It’s 7 a.m. We sit down around a table in the physician’s lounge to discuss and our patients. I am a general and critical care surgeon. Every fourth week I’m “on service” for the ICU. This is my week. I was off over the weekend. I’m refreshed and ready to go. I’m excited. I enjoy the challenge of taking care of critically ill patients.
I get sign out from my partner. It was a busy week for him. He is happy to be handing over the service. A patient was recently admitted to the ICU after a serious trauma that required an emergent operation. He is on the vent and is sick. There are other sick patients in the ICU, but he needs the most immediate attention.
Multidisciplinary rounds start at 9 a.m. with this patient. I found it odd that no family member had been by to see this patient. As my week went by, this patient was slowly improving. Still, there was no family, no one showed up to see him. Our social worker was trying to find a next of kin, a parent, sibling, anyone that may know him. Nothing. We were approaching the end of the week. Despite his injuries, he had youth on his side. He was improving. I was feeling optimistic about him. He gets extubated. Sunday he gets transferred out of the ICU.
Monday morning. My week is over. I sign out the patients in the morning and am on my way home. I’m walking to my car as my pager goes off, it’s the floor, this patient has a visitor. His mother is at bedside and wants to talk to the doctor. I figured I knew him best, so I didn’t turf this to my partner and went up to talk to her.
“Hi, I’m Dr. Farnejad … ” I’m interrupted. Here stood an angry woman, unhappy with his care and yelling at everyone. I’m threatened with violence, legal action, and deportation. Yes, deportation! I try to not let this bother me. This is the first time I’ve seen this woman. This is the first time she has been in. It’s understandable to be upset. I understand, no one wants to see their loved one hurt. I get it. I’m understanding, trying to explain what has happened and where we need to go from here.
This is not the first time this has happened to me. I remember another patient asking for another surgeon when he saw me and very politely said, “I don’t want a sand niggers hand in my body.” I politely complied with his wishes and asked another surgeon to see him. I was dumbfounded then, and was dumbfounded again with this situation. There were no questions about the injury, no “thank you” for saving my son’s life, no question about the care, just disapproval of everything including me and things about me that I can’t change.
But still, this was my patient. I felt a sense of responsibility. I tried, and tried: She wanted another doctor. OK, no problem. I’ll have one of my partners come up to speak with you. I’m off service anyway. Upon my departure, the situation deteriorates, and security escorts her out of the building.
A few days later I’m on call. I get a call that evening. His mother wants to talk to his doctor. What? Why is she allowed back in the hospital? How many times has she been escorted out by security? Does she know I’m the one she wanted to deport? Yes, I’m told by the nurse on the floor, but she still wants to talk to me. I’m thinking to myself, at what point does it become the responsibility of the patient to pick a physician that fit their criteria for race and religion? Ridiculous that I have to ask this question, but it is what it is.
Normally I would be happy to talk to a family member. The patient was recovering, seen daily by my partner and there were no acute issues going on with him. So I made my decision. I wasn’t making a social visit. I wasn’t going to put myself in that situation again.
Physicians have embraced the idea of caring for all patients, regardless of who they might be or how they treat us. I had done all the appropriate things, complied with her wishes and asked one of my partners to see her son. There was nothing more I could do.
When I seek out advice about this situation, everyone is quick to make light of it. The hospital is so concerned with patient satisfaction that they allowed this person who is openly hostile to the physicians and nursing staff to come back into the building after being escorted out by security on multiple occasions. What other profession would tolerate this? Why do doctors and nurses have to put up with this? Why aren’t threats against health care workers taken seriously? And ultimately, what is our obligation as physicians, nurses, and hospital staff in this situation? If the patient doesn’t want a Brown, Black or Asian nurse or doctor, who is responsible for finding the health care provider that the patient approves of?
These situations are difficult for doctors, but worse for nurses, aides, and other staff. Physicians experience such discrimination during our brief interaction on rounds; nursing, and other staff are in a particularly vulnerable position because they are in constant contact with patients and their families.
If being subject to verbal abuse and threats of violence is accepted as “part of the job” because there is more concern about patient satisfaction, then the safety and well-being of physicians, nurses and other hospital staff, there is something really wrong with the system.
I wish I could say this was an isolated event. It’s not. And not that it matters, but I’m an American citizen, born in Iran and have lived in the United States for the past 32 years.
Farshad Farnejad is a trauma surgeon.
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