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  1. Irvine, Cyndy BSN, RN

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"TAKE SPECIAL CARE of him!" I want to yell as I watch the nurse guide the wheelchair with the scruffy gray-haired man into one of the ED exam rooms in our small rural hospital. That's Mr. M, from my neighborhood. I know he's a bit rough looking, with a stubbly beard, dirt under his fingernails, and stained overalls. I know he seems gruff and not very approachable. I know the first thing you might recommend is a bath, a good long soak. "But if only you knew him," I want to say as the nurse wheels him out of my sight.

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Having just started the evening shift, I'm caring for my own patient, a woman with worsening heart failure. I can't leave her to advocate for Mr. M. I hope he's okay.


More than what you see

I think of the nurse I'd seen wheeling Mr. M toward the exam room. I know she probably wouldn't choose to be caring for him. I want to apologize for his appearance and tell her that I know he's an odd fellow, disheveled and untidy. That if she had her choice, if she could choose between him and the patient in the next room, the sweet-smelling lady with the soft white hair, I know she'd most likely choose the cleaner of the two. Again, I want to tell her that Mr. M is more than what he appears to be.


Soon after, I see the ED physician head toward the room. I cringe because it's the new, young, well-scrubbed resident from Chicago-I hope he can see past Mr. M's appearance.


Mr. M's story

In our rural neighborhood, Mr. M is known as the "can guy" because he often parks his old pickup truck along the road and searches the ditches for aluminum cans accompanied by his hearing-impaired friend, Mr. B. Mr. M lives in a dilapidated farmhouse on his old family homestead. He seems to be a loner, except for Mr. B.


The local story is that Mr. M was once a jolly fellow who worked hard and ran a prosperous dairy farm. He married his childhood sweetheart, who grew multitudes of beautiful flowers around the farm. Together they began a family. And then came the measles epidemic. First Mr. M's infant son and then his young daughter succumbed to pneumonia. Just a few weeks later, Mr. M found his wife's lifeless body in the creek, where she'd slipped and hit her head. It was 3 days before neighbors could coax Mr. M from the little cemetery back to the empty house, where he's lived alone ever since. Like Mr. M, the farm has fallen into disrepair, the barn collapsing and the fields reverting to goldenrod and milkweed.


Small signs

These days, Mr. M fends off real estate developers hungry to purchase and subdivide the old homestead. But a resolute Mr. M holds out and chooses not to sell. Perhaps grief has worn him down so he has no desire for whatever a sudden influx of money could buy him. Instead, he prefers to look for cans in the company of a companion with whom he doesn't have to speak.


Mr. M's story lies buried beneath an unappealing appearance and demeanor. Perhaps Mr. M needs to carry an explanatory sign. Perhaps Mr. B would too, were he to come through our hospital doors. Maybe we can envision for each of our less "desirable" patients a small sign on his or her chest that would say, "Treat me kindly, for I have my story."