A Most Discreet Patient

The two miscreants featured in this story probably wouldn’t be recognised as such today. Both are successful and respected specialists, exemplary role models for the residents and interns entrusted to their teaching. One has just received a distinguished alumnus award from our alma mater. At the time of this incident, however, they were hell-raisers, their pranks familiar to a generation of staff and trainees at Winnipeg’s Health Sciences Centre. If there was mischief afoot one or both were sure to be behind it. This incident is exceptional because it was not widely publicised, for reasons that will be obvious. It was a scam concocted while both were junior residents in the ICU. I think that only two other people, a patient and myself, knew the full story.

The patient, Mr. Scott, had been admitted to intensive care, ward H7, for treatment of an intractable cardiac arrhythmia. Despite exposure to all the usual anti-arrhythmic drugs, and some that were still experimental, he continued to generate an alarming number of ectopic ventricular beats. Since he was not incapacitated by his condition it was unnecessary to confine him to bed. Also we wanted to see how exercise affected his heart. Fitted with a Holter monitor that he could slip into a pocket of his bathrobe he had the complete freedom of the ICU. We were nervous about his going further in case he had a bout of malignant arrhythmia but within these confines Mr. Scott was our guest for several weeks. His only medical problems were the occasional side effects of his treatments and his heart otherwise ignored every medication offered. His perambulations around the ICU became part of our daily routine.

Mr. Scott and I became friends. At that time I was the senior resident in the ICU but he was a cardiology patient and not my direct concern. Most days we would have a brief chat over a cup of coffee. He was quiet and introspective, kept his own counsel and patiently endured his doctor’s experimentation. When he wasn’t walking he read. His habits were monkish, certainly not one given to vices or excesses. My picture of him now is a good-natured, private, thoughtful chap.

When Mr. Scott began to look like a permanent fixture I suggested to my two erstwhile junior residents that it was time to talk with his attending cardiologist about freeing up his bed. They would not hear of it. He might have a fatal arrhythmia. The consulting cardiologist was sure a new drug would work but it had to be closely monitored for a few days. His arrhythmia was of a rare type and was invaluable to their cardiology education. I thought their intense interest in his condition rather curious since they rarely went near him, but accepted their protestations.

It was not long after that Mr. Scott decided to confide in me. He approached me discretely one afternoon when the residents were out of the Unit. We were standing in front of the Director’s office, where the inbox for mail and pharmacy supplies was located. Speaking in a low voice, with a hand on my arm, only the intensity of his manner indicated his concern. “Dr. Tweed,” he said, “I must have a word with you. This has been bothering me for some time now and I think you should be informed. You know that I walk up and down this hallway several times every day. I mind my own business and I don’t talk much but I keep my eyes open and I don’t miss much either. Now every day I glance into this box to see if there are any cards for me. Every day there is a box from the pharmacy here, containing six bottles of beer, with my name on it. Now Dr. Tweed I haven’t touched alcohol in years and this is a puzzle to me.”

I doubt that it was much of a puzzle to Mr. Scott and it certainly wasn’t to me. Beer was available from the pharmacy, by prescription, as an appetite stimulant or general comforter for some patients. Mr. Scott was the only patient on H7 taking a regular diet, thus the one for whom a daily beer prescription would not raise questions. Certainly it wasn’t difficult to guess who might be quaffing his beer. A short walk up the back stairs to the resident’s call room revealed the answer. One wall was almost hidden by a stack of beer cases, filled with empty bottles. Happily settled in front of the television, each fondling a bottle of Labatts, were my two indulgent junior residents.

They were neither chagrined nor apologetic. But I was reluctant to start an investigation that would probably get them dismissed from the hospital. Despite their bad record they were good doctors. On the other hand continued misappropriation of the hospital’s supplies would land us all in jail. We reached a compromise. Mr. Scott would be discharged, the empty beer cases would disappear and I would develop temporary amnesia. Pharmacy prescriptions in the future would be only for patients.

I was confident Mr. Scott would keep his counsel to himself and I was right. He was a most discreet patient and having done his duty nothing more was said of the affair.

Author: Arnold Tweed

Retired anesthesiologist living in Toronto, Canada.