Palo Alto neurologist Kendra Peterson's poem “Difficult Patient” (Fall 2017 Intima: A Journal of Narrative Medicine), and the patient who inspired my “American Sonnet for an Addict” (Fall-Winter 2025-26 Intima) are prototypical victims of name-calling – a ubiquitous clinical behavior taught exclusively in the so-called hidden curriculum of medical education. These patients are our albatrosses, another name we ascribe, recalling the curse that befell the entire ship’s crew of Samuel Taylor Coleridge’s famous mariner following his killing of an albatross in the poem, “The Rime of the Ancient Mariner.” They curse us. They burden and encumber us.
The “addict” was offered up to me by the residents overseeing her care. On Fridays I conducted physical diagnosis rounds with the third-year medical students, asking our residents to identify patients with interesting physical findings who might be willing to allow our students to practice their physical exam techniques. The residents contacted me with great enthusiasm, describing her as "a hopeless drunk, in for the umpteenth time on her way to the grave," adding that she was, in fact, a "museum of end-stage liver disease." From the tone of their descriptions, she was one of those most frustratingly futile, hopelessly self-destructing patients who cause so many of us to roll our eyes and wonder why we should even continue to provide care.
In the face of such frustrations, we call them names. Peterson's difficult patient, too, had become the recipient of a long list of name-calling identities, outlined in Peterson’s poem as "a list of accusations," all clearly and officially documented in her medical record. Malingerer was at the top of that list.
Some might argue that our tendency to engage in name-calling is somewhat of a defense mechanism, a method of coping, a strategy for dealing with someone who cannot be helped. It’s a way of tying up an extremely complex patient with extremely complex health challenges in an all too tidy little bow. Once the bow is tied, we can walk away.
It shouldn't surprise us then, that such a patient might feel, as Peterson's difficult patient felt, "mistreated/devalued and dismissed." It shouldn't surprise us that patients who experience such mistreatment and dismissal might behave badly toward us, exacerbating the "burden" of their care, and earning their identities as albatrosses.
When the medical students and I met our "addict," and before any of them put their hands on her to explore the stigmata of liver failure, we asked her when she started drinking. She shared a story of incredible trauma, the loss of a son, the struggles of another son, the departure of her husband – a story, which we speculated, perhaps unfairly, was likely not known to any of her current caregivers. The weight of her story stunned us. We stood silently at her bedside, unable to commence our physical examination exercise.
In many ways, it seems, our name-calling allows us to implicate our "difficult patients" as the ones with the difficulty, and in so doing, we lose sight of our own difficulties, our own failure to recognize that underneath these assigned pejorative identities lies a suffering person. What would it look like if the stories we told about such patients started with that suffering?
The physician in “Difficult Patient” makes a conscious decision to attempt to look beyond the labels, to avoid being "biased by a chart review," to look more closely, more discerningly, to respond to her own senses: "I sensed that you were suffering." As the poet Theodore Roethke has written, she "recovered her tenderness by long looking."
What if these patients’ stories began with an acknowledgment of their suffering? Gregory Boyle, a Jesuit priest who has spent an entire career working with gang-involved youth, writes about awe in a way that connects with this concern. He writes about seeking "a compassion that can stand in awe of what the poor have to carry, rather than stand in judgment at how they carry it."
Our haste as caregivers to judge our patients’ behaviors, and place names upon them, blinds us to what they are going through, and why. Kendra Peterson’s difficult patient, and our sonnet’s addict, should compel us to ask ourselves whether we can stand in awe at what they have to carry, rather than stand in judgment at how they carry it. To truly address a person’s suffering, we must first see and acknowledge it, and as the doctor in “Difficult Patient” concludes, "believe" that they are suffering.
Footnotes
1. Coleridge, Samuel Taylor. The Rime of the Ancient Mariner. https://www.poetryfoundation.org › poems › 43997 › the-rime-of-the-ancient-mariner-text-of-1834. Accessed 12/9/2025.
2. Roethke, Theodore. What Can I Tell My Bones? The Collected Poems of Theodore Roethke. Anchor Books, 1974.
3. Boyle, Gregory. Tattoos on the Heart: The Power of Boundless Compassion. Free Press, 2010.
Joseph Zarconi is distinguished university professor emeritus at the Northeast Ohio Medical University in Rootstown, Ohio, where he recently retired as clinical director for health humanities education. He is a retired nephrologist and active educator, Zarconi, who is co-author of two books on narrative in health care, co-authored peer-reviewed work on topics relating to medical education, narrative medical practice, narrative ethics, humanism and professionalism, cultural consciousness, close reading, and social justice. A member of the NEOMED Master Teacher Guild, Zarconi has been recognized as a Master Teacher by the American College of Physicians.