Just a free spirit?(Guest Editorial)

Sometimes a patient forces us to ask the deeper questions we'd rather not think about in the course of everyday practice. For me, that patient was a homeless woman in the emergency room of the New England hospital where I was a third-year resident on the coldest night of the year.

The woman had been lying outside a train station when she was found by a minister and a social worker. When she refused all offers of shelter, they began to doubt her sanity as well as her safety, and brought her to us.

My efforts to learn more about her met with similar resistance. She would not reveal any personal information, not even her name, and agreed to answer only questions of competency to show she was sane. And indeed, she answered those questions correctly: She was oriented, knew the date, the time, the place, and the name of the president. But beyond that, I had no idea what she was thinking. I decided to admit her against her will. On the admitting form. I checked the box indicating she was "gravely disabled," because in my view she was unable to make proper decisions for herself. The woman was furious.

But I was afraid: Was she going to die on my watch? Was I going to be the last person to see her alive or before she came to harm? Forget about the fact that she'd probably been living on the street and taking care of herself somehow for some time. All too often, residents are motivated by fear. I'd like to think that were I to encounter a patient like that today, now that I'm a few years out of training. I would have the courage to say, "This woman has rights, and I'm going to be more concerned with respecting them than with making a mistake that might reflect badly on me."

Along with being afraid, I was angry. I was on 24-hour call; I was tired and frustrated, and this woman wasn't opening up to me the way most patients did. She saw me as the enemy, but I saw myself as this poor, harried, ...