BehindTheMedspeak: Turning the other cheek is one thing — but this is ridiculous

Dr. Godfrey Onime is a much better person than I am.

That's my bottom line after reading his superb essay, which appeared in the May 27, 2008 New York Times Health section, about how he agreed to care for a sick, elderly man even after the man's family had filed a complaint with hospital administration about a two hour wait in the emergency room before Dr. Onime was able to see the patient.

Here's the piece.

When Hostility Melted for the ‘Funny Accent’

It was 1:06 in the morning when I got the call from the emergency room. An 82-year-old required admission. Severe anemia. Stool test positive for blood.

Like most community hospitals, mine lacked interns and residents. The attending physicians could give the nurses orders by phone and delay seeing patients. But I did no such thing with this patient. I knew him from a hospitalization a month before. I was terrified not to go see him now.

Terrified of his children.

In that last admission, things had not gone well between his family and me. I had been busy with another patient with life-threatening fluid around his heart when the E.R. physician called. So I had not seen the patient for about two hours.

I apologized, but the family was livid. Especially the elder son, a middle-age man with a diamond earring and a habit of jerking his head as he spoke, long blond hair flying. They had been in the E.R. more than six hours, he protested.

“I’m sorry you had to wait,” I apologized again.

The daughter — slim and soft-spoken — asked where I was from, adding, by way of explanation, “The accent.”

I was used to the question. “Nigeria,” I said, and apologized anew for my delay.

After that, I thought everything went well. But the next day, the son filed a complaint with the hospital administration. That was when I decided they did not like me. Maybe their father was too good to be cared for by a black man, an African no less, one they probably thought believed in the healing powers of rocks and trees and the voodoo dance. At least that was how one woman put it after I refused to prescribe antibiotics for a viral upper-respiratory infection.

From then, I had done my best to avoid the children, though I always called to update them on their father’s condition.

But now he was back. They were back. And I was still fighting with his insurance company over the bill from his last hospitalization. The patient’s former primary-care doctor had joined the flock giving up hospital work. Maybe I should, too, I mused.

In the E.R., the bright lights gave the illusion of daytime. The man — frail, pale and taciturn — was propped in bed in a corner room. All three children were present, two sons and a daughter.

They were glad I was on call, said the elder son, the filer of the complaint. His father did not like hospitals and agreed to return only if he would be cared for by “the doctor with the funny accent.” I laughed in spite of myself.

I knew the old man had a distant history of bleeding stomach ulcers. In his last hospitalization, the gastroenterologist looked with an endoscope and did not find the source of the bleeding. I administered a blood transfusion and discharged him on iron pills. But now I suspected he was continuing to bleed.

As with his prior admission, I ordered more transfusions. I also reconsulted the gastroenterologist, who now suggested a “capsule” endoscopy, in which the patient swallows a tiny camera that passes through the system so its images can be analyzed.

Soon my patient was ready to return home, to follow up with his primary doctor, of course. But his children had something to say. “We have been impressed with the way you cared for Dad,” the eldest son began, as I recall.

I whirled to face him, not sure I had heard correctly.

“We have discussed it,” the son continued, “and we think you should be his primary-care doctor.” He jerked his head, hair flying, earring sparkling. “He likes you, plus you also do hospital work. Are you accepting new patients?”

I looked from the children to the old man and back at the children, not sure how to respond. Was I now supposed to ignore their wariness and hostility a month earlier, forget their complaint against me? Was I to hop up and down that they were choosing me, sing joy-oh-joy, dance the voodoo dance?

Then I cautioned myself. Doctors, if not careful, can project their frustration onto their patients. I wondered: Could that be happening here? What wrong had this family done? Weren’t families supposed to be advocates of their sick loved ones, demand expedient and optimum care? I realized I was afraid they would discover that at times I could be wrong, too.

There was an awkward pause while I thought this out. But really, there was just one answer.

“I’ll be happy to be his new doctor,” I said.

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Godfrey Onime is an internist in Lumberton, N.C.