Pray For The Bear

Empathy works both ways

John had been coming to the ER more frequently over the last year. He was a 6'5", bald-headed, black man with wide shoulders, a full and intimidating presence, a Barry White-deep voice, and a tendency to look directly at his "oppressor" as he yelled racial obscenities that invoked fear.

I often avoided picking up John’s chart because he was always just too aggressive for my taste, but this time it was looking like my turn.

Emergency rooms (ERs) have become the acute shelters for many in personal mental and emotional health crisis. Across the country, ERs have specific protocols in place to manage patients who present as emotionally disturbed or potentially violent or threatening violence. These protocols are designed to ensure the safety of the patient, the medical staff, and other patients in the ER.

The steps were clear: quick triage, involve security, verbal de-escalation, and, if necessary, medication. Despite the structured approach, it was becoming clear with the pointed verbal threats of violence laced with racial slurs, that the five police officers and two security guards in the room were going to need some medical support.

As I approached John’s room the intensity and tension in the air was palpable, I took a deep breath, steeled myself and hoped to find a way to connect with John and defuse the escalating situation.

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photo of Author

I am a solid 5'4" curly-haired black woman who believes that I am capable of most things most days. However, on this occasion, I was thinking an escape route to buy us all some time would be the best decision.

Why push someone who is clearly distressed, especially when there is no immediate medical emergency indicated by his extensive ER chart history and initial assessments? It's better to wait and let him settle down first. As a healthcare provider, I don't believe in using medication to assert control in a chaotic but non-violent situation just to expedite the process.

However, there are also times when initiating medical compliance is the bridge between decompressing a hot situation and alleviating the pressure of resistance from all parties. My attending physician suggested a “light first round, just to take the edge off” and I understood the assignment.

In our typical fashion, we had given him the standard "5 and 2"—5 mg of Haloperidol and 2 mg of Lorazepam, a combination of medications meant to calm him—though it never seemed to be enough to work on John. Being a fan of using food as medicine, and as therapy when necessary, I tried to appease him with multiple sandwiches. Unsuccessful after two turkey sandwiches and two dinner trays, I waited for him to go to sleep, hoping he would be calmer, softer when awoke.

Having shown up just past midnight, I let John sleep the majority of my shift. Around 5 AM, the security guards let me know he was awake and asking for the provider. Entering his room, I gently smiled at him as our eyes met. He was laying on the stretcher bed under sheets and blankets, calmer and nodding his head upwards to signal I was okay to come in as he had asked.

“I was thinking you needed the rest. How do you feel?” I asked.

He responded with a low grumbling growl. Now with a full smile and chuckle, I blurted, "I’m not afraid of you. Use your words."

He smiled, and I grabbed a chair. "Let’s talk about why you’re here and see what we can work out.”

He had verbally assaulted and threatened the police officers who were stationed in their police vehicle not too far from where he sheltered for the evening. Northeast Novembers can be brutal and when the bitter cold temperatures set in and suddenly the temperature dips from 32 degrees to 12 degrees, the slightest skin exposed to the air feels like a million tiny little needles stabbing you in the face.

John had been houseless for years. He told me he avoided the shelters because he could never get a good nights sleep, always having to defend himself or others from loud, abusive and sometimes intoxicated men. He said he had been kicked out of many shelters for getting into fights and sleeping on the street gave him peace of mind. 

John had gone on to tell me he had been a Marine, spoke five languages and when the tech Julio entered the room to take his blood pressure, he turned to him began speaking in Spanish. We were both in awe and when John saw our smiles and faces light up, it was as if a completely different man emerge. John was now radiating confidence, he was kind, laughing, smiling and telling us stories from his life as if we were sitting on a park bench.

“Well, go ahead, what other languages can you speak, I’m trying to learn French, so maybe we can work something out,” I joked. Without missing a beat, he turned to me and began speaking German, then French and then Italian. Just standing there in the room with him, we were caught up in his charm and charisma as he told us how long it took to learn each language and stories of the friends he met along the way.

It was then, in that moment it was just the three of us sharing and listening to one another talk about our lives and what we more we wanted to do and accomplish. John had inspired me to simply do more, learn more and to go after every goal.

