"Your Patient Tom is Dead!"
Joe called me on my cell phone from a psychiatric hospital at 6 am, to pass along these unfortunate words. He yelled at me and said he was ending our work.
I liked Joe and Tom. But poor Joe did not realize quite a few things.
Simply, I had no patient named Tom, and had not had anyone with that name or in the state Tom lived for over a year. I assume he had been talking about someone I had treated and diagnosed 1 1/2 years earlier with severe medical problems. He was being "harassed by the IRS," and was overwhelmed with the prospect of a long expensive legal battle -- one that would bankrupt him and one he might lose.
Joe did not realize that if I do not see someone at the suggested frequency, they are no longer under my care. Immature and primitive people blame the physician for actions against medical advice. We do not tell folks to jump off buildings, and it is scapegoating and wrong to blame the doctor, when someone hurts themselves by acting AGAINST MEDICAL ADVICE.
Tom had become a gypsy and was terminated, because he had not been seen for 3 months with serious medical trouble, and left no reliable address or phone number. He was not my patient. He had not been my patient for a year. And indeed, before he left town a year or more earlier he was pleased we had found the possible medical problems to his emotional trials -- of course I could not remove the potential IRS charges and raids.
Many things steal our time, but medical trouble leaves you with no choice.
You must choose the best person and treatment and address it. Tom did not and that is too bad. I liked him a great deal.
Joe did not realize how profoundly sick he had been for decades. He wanted to damage me with his insults. But the issue was he was grieving his lost friend. So was I.
Suffering and loss brings out the best and worst in people. In Joe it was bringing out the very worst.
Joe would start 1/2 our sessions by insulting me. He would forget what we had discovered and the progress he had made. He forgot the fact he had seen fifteen to twenty previous physicians and none had offered him any progress. We had offered him 55-70% improvement, and many new and content days. But he did have some very bad days, partly because he acted as his own doctor and engaged in chaotic medical actions. He treated himself in an impulsive manner. I would ask him what medications he was on, and get 2-3 answers in the same session.
His short-term memory was terrible and far in excess of depression. It showed neurological injury, inflammation or biotoxins.
As a research clinician we are involved in very progressive care. Joe called from the In-patient psychiatric unit to say he was "no longer going to see" me. He said, "Dr. Jones is eons ahead of you." I looked up the doctor in the international database and the Internet and could find nothing. I guess the goal was just to insult me as a way to process the loss of his loss of Tom.
Joe did not realize that treating a labile medically sick person with illnesses that might clot the blood, cause heart attacks or suicide, is not something a clinician wants. We do it as a service to humanity. In Florida if you have three malpractice settlements you lose your license. Taking on a complex patient is service, not a wish. And insurance companies can force a doctor to settle for business reasons because to fight the accusation will be expensive to defend for years.
Initially, Joe said I was "a genius and was so lucky" he had found me. Fine, but often that is magical idealization, and can turn to rage and hate, with some offense or let down.
As I spoke to Joe through my sleepy haze and his hatred, I told Joe I was "pleased he had found someone he related to" and that I accepted that he was terminating my role. Since in-patient doctors always need someone to refer the patient to on discharge, I mentioned to his in-patient doctor, with clear permission, that Joe had been yelling at me and had clearly terminated me. I wished him success with his new patient. He seemed afraid to hear that Joe had no doctor to refer to on discharge and Joe would be stating from scratch. Joe had already dumped the best-trained docs in our area.
An hour later, I was seeing many other very appreciative patients, but I had Tom on my mind. I missed him. I liked him. The secret that some doctor's never tell, is that medical psychiatrists and other physicians with real relationships with their patients get attached and concerned for their patients. They are not "broken bones or rashes," but people who are cared about and are not mere organs.
When patients like Tom are hurt and afraid, it is easy to withdrawal and hide. And while jail is not easy, I would have come to visit Tom and to make sure he was getting good medical care. He made a mistake by avoiding treatment for a year. He put his body and his health last, which allowed inflammation and other medical problems to increase his depression. He let the worst-case IRS scenario add to this medical depression, and he ran to suicide.
From suicide research, I know that blaming anyone is not helpful. In my case it was bizarre since I had not seen him in a year. But even if he had a doctor in his new state, it may not have mattered. The genetic coping-mechanism of suicide cannot be entirely controlled by any family member, any friend, situation or doctor. It is time for them all to grieve. Accusations tossed at different relatives, the government or physicians, freezes healing. Hate holds you in time.
Families and friends need to grieve the loss of their loved one, and not attack each other. And they need to look at their own emotional and physical state to make sure they are healthy and their life and mood are in order.
Joe offers all of us a lesson in immature coping. He has yet to start processing the loss of his buddy. His verbal violence and eccentric abuse will limit his options in care. In many areas, there is only one person with the broad ability or the willingness to take on a challenging person. Complex and challenging patients are more likely to die of many causes, and there will always be a trial lawyer to yell "malpractice." A lawyer would not know 9th grade biology if it hit them in the nose.
I have been sad and surprised to find immature folks expect a 30-year illness to be better in three months, and then move on to someone who was not going to help them fully, but was cheap. Please, this wish for magic will only hurt you.
I dedicate this to Tom, a precious man, who made one error. But it does not diminish my affection for him and the wish that a merciful God will look past his final error.
Much peace dear Tom to you and you loved ones. I wish we had more time together.
Identifying data entirely removed.
I received a call from a pharmacy in the Midwest that was asking for a refill of a non-controlled simple medication. It was a request for a refill for Tom!! I asked if they had the right patient, and they described him perfectly and confirmed his name. He was very much alive. They apologized for bothering me, because as they read over his medications they could see I had not prescribed it. And had not prescribed him anything in a very long time. I was stunned. I had not realized how much his "passing" had upset me. And in contrast to the silly pro-trial lawyer papers which assume any death in an operation is the doctor's fault, like the Naples Daily News, I was not at fault but still deeply affected by the claim this man had died. I wish THAT got into the news papers more.