Dr Bitch

The first words out of his mouth tell me that this patient encounter is doomed.

Then again, it was probably doomed from the moment I started my 11pm shift only to find myself staring at charts for patients who checked into the ER at 5pm. It's now 3am, and I'm still ploughing through patients from 8pm - and still they keep checking in. I feel resigned - the only alternative is to rail against the ignorance of Joe Public who thinks it perfectly reasonable to stampede the doors of the ER for their hangnails, sore toes and runny noses.

"I need antibiotics," he says. "I have an infection."

"Mmmm," is my non-commital response.

"I have a sore throat and a cough."

"OK," I say. "How long have you had these symptoms?"

"Three days."

"Any fever?"

"No. Listen, I'm telling you I need antibiotics."

The rest of the interview goes the same way. He has decided that he needs antibiotics. He saw his GP who refused to give them to him, diagnosing him with a viral illness. His physical examination is entirely unremarkable. There is nothing in his story to suggest he needs antibiotics, besides his conviction which borders on delusion.

"I don't think you need antibiotics, sir."

His voice grows louder. "I'm telling you I need antibiotics and I want them."

"Sir," I say, and I feel a flash of anger and frustration through the haze of tiredness, "it's my medical opinion that you have a viral illness and do not need antibiotics."

"I NEED THE FUCKING ANTIBIOTICS."

His face is growing redder by the moment.

"Sir, you may think you need antibiotics but I don't agree and it is my practice to only prescribe medications I feel are necessary based on my medical opinion."

He shoots to his feet, all 350 obese pounds of flesh quivering with anger. "YOU FUCKING BITCH!" he shouts. "I WAITED NINE FUCKING HOURS FOR THIS?! I NEED FUCKING PENICILLIN AND JUST LIKE THAT OTHER FUCKING DOCTOR YOU CALL IT VIRAL THIS AND THAT!"

"Sir," I say, in what must surely seem to be an infuriatingly smooth tone, "we don't tolerate verbal abuse in the ER."

"FUCK YOU, BITCH!" he screams, his fists clenched. "WHAT KIND OF FUCKING HEALTHCARE SYSTEM IS THIS! I WANT THOSE FUCKING ANTIBIOTICS NOW!"

I feel the adrenaline coursing through me. My heart is pounding - he's much bigger than me and I imagine any moment now, he's going to lash out physically as well.

"Sir," I say firmly, "I am not giving you antibiotics."

"FUCKING DOCTOR BITCH!" he screams.

I am pleased to note the door behind him open quietly and a burly security guard appears, hands on hips.

"Now then," the guard says, "settle down now."

For a moment, I think my patient is going to take a swing at me. He splutters incoherently, his fists balled up at his sides. Then his shoulders sag. He's defeated and he knows it. He's raged like a madman but his anger is impotent. He turns to go and the security guard shows him the door.

Outside, I hear him still spluttering to the guard, but I can't make out what he's saying. I write his chart up, noting that the verbal abuse he heaped upon my head. Under "diagnosis", I print "VIRAL ILLNESS" but in reality I think it should read "POWER STRUGGLE".

It gives me pleasure not to have given him those antibiotics.

Fucking Doctor Bitch: 1
Swearing Patient: 0

And even though I feel as if I should feel some guilt over my little ego trip, over the little stab of pleasure I felt in having the power to withhold from this man that which he so abusively demanded, I don't.

Sometimes, I just gotta admit I'm human too.