snob inside me was pleasantly surprised to hear a new and applicable word and so I inserted it into my note as well.
Last week my pastor asked me, “How do you keep from becoming cynical?” The question caught me off guard; it occurred in the context of a series of conversations on the struggles of caring for people in both spiritual as well as physical matters. My reply was somewhat flippant as I didn’t have a good response. The question was unintentionally pointed; Pastor Tom is a quick-witted man and one of the many reasons why I respect him so much is that even though he appreciates a dry and sardonic sense of humor, he intentionally suppresses it. By contrast, I relish in lengthy conversations about all things dark and cynical. In college I would rant about the evils of systems of poverty, child slave labor, sex trafficking. Nowadays I rant about urban violence, health disparities, child abuse, racism, Donald Trump. I am not shy about these views and justify vocalizing them as a mechanism for challenging injustice, but the genuine and curious nature of Pastor Tom’s question left me unexpectedly exposed to scrutiny. After all, what is justice and how does that apply in medicine? What is the root of cynicism and why are criticism and sarcasm so satisfying?