After a few minutes I began to wonder why had he always so aggressive when he came to the ER?

John admitted to having a few mental health challenges but said he was mostly aggressive because he knew we would let him stay the night, give him food, and eventually the medication we would give him, would let him sleep. He said that by being aggressive and using his size to intimidate others, he found that fear could be a powerful motivator when you learn that most people operate from fear and aggression.

“So if I am aggressive enough I can make you fear me, and if you operate from fear as most people do I will get what I want. Plus Ive been to many ERs, even in the city, the medication dose you used doesn’t touch me.“

I laughed. “I wasn’t trying to sedate you. I was trying to alleviate your handlers, you looked tired.”

“If You See Me In A Fight With A Bear, Pray For The Bear" - Kobe Bryant on Mamba Mentality

It was a slow morning in the ER and so I sat and talked with John for almost an hour. He shared more stories of the wars he had been in, the things he had seen and the friends he had lost. He talked about his mother who was now living on the Upper West Side of Manhattan in a assisted living facility and how he would visit with her once a week. 

I asked him why he wasn’t yelling at me anymore and why he called me the N-word when he knew it was inappropriate. He said he thought he could intimidate me and was surprised it didn’t seem to faze me.

“I’m proud you didn’t let that word get you all emotional. You kept your composure, kept focusing on how you could help me.”

I kept a straight face, no smile, no emotion.

It was hard to figure out what he had meant by that comment, but he seemed pleased with me. I had won some points, for whatever they were worth.

By 6 AM, John was ready to leave. I tried to slow him down and wanted to make sure he was comfortable and had all he needed as he headed out and on his way. As he waved away the nurse and the discharge papers, he pointed at me and said,

”Aight’, I’ll catch up with you later.”

I nodded, “Aight John, I’ll see you, be safe.”

He strutted off in his remarkable blue paper scrubs.

Photo by Hanyang Zhang on Unsplash

It had been at least six months since I’d seen him and that evening in the ER was memorable, at least to me. I am sure he gives many people a hard time, but I was still taken aback at how much of an interesting life he had lived. I was sure I would eventually run into him, his mother and I lived in the same neighborhood and if he visited her once a week, the odds were likely that we’d cross paths.

It was a nice spring day and I was walking home from brunch with a friend as we enjoyed the weather that was finally cooperating. Headed north on Broadway near the 96th Street subway station I spotted a familiar silhouette in head-to-toe blue paper hospital scrubs. A second glance confirmed my suspicion, and once I recognized the tall, broken but determined walk, my face beamed a smile.

Our eyes met, he smiled.

“OMG, it’s John!” I loudly whispered and sped up my pace to get to him quicker.

Approaching him, I immediately reached out and up, like a small child, insisting on a hug and not a handshake.

I caught him off guard. His voice trembled, “How you doin’? You good? I ain’t seen you in a minute.”

Recollecting myself, excitedly I responded, “I’m good, yea, I'm not at the hospital anymore, I’m consulting now. How you doin’?”

Then, in typical NYC stranger small talk, we briefly covered the weather, the mayor, and the problems with subway and within a minute it was time to go. I asked him about his mom and if he needed anything. He said he was on his way to see her now and needed to get going.

“Don’t let me hold you up, I hope to see you again, John.” He reached down to give me a quick hug me, pivoted and walked away.

My friend who had been standing just off to the side of us looking stunned as John walked away asked me , “Do you know you just hugged a homeless man?

“What do you mean?” I replied, “That’s my guy John from the ER. He’s a Marine and speaks five languages, his mother lives over here and yea he’s going through some stuff, but who’s not?”

As we continued our walk, my friend, still in shock began recounting the scenario, as if I had not been with her the entire time.

I was just happy to have seen John at least once and once again he had made my day.

What I Know for Sure

Empathy works both ways.

John reminds me of my humanity and a classic lesson I learned very early on as a child: to not judge a book by its cover. Sometimes even the most raggedy books hold the most profound lessons in courage, sacrifice, struggle, and perseverance.

No matter the circumstances, we are all human, having made individual decisions with consequences that can alter our lives and at some point may place us at the mercy of a stranger seeking grace.

Being present, willing to be vulnerable, and patient enough to receive is the path of empathy and grace.