The Dragon Within

A Reflection on Rage, Love and the Fragility of Care

"Courage is not the absence of fear, but rather the judgement that something else is more important than fear." - Ambrose Redmoon

Rage has been a companion of mine, one I know well yet still struggle to understand. It rises unbidden, simmering beneath the surface during a chaotic workday, exploding into clarity during moments of injustice. But beneath its fiery surface lies a deeper, quieter truth: rage is not just fury; it is love with its armour on. It is the refusal to let go of what matters, to abandon what is sacred. And yet, rage must be tempered, transformed. Left unchecked, it can corrode the very things it seeks to protect.

It began with Tommy. A patient who was hard to be with and even harder to hear, ravaged and savaged by life's relentless blows. He numbed his pain and dulled his senses with alcohol, a choice that seemed to define him to the world. But beneath the smell, the gruff exterior and the fear he could provoke, there was a gentle man. A man who, if you could reach him, might hand you a poem as a token of gratitude for your kindness.

A consultation with Tommy could never fit neatly into the prescribed ten minutes. He was the landmine, the hand grenade in your day, demanding more than you felt you had to give.

Journal entry - 21st February, sometime in the 2020s (a Monday)

Shuffling along the street ahead of me, in a stained coat, trousers hanging low and at risk of catching on the velcro medical slippers which cover his bandaged feet, I see my patient precariously crossing the road. Evidence that he is not housebound. I have to say he is - the system does not allow nuance, complexity, deep humanity to exist within its ever tightening walls. The referral forms with their tiny-minded boxes like bricks to build the rising walls of exclusion. But I know what's under those bandaged feet. It's a minor miracle that he is still standing, never mind walking. Evidence of the anima spiritus within, but perhaps not for too much longer.

Now I am at work and prompted by seeing Tommy, I pull out the stained poem he gave to me at one of our encounters last year. He titles it: Pigeons:

In the new morning mist I feed the pigeons oat seed They flock never sleeping They eat at My feet which bring life To a person with disability To live life in peace You find a quiet mind, joy in simple things A lorry goes by, they flock to the buildings That's the life of the Urban jungle Pigeon To live out life in a city

A reminder of viriditas, the life-force, the wildness within, the need for relationships, the unexpected wisdom dressed up as one who begs in the streets, seeking crumbs, finding nourishment in what others discard, what goes unnoticed.

I have been struggling to know how to respond to a colleague who burst into my room the other day, demanding that "something has to be done" about Tommy. His mess, his stink, his squalor make people uncomfortable. I think that the something we should do is to provide gentle support whilst generously listening, listening to learn about his life and his choices and allowing him to be - and however uncomfortable, we must do what is kind. We've spoken of such. He knows that his body is not for fixing, that the decomposing has gone too far. He's reaching the ocean at the end of the lane. He wants a little freedom and quiet from others' well-meaning interventions. The ones who would tidy him up, put him away. I think of the words that make me bristle: "weeds" and "vermin." The power of naming and labelling to separate, to justify harm. Is this part of our attempt to manage the discomfort of things we cannot control - to distance the creep, the mess, the chaos of it all?

Tommy lingered in my mind after that brief encounter on Monday morning. Maybe it was foresight for what came next.

Journal Entry - 23rd February

It's late. I'm tired. I'm really, REALLY upset and VERY CAPITAL LETTERS ANGRY.

How do I manage this? At work, I've been boiling over - furious, frustrated, ranting - on the edge of melting into deep sadness. I've written a long, ferocious email, but I won't send it. I can't send it. This rage can't be passed on; it needs transforming. I can feel the dragon's muscles twitching beneath my skin. Sarah Kay's poem rises in my mind, and I think of my father. The threat as he lifted his eyes, the power of his silent stare.

There is a beast in my veins that was birthed by my father. It is quiet, it sleeps through most nights. Tonight, sir, my tail twitches in the darkest caves. Be careful, darling. Your footsteps land heavy here. Your racket will wake the dragons.

So why this rage? Earlier, during an intense, overstuffed duty doctor session, Tommy's name appeared. The district nurses, who had been dressing his half-amputated, ulcerated foot daily, refused to go back. He was crying in pain. Could we persuade them to return? The short answer came quickly: no. They justified their refusal in ways that only make sense if you're working to an agenda that excludes patient care.

