“Misdirected anger.” It was a phrase that stuck with me.
A resident used it to describe a family on the ward. Their loved one was in the final stage of illness. They had accepted he was dying. What they could not bear was watching him remain unsettled.
It was a busy medical floor. Multiple rounds running at once. Residents moving quickly, consultants asking questions, clipboards tapping on the counter, monitors beeping somewhere down the corridor. And in the middle of it all, relatives moving between beds, looking for someone who might stop long enough to explain what was happening.
The patient had advanced lung disease. He was agitated, breathless, and intermittently confused. The family kept calling the nurses back and stepping into the path of junior doctors, asking for a medicine, a change, anything that might bring relief. As the hours passed, their concern sharpened. Questions became insistent. Voices rose. The room began to feel tense, as if everyone was bracing for the next exchange.
When I arrived, the resident, otherwise capable and composed, said to me quietly: “Dr K, this family issue is misdirected anger.”
I understood why he said it. It is an easy phrase to reach for. On a stretched ward, repeated questions can feel like pressure. A worried family can start to feel like an obstacle. The label offers a kind of distance.
But I kept thinking about the word misdirected. As if the family had aimed their feelings at the wrong target. As if there were a more appropriate place to point their anguish.
What we were calling anger was anxiety showing itself as anger. The direction was painfully clear. They could see their loved one struggling to breathe, unable to settle, and they could not make sense of why it was continuing.
This is where trust quietly breaks down, not in one dramatic moment, but through small sentences that do not line up. One person tells the family, “He is on appropriate treatment, please bear with us.” A short while later, someone else suggests the opposite: “We need to escalate his treatment.” Both may be well-intentioned. To the family standing in the corridor, it sounds like the team cannot agree on what it is doing.
Then comes the holding line.
“We’ve informed the team. Someone will come and review.”
For the clinician, it buys time. For the family, it lands as uncertainty. They do not hear a plan. They hear a handover to an invisible person who may or may not appear. And when you are watching breathlessness and agitation at the bedside, waiting feels like abandonment.
So they ask again. They stop the next nurse. They step in front of the next junior doctor who walks past. Repetition becomes their only tool. Staff begin to feel chased. The family begins to feel ignored. And the word “anger” enters the room, and takes root.
In moments like this, the most effective response is rarely a perfect explanation. It is a simple acknowledgement, followed by visible action.
"I can see how distressing this is, watching someone you love in discomfort, not knowing when it will ease. Let me see what more we can do to make him comfortable."
That kind of sentence changes the temperature of a room. It tells the family you see what they see. It signals that comfort is the priority, not paperwork, not protocol.
What follows matters too. One clear message from the team, rather than three different updates from three different people. A name and a time, the palliative care team will come this afternoon, rather than a vague promise that someone will be in touch. When words are kept, even small ones, trust starts to return.
Involving the palliative care team early is not an admission of defeat. It is not stepping away. It is active, skilled work: symptom control, honest conversation, and the particular kind of presence that helps families feel less alone at an unbearable time. Naming it plainly, and early, removes the feeling that it signals the end. It signals, instead, that comfort is taken seriously.
I keep coming back to misdirected anger. It sounds neat, and it lets us move on quickly. But most of what we label as anger at the bedside is misunderstood anguish. It is the fear of watching someone suffer, with no sense of when it will ease. It is helplessness finding the only voice it has left.
Our intentions in medicine are usually good. We work long hours, we carry the weight of multiple patients, and we are trying to do right by everyone. But families do not experience our intentions. They experience our actions, our tone, and our clarity. They experience whether we stopped, or kept walking.
In the final days of a life, those details are not small. They shape what the last hours feel like. They shape the conversations that happen in the car on the way home, and the ones that come back months later in quiet moments. For many families, they become part of how grief settles, or does not.
A phrase, a pause, a sentence that says I see what you are going through. These are not soft extras. They are part of the work.
Dr K.
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