She Was Very Thirsty
“I’m an orthopedic surgeon.
The patient shows up for elective surgery munching on a big cup of ice. Big nope. I tell her we have to reschedule her case. She throws a tantrum, ‘But I have dry mouth and have to chew this ice!’
I understand, but we can’t put you under with a belly full of water (risk of throwing up and sucking all that stomach goo into your lungs and dying). We go back and forth like this for a few minutes. I finally say to her, ‘You know, talking to you is like talking to a toddler.’ She didn’t like that at all.
Finally, I tell her to go home and I leave the pre-op area. A few minutes later, the nurse finds me and says Ms. Pain in the Butt won’t leave, she says she doesn’t have a ride home. I give the nurse $20 to call her a cab. To this day, still the best use of a twenty ever. I never heard from her again.”
She Made Her Intentions Very Celar
“I had a patient that I saw quite often for a number of simple illnesses. She would often joke that she came in just because I was working the clinic that day. She said she would check if my vehicle was outside. Over the course of several months, I noticed she was coming in more often and with less clothing on. Short skirts, low cut tops. The last straw was her coming in with a loose fitting shirt and no bra. I fired her as a patient after that.”
Only On Her Crazy Terms
“I had a lady in her 40’s come in the other day who had an extensive and complex medical history and some psychiatric illnesses. She showed up 15 minutes late so by the time I brought her in, the next patient whose turn it was, was already there. She had a list of about six things she wanted to go over. We got through a few of the issues and then mainly focussed on her issue with some pain on peeing on and off for six months, and she wanted antibiotics for it. She refused to supply a urine sample or undergo an STI screen.
About two weeks later I got a note from the nurse that the lady wanted to lay a ‘big complaint’ about me because I didn’t ‘check her blood pressure.’
Like holy crap, you had six things you wanted to get through in your 15 minutes, you showed up late (and so I could have declined to see her and just asked her to reschedule) and now you are angry at me for not doing something that would take more time and wasn’t even relevant to the consult? So happy she never came back.”
He Left Out Some Pertinent Information
“I had a guy who I had seen once before for something minor say that he has been getting short of breath after walking only 20 meters (despite just walking in from the waiting room with no shortness of breath at all). He said it had just started a couple of weeks before. So I went through the main differentials (basically wondering if it is a lung thing or heart thing) and ordered some blood tests to help decide if he needed to see a cardiologist or respiratory specialist.
The next day, I arrived to work with a message in my inbox and his wife is FURIOUS that I hadn’t referred him to a cardiologist. She was thinking about filing a complaint to the Ministry of Health or going to the local Member of Parliament because they weren’t getting the help needed. This got me very worried because I was quite a new doctor. I called her up and she basically said he needed to see a cardiologist because of his cardiac history. I was like, ‘What cardiac history?’ She sent through the notes that basically said that this issue with shortness of breath has been going on for at least three years (not two weeks) and he had seen cardiologists four times and has had extensive testing done including a few ECGs, two echocardiograms and a stress echo, as well as an ETT ECG, all of which came back completely normal.
So I was thinking this guy really needed to see if this was due to his lungs. The cardiology note stated that they thought the same and they referred him for spirometry three times and he declined to go. The wife said they would be changing practices because of this.
I really try to do what’s best for my patients and try to decide the best approach possible in our meager 15-minute appointments but when patients like this make it difficult, it makes me feel so helpless. Then to know these patients would also try to have you lose your job at the drop of a hat…it’s not a nice feeling.”
She Was More Than Just A Patient
“A couple of years after becoming an attending surgeon, I had this miserably pessimistic patient with mostly problems related to self-neglect. She was agoraphobic, barely left her house, and a glutton for misery, basically refusing to do anything that might better her circumstance. She came to see me because she had a gastric bypass somewhere else in the past and wanted continuity of care. Fine
One day she handed me an envelope and told me I’d been served and that she’s sorry her husband the process server couldn’t ever catch me at home because I work too much. It’s true, I was working quite a lot because my wife of 12 years was being insufferable since we had moved away from her best friend in Miami for an incredibly better quality of life and work situation.
Anyways, they were divorce papers. My wife was leaving me to marry her friend’s brother, which I was already anticipating. It worked out well because then I was free to start over fresh with someone who shared my current priorities. Now we have three kids and a great life of rewarding work for only half-days, frequent travel and leisure, and three awesome young children. The miserable patient didn’t feel comfortable having me as her provider after that even though I offered to continue to do so.
Huge win on all counts.”
A Therapist Explains “Clinical Hate”
“I have a bunch of clients I don’t care for. I use the term ‘clinically hate.’ This is much different than personally hate. Here’s the difference: I may work with a child abuser that I personally hate and put it behind me, and they are a great client. I can work with a substance use client that I personally like but is a terrible client and I clinically hate. Now that can include ghosting appointments, coming in every time and saying everything is great, lying, so on and so forth.
Now I’ll give an example of a handful. It’s mainly going to be clinically because I normally don’t let personal feelings come into play. Most people have redeemable features. You can separate them out from what they’ve done. So very rarely do I personally hate someone unless they are a complete jerk.
