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A Piece of My Mind
August 13, 2008

A Stitch in Time

JAMA. 2008;300(6):630-631. doi:10.1001/jama.300.6.630

“I need a woman's touch!” Red-eyed with the use of cocaine, he arrived in the emergency department accompanied by jail guards. His chart spoke of antisocial personality disorder, and the reality of his life suggested that the label was well applied. He had been belligerent at dialysis, which was terminated prematurely, and was now refusing Kayexalate; hypertensive at jail intake, he was admitted to the inpatient service for medical stabilization prior to booking. He underwent dialysis successfully overnight, quickly making enemies of the staff with his surly swearing and many demands. On the morning I met him as his primary physician, he denied me an interview or an examination and refused to allow a blood draw. When his jail hold expired, I planned to discharge him later in the morning to his own care. Normotensive? Check. Normokalemic? Likely, but unable to document without patient cooperation. Counseled on cessation of cocaine? Check. Medications refilled? Check. Transportation? Check. Avoid the unpleasantness, I told myself. Not long before, I had left my two little boys with their sweet morning breath and tousled hair at home with my loving and patient husband. I was looking forward to spending a day at home with them once my work that day was finished.