Goodbye, Ms. E.

I had a bad day.

My most difficult patient in my three years of residency showed up today on the wrong time slot. She always leaves me at my wits end every time she comes to see me and, in effect, ruins the rest of the day. This is precisely the reason why i asked the clerks to always give her the last appointment so as not to be unfair for my other patients. But today, they gave her the second slot. Nice.

"You promised me an appointment to get my toenails trimmed."
"I did."
"Well, nobody called me."

"Lemme check the computer...see, you were scheduled last month, nobody was answering your phone when they called you."

"I did not get any calls. You lied."
"Ok, I'm putting in another request today. Let me email the social worker as well so that she makes sure you get a ride to the appointment."
"Make sure you do that this time."


"Your blood pressure is still not under control. Tell me your meds again?"
"I'm not taking any."
"What's your reason this time?"
"They don't work."
"We've been through this before. I've explained to you that blah blah...."
"Ok, i'll be a better patient next time."
"Yea, i've heard that a million times before."


" I believe i need Valium 10mg twice a day."
" Why?"
" Because of my anxiety."
" How about your Celexa and Wellbutrin."
" I'm not taking them."
" Why?"
" Because i want Valium."
" Well you're not getting any from me."

"I'll stop your Clonidine. It gives bad side effects with noncompliant patients. It won't do you any good."

"I DON'T NEED THESE PRESCRIPTIONS!! I NEED MY KLONOPIN!! GIVE ME MY PRESCRIPTION FOR KLONOPIN!!!"
" You're holding the prescription. It was the Clonidine i took out. You weren't taking it anyway."
" Ok, whatever you say. You're the doctor, i'm just the patient."


" Nobody's been sending me my diapers, my pads, and my wipes."
" How come?"
" You tell me."
" Ok, which agency sends them to you again so i can send another email to the social worker?"
" I don't know?!"
" You don't know who sends you your monthly supplies."
" No. "
" You've been receiving all these things for how many months now and you don't know who's been giving them to you."
" I don't know, you're the doctor and i'm just the patient."

I remember the first time i met her. She was a mess. She had been coming to this clinic for a long time now but i noticed that she did not have her own doctor. Nobody wanted her. I felt bad for her so i took her on my patient list - a decision that later on would always make me want to bang my head against the wall. If only i could turn back time.

My pager beeps at around 7pm. The access center.

"Dr. Duke, somebody is on the line. She says she needs to speak to you urgently."
"Ok, put her on....... Hello?"

somebody answers in a monotonous, expressionless voice...
" This is E. I need my Klonopin."
" I just refilled it. You aren't due for another refill until next month."
" I said I need my Klonopin or i'm gonna die tonight.

And there was this last time i stayed at the clinic finishing up my notes until around 7.30PM. I got my bag and walked out of the doors of the deserted building. I saw somebody on a wheelchair in the dark...creepy.....

" Excuse me, may i help you?"
"*sob* *sob* *sob*"
" Ms E?! I sent you home four hours ago, what are you doing here?!"
" I missed my bus *sob*"
" Let me call you a cab."
" I don't have money."
" I'll arrange it with the social worker."

And a lot of other stuff during my taking "care" of her. She wanted me to sign papers saying that she was disabled. I did not want to. She wanted me to sign papers for an electric scooter. I did not. She settled for a cane. I wanted to do a home visit to make sure her living conditions were healthy, she did not want me to see her house.

Back to today...

"Ms. E, i need to tell you something, I'm leaving next month. This is the last time we're going to meet."
"Ok."
" I just want to tell you that I took on your care 2-3 years ago hoping that we could work things out and make things better for you. I'm sad to say that it looks like i failed. I tried, but i can only do so much."
" I liked you. You were a good doctor and you were the only one who wanted to see me. I liked you until ... until you didn't get my nails trimmed."
"....?!..." what?!!
" You lied."

" Well i don't think you got any better. For a while there i thought we had some progress, but i guess it didn't last."

" I'm a bad patient."
" I didn't say that, but i can say that i am frustrated."
" I'll try to be better next time."
" Goodluck to you."
" My valium?"
" No."

And she slammed the door at me as i walked out of the room.

I was grumpy the rest of the day. I even went off at a nurse who has been testing my patience for some time now. This is a bad day. This is exactly why Ms. E. should always get the last slot of the day. But this will be the last time i get to see her.

Am I happy? No. Relieved, maybe, but not happy. I failed.


****

Our class used to have an hour every month where we get together informally and talk about our most difficult patient issues and learn to cope with them. This is an example of how powerful patients can become and how they can just get a hold of your emotions if you let them.