Fridays at 10: When Life Is Unfair to Both Patient and Doctor

For many years, her psychotherapy appointment was on Friday mornings at ten o’clock. One visit, she casually mentioned she was taking psychotropic medications prescribed by two other physicians, her gynecologist and primary care physician. She fought the idea that she was placing herself at risk by being treated by multiple doctors for her affective disorder. It became clear that I didn’t really know what medicines she was on at all. The patient willingly brought her spouse to what would become the final session as they discharged me from their care. They preferred the care of the gynecologist and, as well, added “enough with this talk therapy when there are pills to solve life’s problems.” This was good bye. That this was neither customary nor a desired transition from long term therapy gnawed at me. Then I reasoned that the patient, in spite of a long history of dysthymia, had been stable for quite some time. She had strong family support. She had a wonderful profession that she loved. It was her decision to be or not be in psychotherapy. I documented the course of events and never heard from her again.

Seven months later, on a Friday, at about 3pm, I received a call from the police. Her body had been found at the beach that morning, with a rifle at her side. The blood drained from my head as I spoke to the detective. The room spun. I was dizzy. The detective was doing his job as he said to me, “Just routine, Doc, I am contacting everyone whose cards she had in the back pocket of her jeans.” She killed herself on a Friday morning with my card in her pocket. That was difficult to bear.

I slumped into the chair, grateful there was no patient in the waiting room. At once, I tried to collect my thoughts and understand my reaction. The shattering news of a suicide has immediate and far reaching effects. The poor soul. And her spouse, daughter and sons. If I am feeling such shock, such horror, what must they be experiencing? Within minutes my next patient arrived and I was forced to move on, the deceased patient’s memory haunting me for some time to come. But what never crossed my mind was that I could be sued. What would the allegation be? She was of sound mind, was never suicidal, and although I did not agree, it was her choice to terminate her care with me. And, as is characteristic of me, my documentation was thorough and contemporaneous.

First, it was the letter from the attorney with a request for her records. Then, a few months later at my office, a server delivered the summons and complaint to me. It was unfair. Preposterous. Incredulous. And yes, it was really happening. And I had no recourse. Absolutely none.

I was blessed with a fine memory. However, the events of the evening after being served with the lawsuit are a complete blur. Did I go directly home? Who was there? Did I stay later in my office on a Friday? Who did I speak with first? What did I say? And then what did I do? Did I have dinner? Did I sleep that night? I eventually spoke about it with my family and received tremendous support. But that came later. In the immediacy of the incident, I do not know, to this day, what I did. A woman drove to the beach and shot herself in the head and I am speaking about the “incident” as the day I was sued. There is a despair, a hopelessness, an isolation, even a drama, that arrives as uninvited as unwelcomed, when faced with a lawsuit. You are drowning and everything that could possibly save you is just out of reach.

Nineteen months later, the decedent’s spouse was killed in a motor vehicle accident and the lawsuit was dropped. My attorney was supportive for that nearly two year period. It was believed I would be released from the suit. I clung to that thought. I never had a deposition, though the thought of it hung over my head like a cancer nearing closer. We will all never know where this suit would have ultimately gone.

What do I know? I know that you can give the best care to your patients and it may not be enough. I know that I can’t know everything that goes on in a patient’s life. I know there is a legal system that can, at least for a time, make me feel responsible for that which I am clearly not responsible for. And knowing that made me very angry.

I am angry no longer. My former patient was likely born with a genetic vulnerability, a thief of joy, stealing her happiness around every twist and turn of her journey here. It took her down a road that led to desperation and ultimately to a violent departure from the earth. Faced with the news of her death, I was saddened deeply. I will never know what horrible road she got on that drove her to commit such an act. Faced with the legal action against me, I suffered. For almost two years, I felt victimized. I felt the world had turned on me.

And then I learned that life makes no promises that it will always be fair. I have my joy back and I treasure it. And whatever happens to me as I go further on my own journey, I will not allow it to be stolen from me again.

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