A difficult patient

My job is to care for people, we take all comers into Bighospital and we don’t discriminate in any way. Inevitably this means that every now and again we have patients who are either in prison or have recently committed a crime.

The two types of criminals that seem to generate the most hatred are rapists and drunk drivers. Violent criminals, burglars, even murderers are preferable and tend not to cause much upset. They are usually very polite and escorted by two guards who keep them in check.

We recently had a drunk driver (of a lorry) who had killed a family of three, mum, dad, daughter and seriously injured the son. The son was in ICU and we had operated on him, the drunk guy had been lucky and had minor injuries and was sent up to my ward.

When I went to see him I had spent three hours in resus battling to save the mother who died and then the son who lived but was critical. I noticed that I had their blood on my ankle as I sat talking to the drunk guy.

Drunk guy was still drunk, he was in the mood to be funny, he had lots of anecdotes about his own teenage son and about his annoying boss and quite happily confessed that he had been drinking all afternoon prior to getting behind the wheel.

I tried to cut him short with the tipsy banter, not really being in the mood for light hearted chatter, especially with him. The trouble with that plan was that he was actually quite funny. I figured it would be the last time that he would get to have a relaxed and normal conversation for a while and stopped trying to keep him to the subject of did he have any trouble breathing.

I let him tell me everything, examined him thoroughly, reassured him he was ok, there would be no serious sequelae of his injuries and that his priority was to sleep it off prior to seeing the police in the morning.

The police arrived a few hours later and told him that he had killed 3 people. I went in and sat with him, I told him how sorry I was. I imagined he must be feeling wretched. “I’ve ruined my life. I’ll lose my licence” he lamented. I left him to his thoughts and his hangover.

The next morning the amusing drunk was gone, in his place an aggressive and angry man. He wanted to see the medical notes (request denied), he then denied being drunk, he started insisting that he was seriously injured and wanted huge quantities of morphine. Lying on his bed was the headline of the local paper “family killed in road accident”, we all looked at it and back at him. “It was the other guy’s fault, not mine” he said. I looked at him and smiled in what I hoped was a reassuring and non judgemental way, “We are here to look after you, we aren’t the police, it doesn’t matter to us at all.”

Genuinely, I cared about this man, he was a father, a son and an employee. His family and friends were going to be devastated by this event, his life and career ruined. He would possibly never get over the consequences of his actions (I thought) and would have to live with it for the rest of his life.

I imagined how he would be feeling and how his family would feel; devastated I thought.

But this turned out not to be the case, they were rude, they were loud and demanding, accused us of neglecting him whilst we attended to the now dead family, attempted to steal the medical and nursing and notes and caused mayhem on the ward.

It was this that disgusted me, not the crime itself, but the lack of remorse, the lies, the attempts to deny responsibility. I managed to stay civil, to care for him properly as is my job, and I was relieved to discharge him the next day.

I examined my own conscience on this, I had no problem caring for him when he didn’t know what he had done, even when he was still drunk. It was his reaction to what he did that was hard for me to understand. I expected remorse and regret and when that was lacking I was dismayed. I expected his family to be devastated and supportive and they were not.

I’m not sure what this says about me as a doctor and as a person. My colleagues treated him like shit from the outset, as did the police. Maybe I should have too, then I wouldn’t have been so disappointed. It isn’t like me to be so naive, generally I am a hard and cynical experienced old hand with the junkies and the criminals.

I will follow the court case with interest, the notes may end up as evidence and if he contests them then I’ll be called as a witness. Part of me would be glad to recount it all in court.

(the details have been changed to protect identities)IMG_3853.JPG

drive safe everyone

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7 thoughts on “A difficult patient

  1. It just means that you are human and you care. You are a non-judgmental surgeon and that is something to be commended for. We all have patients like him and we try to stay professional by not letting our prejudices influence our clinical care. We are all human, we react to other people’s behaviors like human beings. You have done so well in this scenario, there not much you can do about this guy’s problems and I suspect it’s the guilt that is making him act this way. Obviously in denial and does not have the maturity to cope with it all. You have done your best! xo

  2. I don’t think you did anything wrong and in fact applaud you for standing above the others and providing him care as you would have done for any other patient. His lack of remorse and his willingness to blame the other driver is horrifying and the fact that is family acted no different is appalling.

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