Query

Figure. Photo by: Anson Liaw

It started a few months ago. I noticed Dr. Lente's rack of unfinished carts piling up, heard whispers about unchecked lab results, saw his gait begin to slow and trundle, watched him avoid eye contact with colleagues and patients. Even his voice seemed to go down in volume, so that one had to strain to hear him. He was gradually withdrawing from everyone.

He never took any sick time — I would know, since I'd have to cover some of his shifts — and he completed his share of emergency shifts and call days. He was still doing the work he was supposed to be doing. As to whether he was doing it properly, I didn't know, although his averted eyes and barely audible voice suggested a serious problem.

A senior nurse came to me, pointing out the symptoms I had noticed myself. She said she was merely a representative, that many of the nurses felt the same way, and that patients were mentioning that Dr. Lente seemed “very strange,” “different” and “odd.”

My impulse was to say, “Talk to the department head, it's his job to deal with this kind of thing.” But that wouldn't have been a satisfactory response from a friend. After all, I did care about Norman. I wanted him to be the good doctor he once was, not the uncommunicative, lost soul he seemed to be now. I also feared for what would happen if his behaviour got the attention of the department head. Would his privileges be revoked? Would he have an income? Would he be reported to the College? I looked at the nurse and said, “I'll talk to him.”

That night I did a MEDLINE search on “depression” and “physicians.” I also looked up the physician professional support Web site. And what I learned confirmed what I already knew but wanted to avoid: that I had a duty to report impaired behaviour in any of my colleagues for their own good and for the good of the public. By contacting the physician support people I was immediately putting the sick physician in contact with all the resources — family doctors, psychiatrists, counsellors, Caduceus groups, urine monitoring — they would need to get well. There was also one other message: that it was lonely to be a suffering ill person.

I was going to have to turn him in.

The next day I caught him as he entered the staff lounge. I insisted on buying him a coffee at the cafeteria. As we walked there, I noticed his loping gait, his unwillingness to make eye contact, his rather messy state of dress. When we sat down, I asked him as gently as I could, “Norman, what's wrong?”

I was unsure of myself. Who was I to ask personal questions? I expected denial. I expected anger. I expected him to say there was nothing wrong, that I should leave him alone. But, in the end, I didn't have to drag in the observations of the nurses or indirect patient complaints; all I had to do was listen, though I had to strain to hear the long, slow words.

“I'm feeling tired all the time. I can't concentrate to the point that I'm anxious I'll make a mistake at work. I don't know what to do about it; it just gets worse every day. Now it's so bad I don't want to wake up.”

I told Norman that he should see our local psychiatrist and that I would arrange a rapid referral. And I told him the part that was the most difficult to say: that I would report his obvious mental difficulty to the professional support program.

To my surprise, there were no denunciations. Just a slight, almost imperceptible nod, as if he must have known what was coming.

— Dr. Ursus