Editor’s Corner
Not What I Signed up For
L
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not represent the official position of
the American Society of Hematology
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6
ASH Clinical News
AST MONTH, WHILE AT a mandatory conference at our hospital and
idly checking my email, a note from my nurse caught my attention:
“Dr. Ma, can you call me now or let me know where you are?” I
replied, “In a meeting – I’ll let you know when the session lets out.”
My nurse’s next message really caught my attention: “Local law
enforcement has been called.” I escaped from a group activity and
called back my characteristically calm and unflappable nurse.
A series of phone calls from a long-term patient of the hemo-
philia center had raised the alarm. Brenda, the center’s highly ex-
perienced nurse, and Curtis, our well-trained social worker, filled
me in: “We just couldn’t get him calmed down, and we think
he’s threatening to hurt you.” Okay. “He’s in his car driving and
isn’t answering our calls any more. We don’t think you should be
alone, and we wanted to make sure you weren’t in clinic late and
coming out to an abandoned parking lot.” Great.
The patient was upset about the copay for his monthly
narcotics, the winter weather, the poor heat and insulation in his
girlfriend’s apartment, his unemployment, and his lack of disabil-
ity insurance – for which he apparently blames me. He also has
an anger management issue, and depression, and he’s been fired
from work for assaulting people who “got in his face.”
As a child, he had a heart murmur and received disability
benefits. He no longer has a heart murmur, and he blames me for
documenting this. Because he equates his lack of a heart murmur
with his lack of disability, he went from faulting me for cosigning
a resident’s “no M/R/G” note to accusing me of writing the dis-
abilities board to say his application should be denied.
Brenda and Curtis explained to him that this wasn’t true, and
that no adult patients with hemophilia get approved for disability
on their first application, and that he should reapply after keeping
a log of his bleeds and joint pain. He could not be reasoned with.
Curtis found it hard to keep up with the patient’s disorga-
nized ranting, but several phrases stood out: “Make an example
of her. … Get people’s attention. … Mass shooting.” And, my
personal favorite: “If I could, I’d come and blow the b---- up.”
Apparently, he’s been angry with me for a decade. This was
news to me, since I had arranged a monthly clinic visit schedule
for him so we could track his bleeds and pain, thereby helping
him with his disability documentation.
Luckily, that day it was threatening to snow. In North Caro-
lina, not even a potential mass shooter wants to be out on the
roads in bad weather. He turned around and went home.
A few hours later, I was driving to a previously arranged din-
ner while thoughts were scurrying around my head. What would
I do if the patient pulled a gun in clinic? What if he was by my car,
or waiting at my home? Golly, my colleagues would have to cover a
bunch of calls and clinics for me if I were dead or wounded. …
I found little solace when I told others about my experience.
My mother – ever unsupportive – asked, “Why do you always
get yourself into these situations?” Not helpful, Mom.
The husband of a trainee offered to loan me a handgun. Gulp.
Should I think about getting a gun?
I turned to the internet next. I looked up “handgun classes
near me.” A facility located in the same shopping center as my
nail salon offered handgun training. Their website proclaimed
“Violence as a second language.” They offered classes titled
“Defend Your Castle” and “Urban Warfare 1.” I hesitated; I’m not
certain I want to be fluent in violence.
Note to self: There’s a real opportunity to market handgun
safety to academicians. Call it
“Handgun Training for Squea-
mish Liberals.” I’d have signed
up for a class like that, but all I
found was “Boom: Introduction
to Firearms.”
After careful consideration,
I concluded that a handgun was
NOT for me, since I really didn’t
think I could shoot a hemophilic
Alice Ma, MD, is professor
patient. And, firearms are forbid-
of medicine in the Division of
den in clinic, so even if I bought a
Hematology and Oncology at
gun, I couldn’t bring it to work. I
the University of North Carolina
settled on ordering pepper spray
School of Medicine in Chapel Hill.
and a Taser from Amazon.
Now, what to do about the
patient, his hemophilia, and his boiling rage? On the one hand,
he has specialized health-care needs that are best served at our
center. Could we mandate that he be actively engaged with men-
tal health care as a condition of treatment? Could my partner
see him in clinic when I’m not there? Yet on the other hand, he
might go off the rails and decide to follow through on his threat.
How do we keep our other patients and health-care providers
safe, while addressing the needs of this patient?
Serendipitously, while I was wrestling with these questions, I
ran into Arlene Davis, JD, a terrific colleague and co-chair of the
University of North Carolina (UNC) Hospitals Ethics Committee.
Yes! I clearly needed an ethics consult. Soon, I was at a meeting
with representatives from our ethics committee, legal department,
and hospital police. I learned that we should have called th