Two Situations Involving Rules

Situation One: I was walking down the corridor after lunch when I heard someone crying loudly. I picked up my pace, as did the woman who was walking ahead of me. We came upon a middle-aged lady, up against the wall, heaving with sobs, "I want to die! I want to die! I can't be brave any more!" The other woman -- a laboratory worker -- and I managed to get the lady to leave the hallway and step into the chapel. We spent an hour with her as she cycled between regaining her composure and resuming her lament. We pieced together that she had just left visiting her daughter, who had been a patient for a couple of weeks, and who had just received a new diagnosis. Conversation with the daughter's nurse revealed that the lady was not good at managing her diabetes, had skipped several days of visiting the daughter, and had exhibited a change in mental status. After a long time, we were able to persuade the lady to go to the Emergency Room where someone could check her blood sugar in the hope of getting her stabilized. I reported her words, "I want to die!" to the triage nurse. Confident that the lady was in good hands and having received a call to attend a patient, the lab woman and I left her there and went on to our work.

Fifteen minutes later I received a call from the lab worker. She had accidentally left something down in the ER and when she went to pick it up, she learned that the lady had left. When questioned about "I want to die!" she had responded that she had no plan to kill herself that day. Though her blood sugar was likely out of line, though she clearly needed some sort of care beyond what we had been able to provide, since she was not a danger to herself or to others, the ER nurse had no way to keep her and administer treatment. This was a case where rules got in the way of care and there was nothing that could be done about it.

Situation Two: The patient had suffered a cardiac arrest and the team was working hard to bring him back. My job was to support his partner-not-wife-of-sixteen-years. When the patient had Coded, the partner had phoned his daughter, who was on her way to the hospital. Soon, the patient appeared to be stable and the resident came out to speak to the partner-not-wife. "Is his daughter coming in?" she began. "I am so sorry, but because you are not family, I cannot give you any information about his condition." She looked sorry, and the partner understood and did not argue, but looked very, very upset.

Since the patient had just come to the hospital that day, he was not yet assigned to a particular service, and the resident sat down and placed a call to an attending. I heard her explain the patient's situation in detail and then she said, "Okay. I'll call him." The partner was anxious, looking at her watch, wanting to go into the patient's room but not yet permitted, wanting information that she was not legally entitled to. When I saw the resident pick up the phone to place the next call, I moved the partner a few feet so that she would be closer to the telephone. "Now, just eavesdrop," I told her.