Monday, February 18, 2008

Threatened

Recently I was "threatened" by a patient. So the news of therapist Kathryn Faughey being slashed to death in her Manhattan office Tuesday evening has really stayed with me. And it wasn't even her patient. Was my patient's threat serious? Here's the story.

A few weeks ago I saw two women, good friends, together in consultation. Both wanted procedures done (non-facial), similar goals but different procedures needed. Patient one (Uno) had lost a family member to an unexpected (car accident) death within the past year, but assured me that she was through with most of her grieving. We spent time discussing this. I wanted to be sure she was ready to proceed. The second patient (Dos) was Uno's best friend and had taken care of her while her friend grieved. She wasn't so sure her friend was through grieving. I finished the consultation and sent them home to think things over with instructions to both to be sure. They called back a week later and scheduled a day when both could have their procedures done on the same day. Their husbands would come and sit together in the waiting room. I once again, voiced my concern about the timing of surgery for Uno. Still I could not find anything "solid" to hang a refusal on.

Two days prior to surgery, Uno called and admitted she was not ready. She canceled, but her friend, Dos, had her surgery. All went well. Both came back for Dos' followup visit. Uno was so impressed with Dos' outcome, she wanted to reschedule. But as I finished removing stitches, Uno told me that her husband was afraid of her dying if she had surgery. She then told me "If anything had happened to Dos and she had died, I would have killed you." We discussed her husband's fear of her dying. I ask her if she could understand his fear better in light of her fear of her friend dying. I told Uno, in front of Dos, that I really thought she needed to wait for six months or more to grieve more (both she and her husband) before we considered re-scheduling her. I encouraged her to talk to her minister or a counselor without directly acknowledging the threat.

Did I handle it correctly? I'm not a psychiatrist, but I hope I did.

My condolences to Kathryn Faughey' family and friends.

10 comments:

Bongi said...

if i may give my humble opinion you might consider referring her to a colleague. such a threat can't be just left. is there any semblance of trust left between you and your patient? i would be concerned.

rlbates said...

I think there is trust there, Bongi. I will keep trying to get her to see someone.

Dr. Shock said...

You did well under the circumstances. A lot depends on her previous history and other diagnoses. But to my opinion you gave her objective professional advice.
Regards Dr Shock

rlbates said...

Thanks Dr Shock.

make mine trauma said...

Wow Ramona, that is a little spooky. People sometimes say things that they don't intend literally but I would not discount it. I agree with Bongi.

You obviously did an excellent job on Dos, but I don't think Uno's head is in the right spot for you to comfortably perform a procedure on her. Her behavior seems too unpredictable and her best friend agrees that Uno is not through grieving.

If it counts for anything, I think you handled it very well. You discussed the root of the fear without giving power to her threat.

rlbates said...

Make Mine, of course, your opinion counts. Thanks. That's what I was trying to do.

T. said...

I am so impressed with your courage and grace under pressure. Please stay safe - if your gut at ALL gives you deeper misgivings even for a MOMENT, please go with it.

rlbates said...

Thanks T.

Chrysalis Angel said...

I agree with Bongi, Ramona. I think you're very wise to put off her surgery. Remain cautious with this patient.

rlbates said...

Thanks CA. I will.