It’s not easy to establish a relationship of trust with Mr. D., a vindictive and procedural psychotic patient. In a permanent crossover, he asks for appointments, does not show up and poses as a victim. Tenacious, the general practitioner will only reach a follow-up agreement with him following an incredible episode…
Follow-up at the Center médico-psychologique (CMP) for psychosis, Mr. D. has no attending physician, so it is only natural that he is referred to my consultation. Located within the CMP itself, it takes place twice a week, for patients from the center without somatic follow-up. The objective is to carry out a health check, then to direct them towards a colleague in town for a follow-up of general medicine.
The day of the first appointment, Mr. D. does not show up for the consultation, and does not answer my call. To save time on a possible next meeting, I consult his file. I discovered there a quantity of letters attesting to the various procedures of Mr. D. once morest the CMP, the psychiatrists, the secretary, the general practitioners of his district… Mr. D. does not have a treating doctor because he exhausted them all, then reported!
After a few unsuccessful appointments, I ended up seeing him a month later, thanks to the perseverance of Julie, the nurse with whom I received in pairs at this consultation. In the waiting room, I meet a short, “raggedy” man with a vindictive look. In a shrill voice which pierces his aggressiveness, he gets to the heart of the matter without dwelling on the greetings. ” Are you the doctor? No, because I was told to come here to get a doctor, and I’ve been waiting for two months now and I still don’t have a doctor. And then I’ve already been waiting here for ten minutes, no one has come. And who are you first? »
Calmly, I suggest that he discuss all this in my office. I start by telling him that I’m on time and he’s early, and that he’s missed all my previous appointments. He is convinced he has seen me before and ends up concluding that someone pretended to be me the first time! I hold on, calmly. He frowns, but in the absence of reproach, he ends up opening up a little.
Never any concrete exchanges…
I have to reframe the consultation several times. Redo the point. I prescribe him a blood test, once morest which he groans profusely. He refuses the screening exams, so I stick to the classic assessment and offer him a next appointment. He does not show up. He does not answer. Every month, I try to call him. Without hoping too much, I go through his referring nurse to offer him the next appointment he will miss.
One morning, I received an email from the secretary, informing me that he called, furious, asking that I contact him once more immediately. I then tried once more to call him, without success. Another day – when I’m not there – he shows up at the CMP at 8 a.m., cursing that he still has no attending physician, that he hasn’t had his vaccines, demanding that I call him back. . Over time, my relationship with him goes through all sorts of ways: emails transferred from the secretary to the nurse, from the nurse to me, missed calls, missed appointments. Without ever there being the slightest exchange between us.
There are always obstacles in the doctor/psychotic patient relationship. Psychosis constituting a kind of bulwark isolating reality and the world. But I (almost) always manage to establish a link, by one means or another: humor, patience, perseverance, various convolutions…. Today, I am very helpless in the face of this “relationship”, made up of intermediaries, and letters, missed calls, missed appointments. I just can’t get anywhere, and yet I seem to keep Mr. D. busy, and vice versa.
After yet another attempt by the secretary, the procedures begin. Mr. D. warns her: “Madam, you see me sorry, but I might not meet Dr. Sylviery, because I still do not have a treating doctor as she had promised me during our three previous meetings. I see myself in the obligation to report it to the College of Physicians. In the wake of this email, another arrives, completely incomprehensible, where Mr. D. begins a procedure once morest the volunteers of the Red Cross, who have not thanked him one day despite his multiple donations, since 1985. He concluded as follows: Please accept, Mr. President, my safest respects. Realizing he got the wrong recipient, and following a whole series of emails, comes the copy of the report to the Order of which I am finally the object. A paragon of misery, where Mr. D. places himself as a helpless victim of an entire failing health system.
Administration: Mr. D.’s obsession?
I read this email and think that it is very well written and credible. So credible in reality, that Mr. D. must certainly not simulate the injustice he feels of not having a general practitioner in a very real context of medical shortage. So true, finally, that I can’t help but feel sad, thinking of him, whose solitude, in the absence of mystical delusions, is peopled with what is worst in the world, with what is even more terrifying than the devil or ghosts: the administration. As for me, having never been “reported” to the College of Physicians, I am still waiting for a summons for a conciliation which never happened. Perhaps the frequent calls from Mr. D., who has already reported a good number of colleagues, ended up getting the better of his credibility.
A few months later, we receive Mr. D’s death notice. Despite myself, I feel an invincible feeling of guilt. What more and better might I have done to cure him? All this ambivalence, this negative counter-transference that he maintained so well with the caregivers, did he get the better of my objectivity? Did I abandon him? It was very good on his part to push the process until his death. Also, that it is not my surprise when, a few weeks later, the secretary enters my office, the air frightened, begging me to go ” manage “ Monsieur D. bustling regarding in the waiting room, multiplying his reproaches in all respects and asking once once more to see me.
It takes me a few seconds to realize the news. The time to question my sense of reality, to consider the hypothesis of madness, that of a bad dream, before considering what turns out to be correct: Mr. D. had written a false death notice ! Meanwhile, in the waiting room:
– « Mr D! But, well, you, here… but we got worried! the secretary told him. Then his referring nurse arrives.
– Mr D! But you… You are… well, you weren’t dead?
– Deceased ? How did you die???… »
I arrive in time and manage to calm him down. After this episode of paroxysm, Mr. D. calms down, and I make an agreement with him. Together, we agree on a possible orientation towards a colleague whom I undertake to call then to inform by mail so that it is quickly taken care of. Thus ends for me the care, and not the life, of Mr. D…
Vanawine Sylviery, General practitioner. Image © Alain Signori, https://alainsignori.com/
