The Disruptive Patient

        This post was inspired by my Facebook friend Bob Rupe of ‘Bluegrass Motors.’  He recalled an interaction with a less than cooperative customer.  It brought to mind a patient encounter from years ago.

        It was a late night at the hospital.  Back in those days we did not have hospitalists on the staff, so we picked up a lot of cases on unassigned call.  (folks who needed admission but did not have a regular Doc)  A husband demanded to see me about his wife’s condition in the I.C.U.   I was down in the ER and went up to check on things.

        “My wife needs to check out.  You need to fill out the paperwork so she can leave.”

        “Uh, well, sir.  I understand that you want her home.  I tell you the truth though, it isn’t safe yet.  She needs to be on the cardiac monitor another 48 hours.”

        “Well, by God, I say it’s time for her to go home.”

        Uh oh. This was trouble.  “Why do you say that?”

        “For her to be in here looks bad for me.”  (Her problem was self-inflicted)  “It’ll get out in the community why she’s here, and I won’t allow it.”

        I tried one more time.  “Honest to goodness sir.  It isn’t safe.  It’s possible she could die.”

        He glared at me.  “You gonna sign her out or not?”  His voice grew louder.  “Do you know who I am?”

         I wanted to say, ‘Yeah, you’re the guy who is driving his wife crazy,’ but I held my peace.   I thought for a minute.  “Hm.  Let me go look over her chart.  I’ll be right back.  I need a cup of coffee; can I bring you one?”

        “I’ll wait.”

         In those days, we had just hired our first hospital security people.  I had seen Ben down in the ER.  Ben was my patient, an ex-Marine, about 6’4″ and 250 pounds.  He was imposing even without his side arm.  I went to the ER.

        “Care for a cup of coffee, Ben?”

        “Sure, Doc.”

        “I’ve got a fellow up in the I.C.U.  we might have trouble with.  Can you troop up there with me?”

        “No problem.”

        I went back to to the room.  Ben tagged along behind and waited at the door.

        “My friend Ben brought your coffee.  Care for cream or sugar?”

        “No.”

        “Me neither.  I like it black too.”  I sat down and sipped on mine.  “I went over your wife’s chart.  It isn’t safe for her to leave.  Ben here will see to it the word doesn’t get out in the community.  It’d be bad for a man of your standing.”

        “Hmph.”

        “Don’t worry.  Ben’s very effective.  Through the years I only recall him shooting one person.”

        Silence.  He seemed to lose his resolve to intimidate. 

        I was glad.  Use of force is against my code of ethics.  I always call in a specialist for that.

       The man’s wife recovered and went home in three days.  We lined up all the right follow-up.  They never came back to see me.  In a way I hate that.  I wondered how things went for her over the years.  That was one more mean-spirited man.

Dr. B

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10 Comments on “The Disruptive Patient”

  1. gargamel Says:

    Hi Dr. B.,

    one thing that slightly puzzles me in your medical stories is the point of view you take. Your narrative itself seems somehow detached, light-hearted and observing, while the subject of that same narrative seems to be a caring, involved doctor. As the subject of your narrative is yourself, this leaves some sort of discrepancy between your writing and your person.

    Unfortunately this is rather difficult to explain for me, as I am not a native english speaker, so I hope the above makes some sense.

    Observing this, I wonder how difficult it is for Dr. B. to keep balance between onvolbement and detachment. Does it come easily, or not at all?

    Do cases that don’t go well haunt you? From what I’ve read (and I read some ;-) ), I also noticed that you don’t seem to write about such things.

    Makes me slightly suspicious (not in a bad sense), because unfortunately dealing with sick people must lead to medical defeat on a number of occasions – surely often enough for a doctor that it sometimes “gets to him”.

    • drtombibey Says:

      Gargamel,

      These are great questions and deserve a thoughtful response.

      I think you are 100% correct that you have to have some detachment to survive. I go to a lot of funerals and it can get you down. Part of why I write is to deal with it all. The balance of concern and detachment is very hard to strike.

      And you are also correct that terrible failures can be hard to deal with. I remember early on in the heart attack ‘clot buster’ era when we decided to treat a lady with this new medicine and she bled out in her head and died. I cried over that one a good while. It always hurts.

      Some of them do haunt you for a long time.

      My book, ‘The Mandolin Case’ is about a failure. It was not my patient, but I knew the Doc very, very well. The book has a lot of objectives but a major one is to examine how a Doc and the system should respond when something goes very wrong.

      So, your comment is timely. Also I will try to post some other stories about failure along the way before the book comes out.

      There is no way a Doc can get everything right. All I know to do is try as hard as I can. My motto is “Just because I can’t be perfect ain’t gonna keep me from trying to be.”

      Dr. B

  2. Karen Says:

    Dr. B. I often wonder about people I’ve had chance encounters with too – even something as distant as seeing a person crying in the car in the lane next to me, or the way a woman’s eye shift when her husband says something to her. Maybe it’s a fascination with wanting to know ‘what happens next’ that keeps us writing??

    • drtombibey Says:

      Ms Karen,

      I think you are correct. I believe we press on as writers in hopes we might touch someone out there and make their life better in some small way.

      Dr. B


  3. Dr. B, I have no idea what sort of self-inflicted condition this woman was in, but it makes me terribly sad to think that she was in the hospital with a husband worrying about how her being there would “look like” for him. It’s horrible. It breaks my heart to think of someone so cold that they’d want their so-called loved one to come home only so as not to create rumors for themselves.
    I bet you need to deal with people like this all the time. Isn’t it things like this, though, that explain why some people will do anything to stay in the hospital longer and get treated by people who, if not directly attached to them emotionally, at least care about their physical health and want to make that aspect of them perfectly alright?
    The things you see and endure, Doc, make me admire your strength of character and resolve to no end.

    • drtombibey Says:

      msslightly,

      That was decades ago, but it still ranks as one of my sadder days in medicine.

      I read your comment out loud to Julius, my med student with me, and we both agreed you have enormous insight into this clinical scenario. Right on young lady.

      Dr. B

  4. Billy Says:

    Reminds me when I worked in a mental hospital. About the time a patient would start to to get better some family member would demand the patient released at once. We always thought they did it so the patient would maintain the status of mentally sickest when in fact they caused and supported his illness.

    • drtombibey Says:

      Billy,

      Honest to goodness in this case I thought the family member was far sicker than the poor lady in that I.C.U. bed.

      Dr. B

  5. junebugger Says:

    This is a very interesting blog and I’ll be returning often to read some more. Hope you don’t mind if I add you to my blog roll so I can check out your blog more often?

    Regards,
    Jun

    • drtombibey Says:

      junebugger,

      I am both flattered and honored. I am an old Doc who has been at it a long time. I have many stories to share. My hope as a writer is to at least make people’s day a little better when they drop by.

      Dr. B


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