Anyone who works in healthcare will understand the complex dynamics that come with caring for a patient who is crabby, frustrated, and possibly quite unkind.

Nurse Joyce Highland is assigned to care for Alf Cottered, an older man who was recently sent home with an indwelling urinary catheter. If you’re not aware, a urinary catheter is a tube that goes in the urethra and sits in the bladder, allowing urine to drain passively into a bag. I’m pretty sure if I was sent home with a catheter, I could be rather grumpy, too!

We also learned that Mr. Cottered was recently moved by the council into a new flat, and he was struggling to adjust to his new home. His water heater wasn’t working, and he was often annoyed by the noises from the small children who lived in the flat above his.

When you look at Mr. Cottered’s circumstances, it’s pretty easy to see why he might be feeling lonely, angry, and frustrated. However, he took his frustrations out on people who didn’t deserve it, like Nerys Williams and her children, and also on Nurse Highland. He took it a step further and made it clear he was distrustful of Joyce because she was Black and had an accent, going as far as telling her, “You’ll have to speak slower; I can’t understand you.”

We all saw the interaction; he wasn’t actually struggling to understand her, but he was using that as a microaggression against Joyce, in my opinion, to try to shift the power dynamic and make her feel small.

I think this is where the divide happens between people who are angry or frustrated because of their health or their circumstances, and people who are being deliberately harmful. Every single day, I care for people who have experienced frustrations because of the healthcare system. We know that women, and specifically women of color, have their legitimate medical complaints dismissed at alarming rates. Sometimes, these individuals have waited for several months for a medical appointment only to find out that their concerns won’t be, or can’t be, addressed that day.

Expressing frustration is always understandable, but becoming aggressive, hateful, or verbally abusive is never appropriate. Mr. Cottered was crossing the line when he spoke to Joyce in that way. I would like to say that racism was more openly acceptable in the 1970s, but recent events and social climates might prove that we are not as far beyond that history as I would like to sometimes think.

I really commend Joyce for maintaining her professionalism and continuing to care for Mr. Cottered, including going above and beyond by doing his shopping as he requested. By emulating patience and kindness, while also staying firm and calling out his inappropriate behaviors (like accusing her of stealing his money), it seemed Joyce really got through to him. This was evident by Mr. Cottered’s behavior during the water heater explosion.

When the explosion happened, I was a little surprised how emotional I felt when I thought that Mr. Cottered may have been in his apartment and either seriously injured or killed. He wasn’t a particularly likable man, but I could see that he was starting to seem apologetic for his earlier behaviors. When I saw that he had actually gone upstairs to check on the children, I couldn’t hold back my tears. He even ensured that Fred got the children out quickly, staying behind until help came for him.

Mr. Cottered displayed true selflessness in that moment, and I can’t help but think that without the kindness shown to him by Joyce, the ending of that story would have been very different.

When I am dealing with a patient who is deemed difficult, angry, or aggressive, I have to take a deep breath and try to put myself in their shoes. Health crises are scary, and people tend to lash out more when they are scared. Dealing with the American healthcare system is frustrating; there are referrals needed, long wait times for appointments with specialists, required co-pays, and sometimes people are still walking away feeling like nothing was done.

I am also aware that women of color are disproportionately labeled as “angry and aggressive” for being assertive and advocating for themselves. When I see a notation in a chart about someone being aggressive or abusive, I do take note of that and make sure there are safety precautions (like having another staff member aware and nearby in case I need assistance). But I also take into account that sometimes people are rightfully frustrated but maybe have previously taken it out in a way that was perceived as aggressive by a previous healthcare worker.

With all of that being said, there has been an uptick in aggression toward healthcare workers, which seemed to reach a boiling point during the COVID-19 pandemic in 2020.

Healthcare workers, particularly nurses, are at an increased risk of experiencing workplace violence than workers in many other industries. Per the CDC, healthcare workers make up only 10% of the workforce in the US, but they experience 48% of the total nonfatal workplace violence. This has led to increased rates of anxiety, depression, burnout, and post-traumatic stress disorder in healthcare workers. My workplace even has signs in the waiting rooms and patient rooms to draw awareness to this problem, stating that we know healthcare is a highly emotional topic, but that violence or aggression toward staff will not be tolerated.

Although Call the Midwife is a fictional television drama, I definitely find myself recalling some key moments from the show when I am in the middle of caring for my patients. I’ve thought of the midwives’ calm, direct voices during birth, sometimes even using phrases I’ve heard on the show!

The Nonnatus midwives have shown the importance of reminding someone in labor that they are safe, their baby is safe, and we are here for them. Reminding women of their bravery in the moment of birth is also such a beautiful sentiment that sticks with me.

After this week’s episode, I am going to carry the memory of Joyce’s exceptional kindness, without allowing someone’s harmful behaviors to slide under the radar. We can be kind but firm. We can understand someone’s difficult circumstances and their feelings of frustration without allowing them to be verbally abusive.

My appreciation for Call the Midwife grows with each episode. It's a powerful reminder that the struggles of healthcare workers are not new, and I am grateful that the show continues to offer both a crucial spotlight on these enduring problems and inspiring examples of how to navigate them with grace.