Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Letting go of Your Agenda


Compassionate care requires that we trust our patients to guide us.

In my early twenties, three months into my first job as an occupational therapist at a small, rural hospital, I walked into Mr. Bennett’s room.


He had been transferred to our facility for rehab, and very much hoped to return to living at home. He lived alone and didn’t have any children. This was his second stroke, and he had a veritable catalog of comorbidities—poorly controlled diabetes, high blood pressure, hyperlipidemia, and depression.


Mr. Bennett was in bed with the covers drawn up to his neck and the sun shining brightly on his frowning face. I greeted him with an eager “good morning” and my warmest smile.


“I’m here to do your evaluation for occupational therapy,” I said.


“I’m not interested,” he scowled.


I walked slowly toward the bed clutching my clipboard close to my chest, hoping that if I exuded kindness, Mr. Bennett would warm up to me.


“OK. Why don’t I help you get dressed and situated in the chair?”


I gestured toward the chair tucked in the corner next to his bed. He gave me a frosty gaze.


“No. I’m not doing any therapy.”


“Everything we’re doing here is getting you ready to go back home,” I said.




I was determined not to let my waning patience show. I decided to try a more authoritative tack.


“You’re here for therapy. If you refuse to participate in therapy, Medicare won’t pay for you to stay here. I don’t think you’re ready to go home yet, do you?”


“I can see that you and I are not going to get along,” he said.


I took his statement personally, and I didn’t know how to respond.


“I can’t make you do anything you don’t want to do. I’ll come back this afternoon to check on you,” I said.


“Whatever. I’m not doing any therapy.”


After lunch, I stopped back to see Mr. Bennett and found him dressed and seated in the chair next to his bed.


“It’s good to see you up,” I exclaimed.


I used my professional voice to hide the fact that my feelings were hurt. For some reason, Mr. Bennett responded to another staff member’s urging to get out of bed when he so curtly refused mine.


“Do you feel ready for a trip down to the therapy gym? It might be nice to get a change of scenery for a little while.”


“I’m not going anywhere,” he said.


“We can certainly stay here if it makes you more comfortable. How about putting your slippers on so I can see how you’re able to move around?”


I handed him his slippers. Begrudgingly, he took them. With some grunting and exertion, he managed to position each leg, one at a time, across his lap and fit his slippers onto his feet.


“There.” He looked at me like an obstinate teenager, his patience clearly spent. I took a chance and pushed a little further.


“Wonderful! How about we stand at the sink and wash your face?”


“I did what you asked. Now, I’m done,” he said. “I’d like to see a sample of your handwriting—your signature. I can tell a lot from a person’s handwriting.”


I hoped this was my opportunity to forge a connection—I penned my signature on the top of a piece of paper and handed it to him.


“People who make the first letters of their first and last name like you do have a great deal of insecurity. Also, the way you take the time to form all of the letters in your name suggests that you’re inflexible and not very creative.”


And just like that, I was off my horse and on my ass.


It turned out that Mr. Bennett was right. He and I never did get along.


In the weeks and months following, I went over and over our interactions. I’ve always regarded myself as a likable person. Certainly, I’d had patients refuse therapy with me before, but I couldn’t understand why Mr. Bennett had been so angry and obstinate with me. I wanted the best for him.


I was good at my job . . . wasn’t I?


I talked about the incident with my colleagues.


“He’s just a grumpy old man,” they said.


I agreed. And yet, there was a nagging sensation deep in my gut that told me I didn’t fully believe that.


Now, I think I can see what Mr. Bennett saw. It’s painful to look at.


Mr. Bennett had endured suffering the likes of which I’d never known. I entered his space without regard for, or interest in, his experience. I failed to meet him where he was, and instead, presented him with a list of demands, poorly disguised as invitations. I’d believed the fact that I’d spent hundreds of hours in the anatomy lab, passing practical exams and excelling in my clinical training, meant that I knew what was best for him. I’d bought into the narrative that patients who don’t play by the rules are “non-compliant.”


Mr. Bennett taught me the importance of letting go of my agenda in order to see what’s actually in front of me. How to acknowledge someone else’s pain and hold it in lovingkindness. How to be a warming touch that reaches through isolation.


I wonder what Mr. Bennett would say about my signature now.