Sometimes You Need to Say No, for the Patient and Yourself

A frightening midnight phone call leads a young surgeon to reconsider how he approaches his career

“I know where you live. And I’m gonna to find you and when I do, I’m gonna hurt you and the people you love.”

That is the PG-rated gist of how a middle-of-the-night phone call from a patient’s family ended, and it left me cold. The family member called about a patient admitted to me who was also serving a life sentence at the state prison. As one of the guards who accompanied the patient whispered to me conspiratorially, “I’m not supposed to tell you what he did, but it was bad,” he paused to look me in the eye. “Real bad,” he said with more depth of feeling than I thought those two words could support. “Now he is in for life, so he doesn’t have anything to lose. Know what I mean?” What he lacked in subtlety, he made up for in sincerity. So, yes, I knew what he meant.

So that middle-of-the-night phone call left me shaken, real shaken. Heart racing, pulse throbbing in my ears, tightness in my chest, muscles shivering scared. I tried to convince myself that I was safe and overreacting. I told myself the man on the phone couldn’t possibly know where I lived. After all, my phone number and address were unlisted in the phonebook. But then again, if my phone number wasn’t listed, how did he call me? My attempts to reassure myself and failed miserably.

I made a circuit of the house. I avoided the windows like a character in a spy movie, and I checked that all the doors were locked. I closed the blinds and then rechecked the doors. Then I peeked out through the slot in the curtains.

“Was that car parked on the street there earlier?”

“Is that shadow in the back yard a shrub? Has it always been there?”

I cursed myself for not paying more attention to my environment before this moment, especially now that it could mean the difference between life and death.

I relived the details of the phone call. The caller was irate, that was clear. From there, the one-sided conversation got murky. Reassembling his random, incoherent complaints was like assembling a jigsaw puzzle when the pieces seem to be from more than one set. I’m pretty sure the man on the phone said the patient was his bother. From what I managed to piece together, the caller accused me of conducting experiments on his brother and other inmates and even killing them. He charged me with being the reincarnation of Dr. Josef Mengele, the Nazi Angel of Death, who conducted medical experiments on prisoners in the death camps during World War Two. Not that he ever mentioned Mengele’s name. I doubt the caller knew who Mengele was as the man on the phone did not appear to be burdened by an overabundance of education. What he was burdened by was an overabundance of intoxicating substances. His rant slurred around to the same points so often that even someone with OCD would find it tiresome. The one thing no one would have diagnosed him with was eloquence. His speech stuck with small words, mostly just four letters long. He made up for his lack of verbal breadth by recombining those few words in equally creative and nonsensical ways. If cursing is an art form, then this man is the Salvador Dali of profanity.

Nonetheless, he had used his vast and poorly defined investigative skills to uncover my nefarious plot of torture and murder in the “name of science.” Now that the truth was revealed, he was on a crusade to foil my wicked scheme by well, torturing and murdering me. Logic appears to have taken one look at this conversation and developed such an intense migraine that it went to Aruba to recover for the rest of the week.

He didn’t conclude his circular logic so much as he wore himself out from turning it over so many times. That was when he issued his threat and hung up.

Alone in the dark with my sleeping wife just one room away, my anxiety did not abate, so I did something I had told myself I would never do. I have always been conscientious about my firearms. I know from experience that the gun most likely to hurt you or someone in your house is your own, so I keep my guns out of sight and out of reach. I even keep the ammunition locked away in a separate room. But that night, I violated my rule and loaded five rounds into the pump-action magazine, and those rounds were not birdshot. Then I hid the gun in the back of my bedroom closet.

Unfortunately, that brought me less reassurance than I had hoped, and no sleep came the rest of the night. Instead, I laid there, hyper-attuned to every little sound, both real and imagined. Things always seem less scary in the morning, but when the sun rose, I was still shaken. I pulled one of the penitentiary guards aside at the hospital and told him what had happened.

“You didn’t call them from your personal phone, did you?” he asked like I had just told him I put diesel fuel in my gasoline-powered car.

When inmates from the correctional system enter the hospital, no information is supposed to be given to the family before the prisoners return to the prison. This policy is to prevent impromptu family reunions and breakout attempts. But convicted felons and their families also have fundamental human rights that we must respect. So I had been asked to call one member of the family and explain the medical issues to them. Before making that call, a prison official carefully coached me not to give away any identifying information like my name, the name of the hospital or community, or any details of dates and times. The official did not tell me not to make this call from my personal phone.

