An excerpt from The Real Drama—Incredible Medicine.
It was an ordinary day in my family medicine practice many years ago. A variety of patients, many longstanding and from various generations of whole families, were filling the waiting room. Back then, I had four very efficient and nice women working for me, with various duties. We had 3 examining rooms and a small lab. (I’ve cut back since but haven’t left medicine yet!)
All of a sudden, my office manager burst into my private office where I was counseling a patient after her exam, looking panicky and terrified.
She said R.L. (not real initials) was in the waiting room, waving around a knapsack full of guns and threatening everyone.
She said he wanted to see me immediately – and that he wanted ME to take his guns away from him!
He had been a particularly difficult patient, but we had thought we were making progress with him.
He had an artificial leg (everyone thought he had been in Vietnam), but it had come from him intentionally running in front of a truck, to end his life. This was way before he became our patient.
He was found, by psychiatric consultation, to be psychotic (profound disordered thinking and/or feeling), but he had many good and normal aspects of his nature when he was taking the right psychiatric medicines. He didn’t like the psychiatrist and preferred to have me order his medicines.
I immediately figured, “He must be off his meds.” He had been taking pills, which he and we knew were helping correct his faulty thinking, but was always forgetting them – so we arranged for him to have a shot weekly instead (which was, at the time, an acceptable treatment). He had refused to see a psychiatrist regularly, preferring our welcoming office and more personal care, and we also accomplished his general medical care as well, as with any well-run family medicine practice.
I told my office manager to usher him into my office while excusing the patient who was sitting there telling her that I would be with her just as soon as we were finished.
Meanwhile, I began trembling and trying to think fast with a perplexing mix of questions in mind as to how best to handle such an unexpected crisis.
I knew that he trusted me and that that was why he had come. I knew that I couldn’t antagonize him at all, but I didn’t know specifically what would set him off, or what would calm him down.
He was obviously relieved that the office manager would take him immediately to see me. I put on my best, relaxed greeting telling him we were happy to see him, since he needed a checkup anyway, and we could do it today since he came here. He did respond to being welcomed. He clutched his full canvas knapsack tightly.
I asked him right away if he had perhaps forgotten to go to the ER (where we had arranged the weekly anti-psychotic medicine shot). And of course, he said, “Yes, but I didn’t forget, I just wanted to stop that medicine.”
I asked what I could do to help him. He said, “Take these guns away from me. I’m afraid I might use them.”
And he took one out and brandished it in front of me.
I sat still in my seat behind my desk. I thought, “Is this the way it ends?” I had read about doctors being shot by irate patients, and I had no idea what would come next.
I tried my best not even to blink. I said, “R.L., you know we’ve always wanted the best for you. We’ve taken good care of you.”
He said, “Yes, you have — that’s why I’m here. I knew you’d fix it.”
I said, “Where did you get these guns, and how many are there, and why do you want me to take them away from you?”
He said there were three pistols of various sizes and a rifle. He said it was easy to get guns. He then asked, “Are you going to call the police?” I said, “I’m going to do whatever is best for you. You are my patient – for a long time – and we want to help you. What do you think?”
He said, “Take these away from me. I’m scared I might use them.”
I said, “Would you be willing to go straight from here to the ER where they have been giving you your medicine routinely from my order? We will call ahead to be sure they will take you right away. You know you will feel more normal with it.” He said, “Yes, but it has some side effects that I don’t like.” I said, “We’ll deal with that a little later, and maybe change to another just as good, OK?”
He stood up. I was still terrified. He reached down, replaced the pistol he had been holding in his hand inside the bag, picked up the long, canvas knapsack with the rifle and three pistols it, came around the desk as I stood up, rising out of my chair behind the desk. He handed me the knapsack. It was so heavy, I had to hold it with both hands.
I looked him in the eyes. I said, “You’re doing the right thing, you know.” He said, “You’re not going to call the police?” I said, “I have no reason to, you’re going along with the best plan to keep you and everyone else safe, and I am very happy with that. I want you to keep all your appointments, with me and the psychiatrist, and we really care about you and your treatment for your illness.”
He said, “I know, and that’s why I came. I feel better now.”
I walked him out of the office, calmly, past all the staff and the other patients, half of whom had left in terror, not knowing what would happen next.
After an hour, I called the ER to verify that he had gone to get his shot. They said yes.
Pepi Granat is a family physician.
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