Why You Treat Me Like a Dog?: What Should I Have Done?

Sunday, January 15, 2006

What Should I Have Done?

When I was asked to see the 78 year-old Mrs. Goldberg (not her real name) the other day, I was forewarned that she had an "interesting" or "challenging" personality. Indeed, when I walked into her hospital room she was busy getting dressed and preparing to leave the hospital against medical advice. Her husband and daughter stood by speechless.

I introduced myself, told her I was a cardiologist and explained to her that I was there to see her because her primary care doctor thought she had suffered a heart attack. She replied that she had heard that too, and that they were wrong and that all she had was the flu.

I proceeded to ask her a few questions about her medical history. She told me that she had been experiencing trouble breathing while walking to syngagogue for some time now. After a few more questions it quickly became clear that we in fact attended the same synagogue (though she didn't look familiar to me)! She then sat down and agreed to stay in the hospital so we could finish working her up.

Her condition improved rapidly, and this morning I arrived on her floor intending to discharge her. On my arrival, the nurse taking care of her informed me that Mrs. Goldberg was not eating, and that she was saying she was on a hunger strike. I went to her room and asked her about it.

She told me: "I have not eaten in fourteen and a half hours and have now been waiting for breakfast for three hours and it has not arrived. My last meal was the ice cold turkey they served me for dinner yesterday."

I nodded my head.

"I am on a hunger strike to protest the terrible food at this hospital. I am supposed to be on a low salt diet, and not only was the turkey ice cold, but I KNOW there was salt in it!"

I proceeded to examine her, and found her to be physically fit for discharge and told her so. She thanked me and told me she would see me in my office later this week.

As I sat ordering her discharge, the nurse emerged from her room and said: "She wants to go down to the hospital cafeteria to eat breakfast, and she's on a cardiac diet you know." I told the nurse I was discharging the patient, and that once discharged she could do whatever she pleased.

Next thing I know, Mrs. Goldberg, in her hospital gown with the rear open, is standing in front of me.

"Doctor Wanderer," she says, "I have not eaten in 14 and a half hours. The nurse has offered to call the hospital kitchen for my breakfast, but I told her not to because I am protesting this hospital's food. It is not good enough to give a DOG! Is it OK if I go down to the cafeteria for some breakfast?".

"Mrs. Goldberg," I say, "I am discharging you now and you can then go home and eat whatever your heart desires."

"Thank you, Doctor," she replies. "I need to ask you a favor. My husband took all my belongings home and I don't have my wallet. Could I borrow ten dollars so I can go to the cafeteria? I promise I'll pay you back in shul..." (shul=syngagogue).

Wow, I thought to myself. I have never been asked for a favor like that by a patient (unless you count the drug addicts who used to ask me for "cabfare" when I was a medical student in the Bronx). To be honest, it made me feel a little uncomfortable. The nurses stood around with huge smiles on their faces, giggling, and Mrs. Goldberg was waiting for an answer.

What should I have done?

- posted by wanderer @ 12:47 PM

Comments:

Quite the conundrum, Doc. I will be curious to hear what you actually did. If it were me, I would feel very uncomfortable crossing those lines.It is always a safe approach to blame the hospital and their regulations;that you cannot lend money to a patient, but you would be happy to make sure the hospital provides her with a meal, or have a nurse contact someone to pick her up. She is the type of person that no matter what you do, she will be displeased. I'm sure that part of your concern is what she will say about you at shul. What I have learned is that people will judge you by their own experience of you. Most people probably know that this woman is a bit of a wretch and will take that into consideration upon hearing the story.
It is apparent to me that this woman does not know boundaries, and that it was up to you to draw them.

# posted by

cruisin-mom : 1/15/2006 2:15 PM

She's a 78 year old woman, she is allowed her eccentricities. I see nothing wrong, socially, with lending the money to her. Especially since she sounds like a proud woman and I am sure it wasnt easy for her to come ask to borrow money. If there are policies or regulations that prevent you from lending it (which I think there must not be or you wouldnt be asking this question), then the answer seems quite obvious. Otherwise, as a fellow Yid, I would expect nothing less than that you lent it to her.

