When is it OK to Give Up on a Fellow Human?

As we peer upon a struggling soul, none of us know whether we’re witnessing the last of a dying ember, or the beginning of a bright flame.

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Photography by S.J. Objio - Unsplash

Back in my days as an emergency room physician assistant, we had to answer the question - “When do we give up?” - all too often. When the heart of a patient ceased beating in any meaningful way, we would perform CPR, administer electric shocks, and then drugs, until an effective rhythm returned . . . or it didn’t.

But it was never that simple.

Had anybody checked for a “Do Not Resuscitate” order? “No bracelet, no necklace, no family - then proceed.” Protocols were adhered to, but every minute of inadequate brain perfusion translated to ever-increasing levels of permanent brain damage. So, with rare exception, it was complicated.

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When it comes down to the unknown guy on the street or a struggling relative, deciding when to give up becomes even more complicated. Case in point!

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Not my actual patient but you get the idea - Photographer of selfie unknown.

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Through the 1990’s, my main gig as a PA was in a small Family Practice clinic in upstate New York. It was twenty miles from the nearest sizable town. Our building was nestled behind Main Street and across the parking lot from the town’s only grocery store and some marginally maintained apartments.

One afternoon I was the only provider working, with a receptionist, a nurse, and a coding person on the main floor, and the administrator in the basement. I was trying to chart on my most recent patient, when I heard some very loud yelling off in the distance.

My office was right next to the back door. As the yelling and screaming got progressively louder, I got up from my desk and had started walking toward the exit door when it burst open. A woman in her early twenties sprinted past me through the narrow hallway toward the right. Just a few seconds behind her was a man in hot pursuit.

Even as a slow reader, I was able to decipher the “F’CK YOU” in block letters tattooed across the front of his shaved head. Instinctively I did what I’d done hundreds of times before. I stepped in front of “my patient,” extended my hand and grabbed his -though more aggressively than usual. “Hi, I’m Mark VanLaeys, a physician assistant - - can I help you?”

He wasn’t in a chatty mood and within a very short time had broken free. But in that short interval, my always dependable nurse had pulled through. She had apparently almost thrown his girlfriend downstairs where she hid until the state police arrived about ten minutes later.

I don’t remember the details of what happened the rest of that afternoon. There were still more patients to see, though I believe we “lost” a couple with the ruckus. The next morning, I walked in the back door of the clinic as always. The receptionist came to my office - “do you remember the guy last night?”

After acknowledging with a smile, she said, “he wants to talk to you.” Knowing that my first patient was already in the room, I reluctantly asked her to “send him in.” A minute later he came into my office with a baseball cap covering his mildly anti-social tattoo. This time he extended his arm across the desk to me. “I’m really sorry about what happened yesterday.”

When the clock stops

I walked over and closed the door behind him. He sat down and aired a long line of mistakes that he had made throughout his life. He was in his mid-twenties but had already spent years in prison for attempted murder. He was still on parole but shamefully admitted that he kept making bad choices.

He referenced the tattoo on his forehead and then lifted up his tee shirt revealing a full-chest-sized swastika. Yesterday’s out-of-control argument was nothing new, it was just the freshest example of a life-long trend.

As I reflect on the two encounters above, I struggle to get past the enormous amounts of pain, guilt, and anger that were housed in such a brutalized vessel. He was living proof that the effects of addictions, child abuse, and grossly inadequate parenting skills don’t stop at the border between one generation and the next.

With enough of the right outside support, there would have been a fighting chance that he could have broken free from his past. But how many of us would have been able to, if we had grown up under similar circumstances? This guy had built more roadblocks for himself than most of us encounter in a lifetime.

The overall trajectories that our lives take are determined by relatively few things. Some are bestowed upon us, and some we take on ourselves. In a perfect world, only the latter should be subject to our judgement. We’ve all made bad choices, but for a large portion of us, there were loving forces that kept the momentum of bad choices in check. My skinhead patient had not been so blessed.

Please feel free to share your thoughts - others might be comforted or inspired.