Looking for Anger

“It is easy to fly into a passion-anybody can do that-but to be angry with the right person and to the right extent and at the right time and with the right object and in the right way – that is not easy, and it is not everyone who can do it.”

Aristotle

He had been coming to see me for more than a decade. He was in his late thirties at his first visit to the office. An extremely sick young man with two serious and potentially crippling illnesses. There are strong genetic links to both of his conditions (later on I will let you know why I mention this).

An angry, foul-mouthed young man. Every other word that came out of his mouth was profane. Every other person that he runs into on a daily basis is deserving of a nasty word or gesture. Including his wife and children. He woke up with a scowl; he postponed his bedtime as much as he could because he could not find the inner peace that it would take for him to be able to sleep. He was tall, and strong, and nothing seemed to touch him. He existed in a state of perennial condemnation: a hell that his sickness augmented and reinforced at every moment.

I liked him. I am not saying that he was a joy to deal with, but I had a certain affection for him. At first I had to find a way to be able to tolerate his language (I hate profanity) because he was sick and he needed me. He had been through more than a dozen physicians. Maybe because he came across as such an intimidating force none of them had made more than perfunctory efforts to help him. When a doctor deals with complicated cases he or she has to be willing to accept some failures. I think that my predecessors were scared of failing to help this man. Maybe they were afraid of what he would do or say if treatments did not work or produced side effects. They did not try much.

I jumped in with both feet.

You have to try this medicine. You have no choice. It is expensive. It will weaken your immune system. You have to give yourself a shot every week. You will need surgery; it will be extensive and complicated. You will have to stop working for months. There are no guarantees. If you do nothing you will be crippled and disabled soon.

I rarely act in such a hard fashion. I knew that he needed this tough talk. That he would not accept any beating around the bush.

He gave me a look. But he quickly agreed to my terms. It was then that I realized, with significant compassion and understanding, how isolated he was. Not even his family was eager to help him. He had to do this on his own. He understood this well. He had found someone that knew what he was going through. In his own way he was grateful for my talk.

The treatment began. There were almost immediate positive results. The pain and stiffness went away. His energy improved. He even smiled during the next interview, when he told me that he was once again able to work his usual three jobs and seventy hours a week.

Why do you work so hard?

“I have bills. I own three rentals. I work my regular job, then I work on the side on evenings and weekends. My own things. I have three kids and a wife.”

That’s amazing. As sick as you have been…

“Not that any of them appreciates what I do. My wife is a ___ and my daughters are spoiled ___. To say nothing about my lazy, no-good son.”

I had to smile.

There is no way that you would do what you do if you did not love them. I can tell that you do not need much for yourself. You are only doing this for them.

Another look, this one of surprise. Maybe even a tiny bit of insight.

“You should tell them that.”

Why don’t you tell them? That you love them.

A loud burst of laughter from him. He quickly changed the subject.

The surgery came next. Many complications, which both the surgeon and I expected. Things had been allowed to go untreated for too long. Every time that he came to see me, he ranted about how stupid and incompetent the surgeon was. I responded, without fail, by calling the surgeon on the spot and speaking to him in his presence. Thus, he could clearly see that we were both on the same page. It took a while, but he became convinced that we were on his side. Soon after he reached this epiphany the complications ceased. He became able to lead an almost “normal” life. He increased his work week to eighty hours.

Why not slow down a bit?

“My daughters want this and that. My ___ wife never takes my side when I deal with them. My son is never home.”

For a while I had debated whether to delve into his anger. I decided that I knew him well enough to again jump in with both feet. His diagnosis was clear. I had to find a way to make it clear to him, without telling him how to get there.

Do you think that your children are scared of you?

He laughed.

“They sure don’t do what I tell them to do.”

Were you scared of your dad when you were a kid?

Silence.

“I still am. He’s a grumpy old man.”

He started to rise.

Sit down. Talk to me.

For twenty minutes I dug into his past. The story was typical. He obviously had ADHD as a child (and he still did). He could never sit still. His father, a hard worker like he was, was gone all week. As soon as he walked in the door on Friday evening his mother presented his dad with a list of my patient’s errant behavior for the week. A severe beating would follow. The harsh discipline continued for the duration of the weekend, until on Monday morning he would catch a break.

It must have been hard. The one person that you depended on; the man who was supposed to take care of you and love you, was someone who refused to allow you to get close. And your mom was no better; she was only too willing to see you suffer and in pain.

“You don’t understand. I was a hard kid to raise; I didn’t listen.”

You were a kid. The grownups in your life fumbled the ball. It was not your fault. You were born like that; it was your genes; the same genes that made your disease possible. I have no doubt that your dad had the same behavior issues that you had when he was a child. He gave you your genes; he had no right to torture and humiliate you like he did.

“I was tough.”

You were a kid. Not your fault.

Many tears now.

“My dad was mean. He is still mean.”

They did the same to him when he was growing up. He should have known better than to make the same mistakes with you. Not your fault.

Silence.

You go home and you talk to your kids. No; better yet; just sit and listen to them. Not a word from you. Particularly, no profanity. Just listen. Smile.

Two months later he came for his next appointment. I always asked my nurse, before I walked into his exam room, how severe was the profanity shower.

“No cuss words this time,” she said. She smiled.

He was doing great. He took some time off his jobs. He took his oldest daughter on a road trip (to his surprise, she had asked for one). They had a blast.

“She’s a good kid, you know?”

I nodded. “We get along real well now. I understand her.”

Maybe she understands you. She knows how hard you work.

He smiled.

He still had his moments, but he was a different person. He was promoted at work. Less manual labor, which was a godsend for him. He had a semblance of inner peace when he came in. He smiled more.

Anger. We seldom vent at the right person; in the right way; for the right reasons. All of us are born with flaws. Many of our parents fail to embrace us as we are. They want us to keep those traits that they appreciate; they many times humiliate us because we have other characteristics that scare them. Then their anger comes out. We begin to doubt our worth. We feel the guilt.

Listen to your kids. Find out who they are; what makes them tick. Do not set rules that they cannot possibly abide by. When they mess up, and they will, sit down and listen some more.

You are planting a seed. What kind of flower do you want to grow?