“Do your duty in all things.
You cannot do more. You
should never wish to do less.”
– Robert E. Lee
I originally met her through a social connection, but soon after she became a patient, as did many of her numerous relatives. I liked her the best. She was bright; slender; funny. She gave me a typical story: married soon after she finished high school; pregnant a couple of times; husband employed in highly seasonal manual labor. Frequent and sometimes excessive alcohol use; occasional dabbling in cannabis. As I got to know her better it became clear that she was smart and dedicated enough to accomplish anything that she wanted to do. She could have been a professional. Instead she lived from paycheck to paycheck, mostly because no one had set any expectations for her. She was cute and funny: why should she get educated? Surely she’d find the right man…
She was healthy. She came in for the occasional cold, or UTI. There were many times that I tried to talk her into going back to school. She always replied that she felt overwhelmed. Her income was needed. Her children ate up a chunk of her time, and her husband did not see any benefit in investing on an education. Most of all, she did not believe in herself. The idea of being in a position of responsibility where she supervised several employees made her panic. She was convinced that she was not fit for that kind of job, and no amount of coaxing from me would change her mind.
One day she called the secretary to ask for an urgent appointment. She said she had a case of “nerves” that could not wait. When I walked into the exam room I immediately noticed a profound change. She was unkempt. She looked like she had lost weight (that she could not afford to part with). I saw a very faint tremor. She held many pieces of paper in her hands.
“I know this is not a medical problem. I just don’t know who to go to, and I’m at the end of my rope.”
Talk to me.
A long story. She worked in a medical office. She was hired to do clerical work, but in time her employer picked up on all of the positive traits that I saw in her. He trained her to draw blood, and do vital signs, and take histories. She moved on to help with the billing, and to do anything that the other employees were unable to do. She was playing the roles of office manager, nurse, and receptionist. And of course: she was getting close to minimum wage.
The doctor was kind to her, and trusted her judgment. Things went along well until the doctor failed to show up for work for three weeks. No explanations were given to her. She was told to tell the patients that there was a family emergency. They were asked to go to the emergency room if there was a serious issue: no other doctor was left in charge.
Once he came back she noticed a drastic change in his behavior. He was never on time. During office hours he would disappear into his office for forty minutes at a time, even when patients were waiting. He left the office late at night; most of the time he was typing away at his desk. Lab and X ray results were not looked at for days.
Her workload increased. She left the office an hour or two late, trying to pacify the distressed patients. He was not paying her for the overtime. The last straw came when he took her aside one day and told her that he would heal a certain patient by the sheer force of his will. He would perform a miracle.
She could not sleep that night, nor any of the subsequent nights. Her day was spent returning angry phone calls. She saw that people were in pain, and that treatments were not being prescribed. When she felt at her wit’s end she snuck into his office to see what it was that consumed so much of his time. These were the papers that she held. With trembling hands she gave them to me.
I was… I can’t begin to describe what feelings went through me. I was reading a document that did not belong to me. That was certainly meant to be private. On the other hand, she looked like she was about to collapse, and I trusted her judgment when she told me that people were being hurt and neglected.
The papers were the rambling, disjointed dissertations of an insane mind. In them he pointed out that he was the second coming of Christ. He wrote (in disturbing detail) that he had sexual encounters with the Virgin Mary and many other female saints. He was angry that the world had not yet realized who he was. There was a strong tone of depression and even desperation.
I handed the papers back to her.
Does he have a doctor?
“There is a close relative who’s a doctor. I found the name of a psychiatrist on his desk.”
I’ll see what I can do. You’ll need some tranquilizers for now; you have to get some sleep.
When she left the office I called the psychiatrist. When he called back I explained what I knew. I mentioned the papers, but I did not say that I had read them. I said that I understood that he had an obligation of confidentiality, but that I felt that patients being harmed overrode that concern. I asked him what he intended to do about this situation.
“His family doesn’t want to commit him. I shouldn’t even be telling you this.”
I understand. Tell his family that by the end of today I’ll be calling the Board of Healing Arts if nothing is done. I guess that warning includes you. I’m sorry; I know you’re trying to help.
I hung up. I was in a state of total confusion; almost agony. I know nothing of the law. However, my sister is an attorney and I knew very well that once the legal trigger is pulled there is a huge potential for unintended, harmful, and unexpected consequences. Also expensive. I was a young kid; I had no money; I had not been in practice long enough to have a reputation. What would happen to me?
On the other hand, I thought of all of his patients…
The psychiatrist called me back in three hours. His patient would be committed later that day. Arrangements were being made to close his office down. The Board of Healing Arts would be notified. I heaved a huge sigh. I went back to work.
My patient continued to work in the medical field. She never went back to school. I don’t know what happened to the sick doctor.
Duty. I felt that I had no choice, yet I put myself in a dangerous position. Would I do the same thing now that I have so much to lose? There have to be safeguards to keep people from defaming an honest person. Everyone has to have basic rights. Every doctor; every person should be able to make a living. It’s an extremely difficult call as to when that right is trumped by a patient’s welfare.
I think about this a lot. It seems to me that professional life gets more complicated by the day. It’s easy to lose track of why we practice medicine to begin with.
To do the right thing.