I had a guy who was 100% honest that he was going to keep using once out of probation. He made every single appointment and made progress in other areas, so it was clinically relevant to keep working with him. On the last day, after we discussed termination, I asked him if I’d ever see him again. He said without a doubt he’d get arrested again and be in my office. Well, that’s when I let him know if his name ever came across my desk, that I would recommend 6-9 months intensive outpatient treatment after he completed three months of inpatient treatment. His jaw dropped and he questioned if I could do that. I told him to call his parole officer and ask. He then said he wouldn’t get arrested again. That was a ‘clinically hate,’ but personally like. It’s been almost a year and he hasn’t messed up. For some reason, treatment scares people more than addiction.
Now another one that I ‘clinically hated’ was this female that had some odd boundary issues. Basically, we were working with anxiety after she PICKED me. Now that’s important because she had anxiety around men. So she’d spend like the first 20 minutes giggling and looking away. 10 minutes in and she was finally talking, but the next 10 minutes skirting around what to work on. Then the last five minutes actually working on stuff. Now, for some people, that can be a huge breakthrough or massive progress. Some people all you need is the five good minutes. Well, in this case, it was just opening the can of worms that never got dealt with. It went from she was abused, to her anxiety, to the fact that she feels comfortable around me, to she has boundary issues, to she got into trouble last year because of guys, and how many she slept with and that she contracted chlamydia, to, in the last session, her declaration that she loved me and wanted to be with me, but she thought I wasn’t going to ‘be with her’ because she had an STD. No, I’m wasn’t going to be with her because she was a client.
After explaining that, she later called and canceled all the remaining sessions. It was a breath of fresh air that she finally just quit. She was super annoying. Now, you might think that I had an idea or inclination that the sessions were going that way. I did. I had a clue about three sessions before that went down. But there was not a huge red flag until it happened. You always have to be aware of transference or misplaced admiration. Sometimes people put you on a pedestal and I figured that’s where it was going. Not an attraction. You can argue the giggling or nervousness was a sign but when you work with teenagers, it can be common and you start to understand that it’s basically a defense mechanism for them. There was just more and more.
The last one is a ‘personally hate’ but clinically, loved. Now, this guy made appointments, worked hard and did everything asked of him. But it was the same issue for like six months on end. Same story every time, same reaction, same everything. I worked hard with this guy. Now granted, every week the story stayed the same and the reaction got less and less until one day he said, ‘I don’t need to talk about this anymore. I’m good.’ It was a by the books processing. Now I can tell this guy’s story better than he can. Still. He used the skills taught and managed new stressors and there was advancement and everything, it was just so draining every time. I hated listening to the guy’s stupid story and I hated him for it, but he was a great patient.”
She Was Obsessed With Him
“Before I say anything, I have to say that working with people with mental illnesses or other mental difficulties is easily what I miss most about working in that field. Even in my limited experience, I had enough folks that were so genuine, eager to get help, thankful, and wanting to help with difficult research to help others despite the crappy hand they’d been dealt that it was awe-inspiring. Even with the worst ones, you’re glad to not see them again, but you hope the best for them.
As for a specific patient, even though I felt for her, I was still selfishly glad that she didn’t come back:
I used to manage clinical trials for some bigger name places. One of the last trials I managed required working with folks with schizophrenia who were not on medication. To be fair, this story is NOT typical of those folks, and I don’t want to stereotype them, but I’m just saying this to explain the behavior in this instance. The study involved 3-4 visits totaling 10-12 hours with these folks, so I got to know them fairly well. My portion involved an extensive clinical/diagnostic assessment and some other computerized tasks, so all told, I spent four-ish hours alone with them (the rest was taking them to other providers/appointments for the study). This all occurred in a room that: A. Didn’t have a panic alarm and where B. I was not closest to the door, which are two big no-nos. I did bring it up when I first started but I was younger, more naive, and figured the odds of something happening in this context were low.
I worked with upwards of 120 people and heard all kinds of stuff, like a little old lady who described her vivid hallucinations of people being cut up into pieces, slaughtering others, etc. just as calmly as she talked about her love of scrapbooking. None of this stuff ever bothered me, largely because even when people describe stuff like that there are so many other indicators to tell you whether or not they’re dangerous, and most of the time they’re not. Several others were pretty terrified of the other portions of the study (not disclosing, but people without schizophrenia were afraid of it, so it was normal) but were so compelled to help our research so others wouldn’t have to feel the way they felt that it was inspiring.
Then I had one who was incredibly obsessive. I didn’t spend enough time with her to figure out if this was separate from or a part of her schizophrenia, but she ended up pinning me in the corner, grilling me in an aggressive-but-crying manner about why I kept asking her to come back to these appointments but didn’t want to date her (she had NEVER mentioned this until this point). Again, no panic buttons, no way out. I’m a small guy and she was taller and much larger than me. Thankfully her mom came to pick her up a little early and it saved my butt. But it happened in a matter of a minute or less and that’s what scared me most.
Suffice to say, I told my supervisor I would NOT be continuing that study until he rearranged the clinic so I was closest to the door and we had a panic button/protocol in place.”
