She was a tall woman, intimidating even, especially when she raised her voice. Nurses were reluctant to check in on her, and she refused every blood draw; sometimes she would allow her mother into the room, but they would always argue vehemently.
Her explanation to me was always the same: her life was being threatened. Her mother was trying to kill her, poison her, hurt her. She was jealous. She didn’t understand her gift, she wanted to take it away. And the doctors? They wanted to take it too. They wanted to test her, challenge her, poison her.
Samantha didn’t mean to push her mother down the stairs, but she needed her to get away. Her mother was nagging her again, telling her to see the doctors, do the tests, and Samantha wouldn’t hear it anymore. She felt the world closing in and needed to push her way out. When the paramedics and police arrived, domestic violence was suspected, but it became clear that Samantha did not have a great deal of control over her paranoid thoughts or violent reactions. She arrived in our emergency room on a gurney, in restraints, surrounded by white coats and uniformed officers, her paranoid nightmare becoming a reality.
However, most of them refused to see her. Psychiatry refused to have her in their ward. Internal medicine politely declined, and obstetrics wanted nothing to do with her. Once they established that her baby’s health was intact at 40 weeks and one day.
The only service that accepted Samantha and felt comfortable treating her psychosis while monitoring her and her baby’s well being, was family medicine. It wasn’t a noble gesture and it wasn’t the “luck of the draw;” we were simply the only team comfortable with all aspects of her care. We understood that her baby’s life was actually in danger should her psychosis go on uncontrolled.
I visited Samantha several times a day, during pre-rounds and in the afternoon. Although it’s difficult to say what kind of rapport we had, I felt like she trusted me. She at least trusted me enough to take Haldol every day and to let me check labs on her once before I transferred her to the obstetrical service to be induced at 41 weeks. Despite the fact I couldn’t make it to her delivery in the middle of the night, it meant the world to me that she asked me to be there if I could.
Samantha wasn’t my most complicated, troubled or demanding patient. Her condition was not very complex and she responded well to medication. Nevertheless, she stands out to me because no one else wanted to take care of her. In fact, no one else felt that they could take care of her. The time I spent with Samantha made me feel immense pride in my specialty – family medicine – a field that truly treats everyone.