We rarely have much difficulty identifying our patients – they are the people who are bleeding or screaming or look ill or are stretched out on the trolley or vomiting and so on. Sometimes, however, confusion does arise and it can cause problems - as it did the other day.
On the computer screen I put my name against that of the next patient to be seen then collected the medical documents. I noted the patient to be a young, adult female whose triage diagnosis was depression. I decided to take her to one of the very basic consultation rooms where we would not be overheard by others in the main treatment area with its simple curtains separating the treatment bays. The room contained one chair and one bed plus a sink and small work bench.
Opening the waiting room door I called out the patient’s name and watched as two young adult females, together, got up and walked into the room. Looking at them I started to ask which person was the patient but the first woman interrupted me emphatically stating that we needed two more chairs. “We must sit in a circle and hold each other’s hands as we work through this problem.” She continued. “I know what she is going through because I have been there myself and we have to communicate properly to help her get through it.” She paused momentarily and I thought I saw an opportunity to ask, “Excuse me but ….”, but that was as far as I got before she started again.
She rambled on and on and on while the other young woman stood silently, eyes downcast and shoulders slumped. I decided a bit of assertion was called for and, raising my voice just a little and talking over here tirade, asked, “Are you the patient or is this lady the patient?” indicating her companion. “Don’t you interrupt me! No I am not the patient. I have been a patient before …..”
“Then please leave the room and let me speak with the patient.”, firmly and emphatically but it was no use. My antagonist then accused me of arrogance and, “… the most unprofessional, disgraceful behavior she had ever come across ….. etc, etc, etc ………..” and “Come on Jenny, we are out of here. We will go and find someone who cares.” And the poor hapless patient turned to follow her “mentor” through the door.
I realized that the woman doing the talking was probably a manic depressive and currently in a manic phase, or getting close to it. She had mentioned in her opening statement that she had, “been there myself”. The patient had not uttered a word and was obviously dominated by her friend. I felt that if I could not persuade them to stay then either or both might come to serious harm. In a flash of inspiration I said, “Wait. Would you like to speak with a woman doctor?” They stopped. “All right, she can’t be any worse than you.”, replied the talker and they came back into the room.
By chance the shift supervisor was a young woman, a qualified emergency medicine physician and an extremely pleasant person to work with. I outlined my problem to her and she agreed to take over the case. Quite some time later the patient was admitted to the main area of the emergency room, where could be kept under continuous observation. The other woman came with her and sat beside the bed strangely quiet. I looked at the supervisor with raised eyebrows and a questioning look. She just smiled, “I’ll speak to you later.”, she said.
We got about our business and, apart from dutiful glances as the patient from time to time, which is a habit we all have when such a case is in the room, I thought little more of it. Then, a couple of hours later, the talkative one suddenly approached me saying, “Look, that ambulance is taking too long and I am going to have to take her to the other hospital myself.”
“I’m sorry, but you will need to speak with the lady doctor as I am not involved with your friend. But, as you will have noticed, the ambulance people are very busy. I’m sure they will take your friend as soon as possible.” She turned and walked back to her friend without speaking again.
It wasn’t long after that that I noticed an ambulance crew moving the patient onto their stretcher and take her out to their vehicle. The talkative one followed. And that was that.
Over a cup of coffee, in a rare quiet hiatus, my colleague told me the patient was indeed extremely depressed and required admission to a psychiatric facility. “And what about the other one?” I asked.
“Oh, she told me she used to be manic depressive but is cured now and doesn’t need the tablets any more. I did my best to persuade her to get back to her doctor for follow up. I hope she does.”
“I couldn’t agree more.”
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