He Was A Danger To Everyone, But They Had No Clue
“I work at an assisted living facility. The floor I work on is basically a high functioning inpatient psych ward.
I had a patient who would write very long lists detailing how to kill the staff. Things like, ‘I need to find a knife. I will slit their throats,’ etc… Whenever he wasn’t writing lists, he would pace back and forth between all of our alarmed doors. He would try to open them and shove them when the alarm went off. When someone does that, a VERY LOUD piercing alarm goes off and the radios stop putting out any message except ‘ELOPEMENT SECOND FLOOR WEST STAIRWAY’ over and over. This was hundreds of times a day. He would attack anyone who came near him, especially staff. It was getting bad. At one point, he broke all the picture frame and smashed the flat screen tv in the common area into the ground. He smashed the tables, the windows, doors, anything he could get his hands on.
His niece went to his house where he lived with his two brothers. It was covered floor to ceiling child smut. A lot of it they recorded themselves, some dating back to the early 1970s.
So yeah…I was happy to see him be arrested over that.”
Substance Abuse Is The Worst
“There were a few but they all had substance abuse in common:
Number one was this bride who got dragged into the ER because she couldn’t behave and was very wasted. She was the nastiest piece of trash human being I had to interact with, ever. I could not believe what a complete jerk she was. The worst part was she didn’t get nicer when she was sober.
Number two was a diabetic with a blow problem. The problem he had was he took lots of blow and zero insulin. High blood sugar, a total jerk, and coming down from the blow. That meant he required ICU level monitoring while being completely uncooperative with it. I would not have been sorry for his death. He was basically an every few days customer.
Number three was a raging drinker with respiratory disease. He would get loaded and start yelling then have trouble breathing. He would be yelling racial insults to everyone in eyesight between wheezing. He got a lot nicer when he sobered up but he was a royal jerk when he was hammered.
Of course, there was the IV substance user who no longer had decent veins. She would get some insulin (likely from one of the jerks who weren’t taking it) and load herself up via injection so that her sugar would be low (temporarily) and we would put an IV in her and give her glucose. After she got the IV she would run and escape so that she had a line to get high with. This happened all the time. There were evolutions of this but the basic premise continued for a long time.
You have no had bad interactions until you have had to deal with the parents of the rich white kids who ended up in the ER because they were blackout wasted in public. Conversations like this:
‘Yeah, your son is here because he was trashed.’
Gasp! ‘Not my honeysmookins! He would never, you must be confused!’
‘No ma’am we aren’t confused.’
‘You must be mistaken, if this gets to my insurance, I’ll sue this hospital!’
Here’s a story of the worst parent ever: Kid gets into a car crash at about 5:30-6:00 am. He hit a pole and was probably trashed. The first thing he said to me is kill him. ‘Please, kill me.’
I was like, ‘No, you’ll be fine.’
He said, ‘I know but I want you to kill me now. Put air in my veins or give me something but please kill me.’
I said, ‘Yeah…no. But what’s the problem?’ He said it was his mom’s car and she loved it more than him. Once she found out he damaged it, she was going to kill him, so he’d rather I do it now. I told him that the insurance covers cars and people are the most important speech but he stuck with his story.
Finally, his mom showed up and the first words out of her mouth were, ‘How’s my car? I’ll kill you if you damaged my car.’ I have never felt so bad for a kid in my life. Eff that lady; that kid deserved a better parent.”
The Worst Of The Worst
“The worst was this crazy wasted streetwalker. Not only filthy (and by that I mean, freaking filthy – you could smell her before you saw her) but a total piece of irredeemable dung. She liked to regale strangers in the waiting room with tales of things she has had put up her bottom. She made up false complaints of harassment and abuse against staff and also tried to steal anything and everything she could lay her hands on. She’d insist she was ‘misunderstood.’
She was one of the very few people I had absolutely zero sympathy for whatsoever.”
His Trauma Was Just Too Much
“A friend of my parents, who is a therapist, told me this story when I asked her about how she coped with her patients’ suffering. She told me that there was one patient she had and wished she would never have met, through no fault of his own, though. She wouldn’t give me much detail of course, but this is the gist of the story.
She had a patient who came to counseling after decades of trying to cope with his childhood trauma on his own and failing. It took quite some time for him to finally be able to tell her how he had been terribly abused as a kid. He proceeded to tell her about all the horrific things that had been done to him. It was absolutely terrifying and heartbreaking that anyone could go through this and according to my parent’s friend, it was surprising he even could survive. The horrors the patient described made a lasting impression on his therapist and started messing with her badly for some reason. She was not used to treating trauma of this kind and it came to a point that she would be reluctant meeting her patient because she knew he would talk about things that frightened her. She didn’t want to break his trust, though, and he really needed the therapy, so she said nothing.
After a while, however, the patient noticed that he was unwillingly making her uncomfortable and mentioned it in a session. They both agreed that she couldn’t help him under these conditions and it would be better if she referred him to a colleague.
She told me she was quite relieved not having to deal with this patient anymore but at the same time felt inadequate and unprofessional for being frightened by his pain.”