And I'm furious. But it's deeper than the immediate situation. Something about injustice, exclusion, damage, not being seen. My anger flares as I think of those rising through the ranks, managing teams when they can't manage the real work of caring. The nurse who refused to help, who couldn't meet my eye, wears the title "team leader." But she treads a path I will not follow.

The system saw something - a box unticked, an opportunity to dispose, to turn away. "Not housebound anymore," it decided, rubbing its bureaucratic hands. Another reason to hide behind protocols, rules, and tick boxes. Another wall in the impossible labyrinth. Manomaya - man-made, an illusion with the power to destroy.

I feel deep despair in trying to make the Sisyphean journey again with patients in our care. Like a Sherpa on Everest, each step weighed down with an ever-heavier burden, cracks in the ice spreading beneath me. Back-breaking responsibility: make sure no one gets injured; make sure no one dies.

And all this while the hypocrisy of shiny mission statements echoes: Committed to Compassion, Respect, Partnership, and Care. How dare they cheapen those words? Words penned by managers keeping their hands clean, secreted behind screens. Not like me this evening, covered in someone else's pus - the product of a failing immune system, and a failing system, struggling as desperately as I am.

Tommy and I were together in that mess, in his desolate, dirty flat. We laughed through tears and smoke. Urine and cigarette butts sat in a bucket by his feet - what was left of them.

"You look so young," he smiled.

We realised we were the same age.

"We've had different lives," I replied.

Time stood still. In the quiet, I tended to his dying foot.

"They won't cut it off, will they?"

I didn't reply. We both knew.

I unwrapped the sodden bandages, left unchanged for days after the nursing manager sent a petulant email discharging him, the words stamped with finality. "Patient discharged." A curt, cruel foot stamp of a NO. Then, bafflingly: "Kind regards."

Tommy tried to explain.

"I didn't mean to swear at her, but she just kept shouting, and I was in pain. She was so rough. She said they shouldn't be seeing me if I could walk."

But isn't that what we should be doing? Helping people walk, get up and get out?

Had I been accustomed to blindly obeying the barked regimental instructions of our compartmentalised system, perhaps I would have stayed in my box - the one marked "doctor." But, fed up with feeling trapped and locked in, I stepped outside. That evening, I became more than his doctor. I was his nurse, his advocate, his fellow sufferer.

I gently cleaned his wounds, wrapping his foot in soft, clean bandages - white, warm, and fluffy. A stark contrast to the dirt, mess, and stench surrounding us. In the shared silence, heavy with unspoken truths, we both knew what neither of us could voice: the inevitability of another amputation, the inevitability of systems failing those who need them most.

As I left, the smell of cigarette smoke clung to my hair.

"I'd give you a poem if I could stand up," he said.

"Next time," I replied.

The rage I felt that day wasn't just for Tommy. It was for the system that stamped "Patient discharged" with cold finality and signed off with "Kind regards." For the manager who couldn't meet my eye. For the mission statements - Committed to Compassion, Respect, Partnership and Care - hollow as sweet wrappers, all bright promise and no nourishment.

But my rage didn't stop there. It turned inward. Why did I care so much? Why couldn't I let it go? Rage, I've come to understand, is a mirror. It reflects what we value most - dignity, justice, belonging - but also forces us to confront our limitations. It asks: will we be consumed by the fire, or let it illuminate a path forward?

As I sat with Tommy, I felt the dragon stir. Its muscles twitched beneath my skin - the visceral force that comes from love and anger combined. Alongside it, my wild twin: the shadowy, untamed part of myself that resists authority, bristles at injustice, refuses to look away. The girl who stuffed pillows in her bed to sneak out at night. Who learned early to say "no," even when it wasn't safe to say so.

She is a force for survival, but she must be held carefully. The challenge is integration - honouring her strength without letting her cause harm rather than healing.

Care is messy, inconvenient, and deeply human. When I wrapped Tommy's foot in clean white bandages, I wasn't just tending a wound. I was bearing witness. And that, I think, is what rage in service of love ultimately asks of us - not to perform compassion, but to refuse its counterfeit. To notice what matters. To stay in the room.

The dragon doesn't need to be slain. It needs to be seen.