I saw the 2 burly police officers in the hallway before I saw my patient. They wore latex gloves, ready to take action no matter how messy it got. I didn’t think much of it. Blue men were not an uncommon sight along the hospital wards of San Francisco General Hospital. My plan was to pass the scene unencumbered on my way to Mr. Henry’s room. But like traffic passing a fresh accident on the freeway, I slowed slightly as I passed the police officers to look to my right to see the source of the crash. The sight of Mr. Henry stopped me short. His matted hair stood all over his head as he sat in a wheelchair. He cradled his belongings in his arms though he still wore a blue hospital gown. Two White women stood 3 feet in front of him. The older one was a social worker. She held her hands on her hips. The younger one was the doctor in primary charge of Mr. Henry’s care in the hospital. She crossed her arms across her middle.
“What’s going on?” I asked, surprised. Mr. Henry was supposed to go home that day, but yesterday the Infectious Disease doctors said he needed to stay in the hospital for 2 more weeks to get antibiotics for what may possibly be residual infection of his left shoulder joint. He had already been in the hospital for 6 weeks getting antibiotics for it.
“I wanna go home!” he pleaded.
“We don’t think it’s safe for you to go home,” the younger of the 2 White women said. “We think you need to stay for more antibiotics.”
Mr. Henry was a hemodialysis patient, scheduled to go a dialysis center outside of the hospital every Tuesday, Thursday, and Saturday for his dialysis treatments. Antibiotics could easily be delivered into the blood vessel already connecting him to the dialysis machine. But Mr. Henry had most of his dialysis treatments in the hospital because he rarely showed up at the dialysis center.
“They won’t pick me up,” he had said of the transportation service and even the yellow cab company several social workers had arranged for him in the past. But I’m not sure that I would have picked him up either. Mr. Henry was a loud, grungy Black man and looked like he would create chaos, as he often had. He embarrassed me.
Now he sat in the hallway like a little boy, begging to go out and play. Except he was a grown man and sending him to his room would require force.
“I’ll go to dialysis and get the antibiotics!” he swore.
“Since when? I thought you said no one would pick you up?” I reminded him, a hint of lightness in my voice, hoping to lighten the mood closing in on us.
“I will this time. I have a card now.”
I looked at the White women. They shook their heads. “He’s had the card before,” the younger one said to me.
I walked closer, leaned down, and touched his shoulder. I tried to bring down the situation by helping him see what the doctors saw. It’s only a couple more weeks, I said, and then this will be behind you.
“I don’t wanna be here no more! My shoulder is fine!” he pleaded some more. He lived in one of the poorest, most drug-infested neighborhoods of the city. He worried his flat screen TV wasn’t there any more. He worried the disability checks that came every week weren’t waiting for him. His caseworker hadn’t been by to see him at all.
I put aside my doctor side now to see his. Doctors had been telling him for weeks that today was the day that he could go home. And then last night they had changed their minds and decided that maybe, possibly there was still an infection that needed further treatment. Treatment that he couldn’t be trusted to get for himself.
“We don’t think you can make that decision,” the young White woman said. “I’m sorry, I will have to get the court involved to make you stay here.” Her brows furrowed like she really was sorry for feeling forced to do such a thing.
I saw the Asian nurse approaching, a vest restraint in her hand. The men in Blue stepped closer.
“Mr. Henry,” I leaned down again, whispering this time. “I’m so sorry this is happening to you. It’s not OK. But if you don’t lower your voice and stop arguing, they are going to start doing things to you.”
“Why?! I haven’t broken no laws! I don’t wanna be here!” He cried now. I wasn’t helping. My heart ached as I stood. I looked up and to the right to call back my own tears.
“Can I speak with you please?” I said to the primary doctor.
We walked a few feet behind Mr. Henry.
“I know he is a mess, but don’t do this to him.” I was the one pleading now. I was only in charge of taking care of his dialysis needs in the hospital.
“We just don’t think he has the capacity to make the right decision right now,” she said.
“Capacity? Based upon what?” I asked.
A psychiatrist had been involved. I rolled my eyes. I’d seen this before. We doctors often seemed to question a patient’s capacity when they disagreed with us. Especially, if they were poor or odd or otherwise different.
“He gets to mess up,” I said and walked away. I couldn’t witness the scene any longer.
Mr. Henry was discharged that day. And he quickly messed up. He only showed up to his dialysis center twice in the next 2 weeks, but 3 times to the hospital. But at least he wasn’t subdued and restrained for wanting to go home.