Credible Threat

It was one of those situations where all your questions were answered the minute you laid eyes on the patient.  The ER had described him as having decompensated heart failure and uncontrolled high blood pressure.  He was 'non-compliant' with his medications and needed to be admitted.  I told the doctor I'd be down to the ER shortly, and that we'd tune the patient right up.  This was met with a snort.  "Good Luck," I was told, and hung up on.

Bill was big.  400 plus kind of big, and in a constant sweat, and wearing clothes that hadn't been washed in a while.  He needed a haircut and a shave.  And he wouldn't look you in the eye.  And there was a large ball of tinfoil in his fist.

I don't think it took a great deal of medical expertise to realize that paranoid schizophrenia was Bill's real issue (and if you didn't realize it yourself, it was documented all over his chart) - but his heart and his blood pressure needed some work, too.  So we sent him to the medical floor, where the constant stream of people coming in (the guy to put in an IV, the nurse to hook up his Lasix, the echocardiographer with her ultrasound machine, the chaplain, the med student, the resident, the food server), the beeping of the monitors and the blare of his neighbor's TV whipped his paranoid delusions into a frenzy.  He started telling nurses that he was a CIA operative.  He was sure there was poison going into his vein and pulled out his IV.  His tin foil was taken away from him, leaving him unprotected from the harmful rays of cell phones.

As the afternoon wore on, Bill got more and more out of control.  He told nurses that he was prepared to defend himself "to the death" and pulled a plastic butter knife from somewhere on his person.  They called security.

If I could, like Superman, fly around the world clockwise and turn back time, the rest of the story would go like this.  Security removed the plastic butter knife from his hand and Bill was taken up to the Psychiatric floor, where things were quieter and his medications had a chance to start working, and Bill was attended to by a whole bunch of folks who were concerned about his well being.  He got a little better and left the hospital.

Instead, security called the police.  And the police came and arrested him for threatening the nurses with a deadly weapon, and cuffed him and took him to jail.  All of this was down without any notification or consultation with the physicians who were caring for him.  An intake check revealed that he had a website on which he espoused his many conspiracy theories and discussed his ideas to foil the government plots that had been set in motion against him.  He was deemed a credible threat, and Homeland Security was notified, and some local FBI agents came to the jail to interview him.  Finding him relatively harmless, he was eventually let go.  Not returned to the hospital, for the help he still needed - he was simply sent home.

Home for Bill was the Bel-Aire.  The walls were paper thin there, and a few nights after his release a loud domestic argument in the room next to his agitated him and he began banging on the walls, and shouting threats.  The police were called.  They kicked in his door.  He grabbed a nearby plastic fork from one of the many take out cartons that were strewn around his room.  The police shot him in self defense.  He died.

I don't think it takes any sort of special expertise to realize that jail was not the proper destination for Bill.  He was not a criminal, he was a person with a mental illness.  He was a patient in need of medical care right up to the moment when the police decided to take control of the story of his life and, without too much thought or investigation, end it.

Every time I pass the Bel-Aire, I think about Bill and I feel guilty that I've allowed the police's version of Bill's story stand without countering with mine.  He was literally framed.  The paper reported it as a story about how dangerous it is to be a cop.  I agree - it's dangerous.  But surely we can work together to see people as themselves, not as threats to be eliminated. I wish so much that someone had called me - the patient's physician - instead of taking him to jail or before releasing him from jail.  The police couldn't do anything about Bill because Bill was not a law enforcement problem.  He was a patient.  He was my problem, and I was willing to help - in fact I was in the very midst of helping when he was taken away in handcuffs.  I'm still really angry that Bill's life ended the way it did.