No one should conclude from my continuous ranting against the disrespectful behavior of doctors that I consider myself above such behavior. Far from it. I know how very easy it is to be disrespectful to patients, how the forces of contemporary medicine promote disrespectful behavior, and how there is very little condemnation of it within the profession.
Were I ever inclined to forget, I could just think back on the lowest moment of my internship.
There were certainly many low moments during my intership. In fact, one could argue that internship is a continuous year-long low moment. You'd think that it would be hard to mark the actual nadir. However, I'm quite confident that the lowest moment was the most personally embarrassing moment for me: at 3 AM on a dismal winter morning, I found myself on a medical floor screaming at a little old lady and threatening that I would break her arm.
I trained at the "House of God". It was pretty much at Samuel Shem described it; its medical floors were filled with elderly victims of dementia, suffering from various medical problems which we should not have been treating as aggressively as we were. You could walk down the hall and see a neat row of elderly women posied (tied) into reclining chairs staring into space, or repeating meaningless sounds, or talking but making no sense. They were all named Ida or Rose.
Like most obstetricians, I did a rotating internship which included 6 months of general medicine. I absolutely abhorred it. Taking call was the worst of all. You ran around like a crazy person all night, treating chest pain and various complications, all the while hoping that you would not get another "hit".
A "hit" was a new patient. Right away you can tell that we did not view a new patient as an opportunity to heal and learn. Far from it. In our sleep deprived, egocentric world, a new patient was admitted to the hospital to knock us down. The fact that she was actually sick just indicated her malevolence. Sure, she had been sick for days, but she had deviously chosen our night on call to show up at the hospital.
One winter evening, I was called to the ER with my resident to accept our latest "hit". Ida (of course) was an 88 year old, unpleasantly demented resident of a local nursing home. She had a bleeding gastic ulcer and was sent to the hospital for transfusions because of a very low hematocrit. When I got to the ER I saw that Ida was unaware that her hematocrit was barely compatible with life, and was scratching and spitting at the nurses while issuing a stream of invective.
Our first mission was to get IV access. Everyone who had tried in the ER had been unsuccessful. My resident and I assessed the situation and handled it in a way that seemed perfectly logical to us at the time. We tied Ida to the stretcher with rolls of Kling gauze. While the resident tried to keep the patient from spitting on me, I put in the IV after a great deal of difficulty. The red blood cells started running in.
My resident cautioned me that I should accompany Ida to the floor and supervise her placement in bed. The IV was extremely precious, and I should do whatever I needed to do to preserve it. That also seemed perfectly logical to me. I trailed behind the stretcher on the way up to the medical floor, and after the patient was placed in bed, I personally tied each of her limbs to the bedrail TWICE. I was taking no chances. At the time, I saw absolutely nothing wrong with what I was doing. Indeed, it seemed merely prudent.
I did not hear anything more about Ida throughout that evening. At about 3 AM, after managing another patient's chest pain, I happened to pass by Ida's room on the way back to my bed. Two bright eyes peered at me from the gloom. As my eyes adjusted to the darkness, I saw that Ida, clearly a protegee of Houdini, had managed to remove all four of her double restraints. She had pulled off the bandages covering her IV site and was holding the IV tubing in her hand in preparation to pulling it out.
That is when I uttered the fateful words in a voice so loud that nurses came running from up and down the floor:
"Ida," I shouted, "if you don't let go of that IV, I will break your arm!"
Ida, of course, smiled sweetly, pulled out the IV and spit on me for good measure. I turned to find a circle of nurses staring at me with mouths agape. I burst into tears, the one any only time during my entire residency. The nurses figured that I was too distraught to manage the situation, and called the resident to restrain Ida yet again, and replace the IV. Although people tried to console me, I was inconsolable. I just kept saying over and over again,
"What has happened to me? I threatened to break a little old lady's arm."
I don't remember what happened between then and morning rounds. I do recall that by the time of morning rounds, I was completely recovered and back to work again.