The night I totally lost it

This doctor's frustrations led to a temper outburst. Its strange conclusion left her with many unanswered questions.

By Lauren Barron, MD
Family Physician/Waco, TX

The Emergency Department called me for an admission at about 3 a.m. I was an intern, had been on call for several nights, and was starting to feel it. Maybe that's partly why it all happened.

I remember this particular patient. It was Jacob Campbell. Again. I was instantly furious because I'd already admitted him three times that month. It was a lot of work every time. He was a very complicated end-stage AIDS patient, 55, barely able to communicate, and wasting away in spite of everything we did for him. He had a fever of unknown origin—a difficult work-up in the best of circumstances—but in an AIDS patient, the fever could be from one of a hundred sources. It was an incredibly frustrating case because we could do little for him. We never found a reason for his fever and finally just chalked it up to the AIDS virus itself.

But his social situation was the real challenge. His wife, whose name I can't remember, was nice, but kind of dense. I could never get a straight answer when I tried to find out exactly why she'd brought Jacob back to the hospital. She couldn't keep his medications straight. She was the only one taking care of him at home and was completely exhausted. I honestly don't know how they managed. But she couldn't bring herself to put him in a nursing home.

Jacob's wife was at least 20 years younger than he was. She was a really big woman—no, make that fat—and had gold-rimmed teeth in front. She smiled a lot, which seemed odd to me. It's not like she had much to smile about.

I'd heard somewhere that Jacob became a preacher after he was diagnosed with HIV, but his church disavowed him when it found out that he had the disease. I was never sure how he had ended up with AIDS. I'd read in one of his old charts that it was from IV drugs, but one of the other residents mentioned prostitutes.

His wife literally never left his side. I told her to go home and rest, but she never would. But she always talked too much and asked too many questions. I remember how hard it was to get out of the room when she was there. I often had to explain the same things over and over. It drove me crazy.

She would finally agree that he needed to go to a nursing home. It wasn't easy at that time to convince a nursing home to accept an AIDS patient. But the social workers would work their magic and find a bed. I would write all the orders and prescriptions, spend an hour dictating the discharge summary, sign all the transfer orders, and get him ready. The ambulance would be on its way to take him to the nursing home. Then, at the last possible minute, his wife would call the whole thing off and say she'd decided to take him home. This happened so often that I lost count.

Meanwhile, Jacob's condition was deteriorating. He was very tall, and his huge crusty feet stuck out from under the sheets. He had been handsome once, but by then, his face was skeletal and his eyes were vacant. He had thrush, and his lips were always cracked. He didn't seem to understand much of what was going on around him. When he tried to talk, his speech was unintelligible. His wife could usually tell what he was trying to say, though, and she translated for us.

As I was on my way to the Emergency Department, thinking about his case, I was angry about all the work I'd have to do on him. Again. That night had been especially bad, with constant phone calls, pages, and ED admissions. I hadn't been home since the day before. I couldn't remember the last time I'd taken a shower. And I was starving. When I'm hungry, I'm in a bad mood, and I mean wicked.

I rounded the nurses' station. I could see them both, in Room 12. Jacob's wife was pacing. Jacob was lying on the gurney, staring up at the ceiling. She had her hands on her hips, and the first thing she said to me was, "Can't you just do something and put him out of his misery? Because I can't handle this anymore."

And suddenly, I flung the clipboard that held his chart across the room. It clattered against the wall and bounced onto the floor, spilling papers out everywhere. I yelled back at her. "You can't handle it? You can't handle it? How can you say that in front of him?"

The next thing I knew, we were in each other's faces, yelling at the top of our lungs. We never laid hands on one another, which was lucky for me, because she outweighed me by 150 pounds. Nurses and technicians streamed in, pulling us apart. Jacob never seemed to notice. He was stretched out on the gurney with his mouth and eyes open, barely blinking.

I guess the nurses asked me what had happened. I must have tried to explain. It was all a bit of a blur to me. The ED staff didn't say much to me for the rest of the night. Nobody wanted to look me in the eye. You could tell everyone was talking about it. It was humiliating. I was so rattled that I didn't sleep for the rest of the night. I was trying to figure out why I had lost it. I felt shock. Shame. Embarrassment. Indignation. Nausea.

For all I knew, I was going to be reported for unprofessional behavior. At 7:30 that morning, I had to make rounds. I knew she would be in his room. I was mortified at how I'd lost control, but even more worried that we might get into another fight. There was no way to avoid facing her.

She was standing outside his door. As soon as she saw me, she grinned from ear to ear, showing her gold teeth. She headed right for me, reaching out to me with her arms open wide. She grabbed me and squeezed me into her huge chest, rocking me. She hummed into my hair, "It's okay, it's all right, I know you, thank you doctor, I love you, we're best friends now, it's all right, it's okay." I let her surround me.

I don't remember what happened with Jacob during the rest of that hospital stay. He was in and out several more times. His wife took care of him at home as long as she could. He finally went to the nursing home, and died a few months later.

I don't think I ever actually apologized. But after that night, I was always glad to see her and we seemed to understand one another. Not in spite of what happened, but because of it.

I wonder about her a lot, even after all this time. I wonder how on earth we could have flown at one another like that. I wonder about her kids, whether or not she ever turned up HIV-positive, or if she has remarried. I wonder if I had talked to her about hospice when he was so sick, or if I had pushed the social workers hard enough to try and find some way to help her. I wonder why she stayed with him, what their story was, how they met, and what she saw in him. I wonder why I didn't ask those questions at the time. I wonder if I hugged her back.

 

Lauren Barron. The night I totally lost it. Medical Economics 2002;22:71.