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I’m actually not a football fan, I didn’t even know who Ray Rice was until I saw on CNN the now-infamous elevator video of him punching his then-fiancee an elevator and then dragging her unconscious body through the door. But after only 10 minutes of watching the different experts weigh in, including the ex-wife of Mike Tyson/domestic-violence–survivor Robin Givens, I realized my shoulder muscles had started to tense. I was getting the same knot in my stomach I get when faced with an impossible social problem in the hospital that I can’t fix: the alcoholic in awful withdrawal who refuses to go to treatment; the homeless man with heart failure who won’t follow-up at his appointments; the unfunded dialysis-dependent immigrant who gets dialysis only once a week, emergently, in the ED; the very elderly women with a fractured hip who insists on going home. And, of course, suspected elder-abuse or domestic-abuse victims, who are discharged back to the house they had come from.
Rice’s wife, the former Janay Palmer, issued a statement essentially saying everyone needed to mind their own business and that she would support her husband.
She is, of course, correct; it is their business. But as is so often the case when something tragic happens to or regarding a celebrity (whether it is Robin Williams’s suicide or Philip Seymour Hoffman’s drug abuse) their life in the spotlight then becomes a mirror to society’s woes and a platform, for better or worse, to discuss issues that affect the masses.
As I watched the news, the frustrated part of me, the controlling-fixer part, wanted a more logical and just (in my mind) outcome: a declaration that she is leaving the relationship, his suspension causing him to enter a life of counseling and successful reform. But the realistic part of me – the part that saw my mom stay with my dad despite years of pathologic alcoholism and then, once she had kicked him out, go directly to another women who then supported not only his drinking but also his unemployment for 13 years until the day he died from the disease – knows relationships are complicated and often pathologic.
I also know from both my own experience and my experience as a physician, that until the victim, whether it is the drug addict, the alcoholic, or the elder abuse and domestic abuse victim, decide for themselves that they want to change, those of us who want to help are relatively helpless.
In most of my patients with drug and alcohol addiction, and in my handful of suspected abuse cases, the outcome is almost always the same disappointing but almost scripted scenario. Addiction or abuse is suspected by one of the providers, house staff, nurse, medical students, or me because of the clinical situation, something overheard by a nurse, or the concerns of a family member. We try to gain more insight or information by talking to the family or patient.
We consult social work and the note inevitably says "patient denied problem/refused treatment at this time. Resources and contact information were provided to patient and family."
When I read those words, I get the same muscle tension and helpless knot in my stomach as when I was watching the news. My body aches as my mind makes the painful realization and transition from, "There must be something we can do" to "There is nothing more we can do."
We discharge the patient, "resources" in hand, and simply hope.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
I’m actually not a football fan, I didn’t even know who Ray Rice was until I saw on CNN the now-infamous elevator video of him punching his then-fiancee an elevator and then dragging her unconscious body through the door. But after only 10 minutes of watching the different experts weigh in, including the ex-wife of Mike Tyson/domestic-violence–survivor Robin Givens, I realized my shoulder muscles had started to tense. I was getting the same knot in my stomach I get when faced with an impossible social problem in the hospital that I can’t fix: the alcoholic in awful withdrawal who refuses to go to treatment; the homeless man with heart failure who won’t follow-up at his appointments; the unfunded dialysis-dependent immigrant who gets dialysis only once a week, emergently, in the ED; the very elderly women with a fractured hip who insists on going home. And, of course, suspected elder-abuse or domestic-abuse victims, who are discharged back to the house they had come from.
Rice’s wife, the former Janay Palmer, issued a statement essentially saying everyone needed to mind their own business and that she would support her husband.
She is, of course, correct; it is their business. But as is so often the case when something tragic happens to or regarding a celebrity (whether it is Robin Williams’s suicide or Philip Seymour Hoffman’s drug abuse) their life in the spotlight then becomes a mirror to society’s woes and a platform, for better or worse, to discuss issues that affect the masses.
