so why in the world did you get all crazy on me today in clinic? i want to ask my patient this question. i want him to tell me why, in the middle of our monthly f/u for medication management of his schizophrenia, chronic paranoid type he chooses to stand up suddenly, nearly overturning his chair, open hand slap the door then open it and slam it against the wall all the while yelling “no more questions, no more questions”. i want him to explain why he becomes agitated, violent and storms out of the clinic, banging doors, walking back and forth in the hallway eventually leaving the hospital only to be found and brought back to the ER so he can be involuntarily admitted by me.
i would like to know why he betrayed my trust. i would like to know why the mental health tech who took and searched his belongings found a 6-inch switchblade. i would like to know why he feels the need to carry this dangerous weapon and can someone tell me why we don’t have adequate safety coverage to ensure that patients DON’T walk into the hospital armed to the teeth?
between patient and doc there’s an unwritten code of conduct. we learn to trust each other. i have to trust that what you tell me is the truth and you have to trust that what i tell you is the truth. if i didn’t care i wouldn’t go through all this delayed gratification so that the auditory hallucinations you suffer from don’t overwhelm you. i wouldn’t take time out to discuss all the symptoms with you, to look you in the face instead of start writing my note, to write out in simple 3rd grade english your medications, your labwork and the fax number so the clinic can get the lab results. i wouldn’t care that you went back to your home country to see your girlfriend or that you made a large dinner for your family 3 weeks ago. i wouldn’t spend all that time on the phone with insurance companies or faxing them forms; filling out forms to social security; re-writing prescriptions for 2 weeks because you lost your script, you only have 2 days left and you missed last month’s appointment; calling you when you don’t show up or call so that i can re-schedule the appointment or tracking down your charts in medical records b/c somehow your appointment DIDN’T show up so they DIDN’T get your chart ready.
i wouldn’t pray for you during the session or after. i just wouldn’t!
so why did you do what you did today?
why did you scare me? why did you disrupt my day so i lost my appetite? why did you make me cry on the phone tonight with my friends b/c i am afraid you might hurt me so i won’t want to see you again? why did you make me involuntarily admit you? why did you leave me shaking? why didn’t you take all your medication so that the hallucinations wouldn’t be so overwhelming? why did you lie to me all these times? why did you leave me feeling vulnerable so i had to ask a colleague to hug me? why did you force me to have to go talk to a million people and raise a right ruckus to get appropriate security in order that no one gets killed?
if i didn’t care, i wouldn’t be here. so again, i ask, you — why?