“Oh ya, rookie mistake,” the guard said with a shake of his head at my idiocy. At that time, Caller ID wasn’t a standard feature with phones, but an extra you had to pay more to use. I didn’t have caller ID on my phone, but as the officer so sensitively put it, “every dirtball in the country has caller ID.” Then he continued, “well, I wouldn’t worry, usually nothing comes of it.”

“Usually nothing,” proved to be a phrase offering less comfort than I would have liked. It’s like explaining the statistical safety of air travel to someone in a crashing plane. I was well aware that just because most people would be ok in a situation like this did not guarantee I would be.

Despite my sleepless nights, the patient recovered from his emergency surgery without incident and returned to the correctional center infirmary a few days later. I blocked the phone number the angry call had come from, and nothing more ever came of it. But the loaded shotgun sat in my closet for weeks after the event, and my hyper-vigilant attention to any changes in my surrounding persisted as well. I would be startled awake by random noises and lay in bed with a racing heart for some time until I finally was able to get past the event. Time does heal, and eventually, I unloaded the shotgun and put it away, but I did continue to double-check that I locked every door.

I never talked to anyone about this. I didn’t want to look weak or crazy. And that probably wasn’t a good way to handle it because I got a little weird about the phone. I no longer identified myself by name when I answered the phone, and I refused to talk to anyone who didn’t immediately identify themselves, and the purpose of their call, which it turns out is a surprising number of people. My new phone policy resulted in several awkward conversations and one colleague who became quite offended.

“Hello,” said my wife answering the bedside phone in the middle of the night.

“Is Dr. Black there?” said an unidentified male voice.

“May I ask who is calling?”

“I’m calling Dr. Black, is he there?”

“Who would like to know?”

“Is he there?”

“You can reach him on his cell.”

“Damn it, is he there or not!”

Click, buzz. . .

I don’t think it is ever wise for a woman home alone to admit that to an unidentified man on the phone, and given the circumstances, I’m going to stand behind my wife on that one.

The first time I learned about Doximity Dialer, I immediately recognized its benefit. I don’t want to sound like an advertisement for the website I am writing for, but I do use this feature to call my patients. It allows me to call them from my cellphone and display the phone number for my office on the Caller ID. Doing so keeps people from getting my number and then abusing it. If they call back the number on their phone, it goes to my office staff or the answering service. Dialer has proven helpful in dealing with the criminal element and keeping clingy patients from abusing their access to me at all hours of the day and night.

Another critical point is that I should not have admitted a patient like to a community hospital — how that happened is a different story that occurred at the intersection of corporate greed and political ineptitude. How he came to be in my care was not my fault, but it was my problem, and I lacked the experience to deal with the issues involved in caring for someone like this. Worse yet, despite agreeing to take these patients, the hospital lacked the resources to keep its personnel safe. This man proved to be just as dangerous as advertised. When I complained about this to the supervisor from the prison, he explained to me, “The guards only job it to keep the inmate from absconding, its not their job to protect the people who work in the hospital. That is your job.”

It may have been my job, but I lacked the experience, and the hospital lacked the resources needed to do the job right. We are lucky that no one was physically injured, although many were abused in other ways. For my failure to prevent that, I am sorry. As much as young doctors want to be all and do it all, we need to recognize our personal limits and the limits of the system we work. Exceeding those limits is dangerous, not just for the patients, but also for ourselves. There comes a time when you need to say no. It’s not easy and certainly not what we train to do, but sometimes it is the right thing to do.

And finally, whenever you call someone, tell them who you are and why you are calling. It’s just basic courtesy, and that courtesy is there to avoid misunderstandings and hurt feelings.

PATIENT ADVISORY

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The article lives here: A Doctors LifeSometimes You Need to Say No, for the Patient and Yourself
Charles Blackhttp://chuckbphilosophy.com
Charles Black is a general surgeon with more than twenty years expereince practicing in the US. He now lives and practices on the South Island of New Zealand. Outside of medicine he is a husband, father of three, writer, photographer, TED speaker, outdoorsman and fireside philosopher.
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