As I watched the news, the frustrated part of me, the controlling-fixer part, wanted a more logical and just (in my mind) outcome: a declaration that she is leaving the relationship, his suspension causing him to enter a life of counseling and successful reform. But the realistic part of me – the part that saw my mom stay with my dad despite years of pathologic alcoholism and then, once she had kicked him out, go directly to another women who then supported not only his drinking but also his unemployment for 13 years until the day he died from the disease – knows relationships are complicated and often pathologic.
I also know from both my own experience and my experience as a physician, that until the victim, whether it is the drug addict, the alcoholic, or the elder abuse and domestic abuse victim, decide for themselves that they want to change, those of us who want to help are relatively helpless.
In most of my patients with drug and alcohol addiction, and in my handful of suspected abuse cases, the outcome is almost always the same disappointing but almost scripted scenario. Addiction or abuse is suspected by one of the providers, house staff, nurse, medical students, or me because of the clinical situation, something overheard by a nurse, or the concerns of a family member. We try to gain more insight or information by talking to the family or patient.
We consult social work and the note inevitably says "patient denied problem/refused treatment at this time. Resources and contact information were provided to patient and family."
When I read those words, I get the same muscle tension and helpless knot in my stomach as when I was watching the news. My body aches as my mind makes the painful realization and transition from, "There must be something we can do" to "There is nothing more we can do."
We discharge the patient, "resources" in hand, and simply hope.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
I’m actually not a football fan, I didn’t even know who Ray Rice was until I saw on CNN the now-infamous elevator video of him punching his then-fiancee an elevator and then dragging her unconscious body through the door. But after only 10 minutes of watching the different experts weigh in, including the ex-wife of Mike Tyson/domestic-violence–survivor Robin Givens, I realized my shoulder muscles had started to tense. I was getting the same knot in my stomach I get when faced with an impossible social problem in the hospital that I can’t fix: the alcoholic in awful withdrawal who refuses to go to treatment; the homeless man with heart failure who won’t follow-up at his appointments; the unfunded dialysis-dependent immigrant who gets dialysis only once a week, emergently, in the ED; the very elderly women with a fractured hip who insists on going home. And, of course, suspected elder-abuse or domestic-abuse victims, who are discharged back to the house they had come from.
Rice’s wife, the former Janay Palmer, issued a statement essentially saying everyone needed to mind their own business and that she would support her husband.
She is, of course, correct; it is their business. But as is so often the case when something tragic happens to or regarding a celebrity (whether it is Robin Williams’s suicide or Philip Seymour Hoffman’s drug abuse) their life in the spotlight then becomes a mirror to society’s woes and a platform, for better or worse, to discuss issues that affect the masses.
As I watched the news, the frustrated part of me, the controlling-fixer part, wanted a more logical and just (in my mind) outcome: a declaration that she is leaving the relationship, his suspension causing him to enter a life of counseling and successful reform. But the realistic part of me – the part that saw my mom stay with my dad despite years of pathologic alcoholism and then, once she had kicked him out, go directly to another women who then supported not only his drinking but also his unemployment for 13 years until the day he died from the disease – knows relationships are complicated and often pathologic.
I also know from both my own experience and my experience as a physician, that until the victim, whether it is the drug addict, the alcoholic, or the elder abuse and domestic abuse victim, decide for themselves that they want to change, those of us who want to help are relatively helpless.
In most of my patients with drug and alcohol addiction, and in my handful of suspected abuse cases, the outcome is almost always the same disappointing but almost scripted scenario. Addiction or abuse is suspected by one of the providers, house staff, nurse, medical students, or me because of the clinical situation, something overheard by a nurse, or the concerns of a family member. We try to gain more insight or information by talking to the family or patient.
We consult social work and the note inevitably says "patient denied problem/refused treatment at this time. Resources and contact information were provided to patient and family."
When I read those words, I get the same muscle tension and helpless knot in my stomach as when I was watching the news. My body aches as my mind makes the painful realization and transition from, "There must be something we can do" to "There is nothing more we can do."
We discharge the patient, "resources" in hand, and simply hope.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
