being the bad guy

I stood there next to the hospital bed with chart in hand as the patient answered my questions through hysterical tears. "Please just call my pain doctor" she sobbed. I tried to explain that I can't call an attending about a patient I know nothing about. I calmly appealed to her to answer my questions and tell me about what was happening. I knew going into the interview that this patient would get no pain meds. She was being managed by a pain clinic which tied our hands to the ability to alter her pain regiment. As this painfully uncomfortable interview progressed, I learned that she had stopped the medication for her peripheral neuropathy and after we ruled out acute reasons that would justify a hospital admission, it was clear that this woman would be going home. I knew she was lonely, I knew she was uncomfortable, and I knew she was unhappy. But does that justify a stay in the hospital? Here was a 400lb woman who can't ambulate with an exacerbation of a chronic illness that needed to be addressed in the outpatient setting. If she was admitted she wouldn't have left the next day. She risked DVTs, pneumonias and all sorts of other hospital acquired illnesses.

I walked back into the room knowing that the conversation would end poorly. She had already fired physicians this year when they told her that she was getting better and I figured she'd have no qualms about yelling at a medical student. As I explained that we ruled out a DVT and cellulitis as possible causes and told her that we wouldn't be able to give her any additional pain medications, as I calmly told her that her pain doc recommended discharge and followup in his office, and as I told her there was nothing that necessitated her being admitted, the anger struck. And it was at me.

As medical students, the residents and attendings usually shield us from the anger of the patient. This was the first time that I and I alone was delivering news that was unwelcome. As I apologized that she felt so unhappy with her care and told her what the doctors said, I was the bad guy. I wasn't the smiling happy medical student that the patients love because we are the innocent bystander. I was the one she was mad at. I was the one she was criticizing and yelling at.

As a people-pleaser, this bothered me and made me uncomfortable. It made me feel that I wasn't taking care of the patient. That we were missing something. But then I brought myself back to reality. While I don't feel like I did anything good for my patient, I felt like i was acting on the principle "do no harm." It sucked and I felt awful that I couldn't make her pain go away. That I couldn't make it all better. But I guess this is life. Sometimes I'm going to have to make tough calls that aren't what my patients want in the interest of preventing harm. It was an uncomfortable feeling.