fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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Hard Questions

My routine clinic day was interrupted by a startling message. During a moment of extreme stress, a long-term patient of mine left a threatening voicemail on my colleague’s phone. The target of her anger was me. It was difficult to discern her garbled speech in the recording of her screaming, but I heard loud and clear that she intended to find me at my clinic and physically hurt me – or worse.

During the years of working together a pattern emerged: the very real difficulties in her life overwhelmed her. Her coping mechanisms included alcohol, drugs, and medication non-adherence, which resulted in severe pain and feeling unwell. She felt lonely and scared and took that out on me, a safe, steady presence in her life. I cared for her yet conveyed boundaries, which generated feelings of regret and fear that I would reject her. An exhausting dance. Sometimes we had weekly contact. Other times she disappeared for months at a time.

At the time of this disturbing voicemail, we hadn’t seen each other in months. Her family, health and financial stressors had multiplied. She felt acutely ill and called 911. While waiting for the ambulance she phoned the clinic and lashed out at me via the voicemail.

She was hospitalized for her condition. I reached out to her by phone. She hung up on me when she heard my voice. I met with my supervisors and security at work to construct a plan. They inquired whether I thought her threat was credible, given her pattern of lashing out, then apologizing, when feeling a lack of control. I wanted to give her the benefit of the doubt. But I didn’t want to take foolish chances.

We created a plan of action to provide security for me and a mediated meeting with the patient. For the first time in my 20-plus year career, I felt scared. I never had the opportunity to see this plan through because my father died the following day, and I missed work for several weeks.

Upon my return, the patient no-showed to her appointments with me. I no longer work at that community health center, and I do not know about her current state of well-being. I have compassion for her unraveling and her reactions. She tried her hardest despite bumping up into numerous roadblocks. She suffered deeply and caused others to suffer. It all is painful.

Pamela Adelstein
Newton, Massachusetts

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