# posted by

energynorm : 1/15/2006 4:24 PM

George, I must respectfully disagree. Just because a person is 78 does not give them the right to be rude to the very people who are trying to help her. And at the age of 78, it cannot be news to her that hospital food isn't good. Perhaps as a fellow Yid, she might have been respectful toward the people who were trying their best to save her life. I know plenty of people 75-85, who do not wish to be told they are eccentric and treated as such. Perhaps she was fearful, and understandably so...causing her to act out. But my hunch is, this is her personality and way of operating in the world. I would not be surprised to hear that if the good Doc gave her the money (which I am guessing he did), that she was heard complaining about how terrible the cafeteria food was, and how could Dr. Wanderer have allowed her to eat there!
Being a good person does not mean you have to allow people to be abusive toward you. From reading your blog Wanderer, I can tell you are a kind person, and can't imagine that you would not have done all you could to make sure she was taken care of. You would not have left her stranded. I do not see lending the money as part of your duty to her as a physician and quite frankly I think she put you in a very awkward position.

# posted by

cruisin-mom : 1/15/2006 6:42 PM

Hmmm, interesting responses (Welcome george!). I'm not sure if I agree with you, goldstone, that a patient needs to display "unquestioning obedience," but your point is well taken.

I'd like to see what Doc Bean and Psychotoddler think - hopefully they'll be by soon, and then I'll tell you what I did.

# posted by

wanderer : 1/16/2006 5:26 PM

okay, Wanderer, so what am I, chopped liver?!!!

# posted by

cruisin-mom : 1/16/2006 6:47 PM

Oh no no Cruisin' Mom - only the best foie gras! I love your comments!

I just don't want to spill the beans (no pun intended) until I hear from the two docs...

# posted by

wanderer : 1/16/2006 6:58 PM

I would only do it if I had taken care of this patient for many years and knew her to be (1) not a pesterring needy ninny and (2) trustworthy. Neither of the above is true so I wouldn't have thought about it for a millisecond.

"Oh, Golly. Sorry, I don't have any money on me, but as soon as your family returns you can use a credit card downstairs, or you can snack on some hospital food until then. G'bye!"

# posted by

Doctor Bean : 1/17/2006 6:33 AM

I agree with Cruisin Mom. First of all, this woman is crazy. Second, she has major boundary issues and you should discourage her in any way that you can. Third, I've only been hit up for money once, and that guy was a major drug seeker, and I had no problem turning him down.

# posted by

PsychoToddler : 1/17/2006 2:55 PM

So Cruisin Mom' looks like you sided with all the M.D.'s (goldstone is a doc too).

The relationship between a patient and their doctor is very unique. There is a certain confidence and contract that exists between them, and certain boundaries do have to be kept.

This patient crossed some boundaries, whether because she is narcissistic, or because she is just a weirdo. Obviously I could care less if she pays me back the ten bucks, but its more the message it sends and the familiarity it implies that she would ask me.

There has to be a therapeutic distance between a caregiver and the cared-for. This is based on the patient trusting the caregiver to maintain their impartiality and confidentiality. Getting into money-lending (even to a fellow Jew from my synagogue) is just not conducive to an effective therapeutic alliance.

So what did I do? Basically something along the lines of what Doctor Bean suggested. I told her it would be some time before she would be officially discharged and couldn't go to the cafeteria until then, that she was welcome to have something from the hospital kitchen in the meantime, and that her husband would be by soon enough with either money or food from home.

She seemed satisfied with my response. We'll see if she shows up for her follow-up appointment.

# posted by

wanderer : 1/17/2006 6:28 PM

Yay Doc! So glad you didn't give her the money. My husband is a dentist, so I have an understanding of the situation (no wise cracks about dentists, P.T.) Boundaries have to be drawn, and quite frankly, even more so when a patient becomes abusive.

# posted by

cruisin-mom : 1/17/2006 7:14 PM

I am very bad about enforcing boundaries which is why shabbos i hide in my house and pretend I'm not there.

# posted by

PsychoToddler : 1/25/2006 12:59 PM

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