Tuesday, September 05, 2006

Risky Business

You probably know that Steve Irwin, the Crocodile Hunter, was killed this past weekend by a sting ray in the course of filming a show.

What you may not know is that Dr. Wayne Fenton, a schizophrenia researcher at the National Institutes of Mental Health, was killed this weekend by a schizophrenic patient he was seeing in his private office.

I didn't know Dr. Fenton, I don't think I even knew of him, but I learned of his death at a Labor Day barbeque I hosted, from one of my neighbors who is also a schizophrenia researcher and who did know him.

My husband asked me last night, "Don't you worry about being alone in your office with patients?" I don't. There's only so much I can worry about, and for the most part, my patients constitute a rather tame crew. My husband says that when he lets himself think about it, he does worry about me.

Even if I don't wrestle with crocs for a living, the reality remains that people with psychosis can behave in unpredictable ways. As a child, I lived across the street from a neurologist. His office was across the hall from a psychiatrist and one day, a patient walked in and shot and killed the psychiatrist. Needless to say, my mother thought I should consider another career.

I once briefly treated a patient who was preoccupied with thoughts of killing his former psychiatrist and who had previously been banished from a local psychiatric institution for threatening psychiatrists there. He was psychotic, bizarre, violent, and needy. After a few months, I sought consultation and, as a result of this, told the patient I would not continue to see him in my office-- the consultant had suggested that it was too intimate and secluded a setting-- but that I would be happy to see him at the clinic where I work. The hours I'm at that clinic conflict with the hours this patient worked, so while I made the offer, I knew it wouldn't fly. When I told the patient, he became angry and began pacing around my office and making threatening gestures. I went into the hallway, and to get him to leave, I had to have the police come. He phoned later and wished me a doomed future-- perhaps the closest anyone has ever come to the "F*** Off Rule" SHP talks about in her post today. Foofoo added to SHP's comments with a horrifying story of how he'd been assaulted, bitten, and broken by a violent patient he'd pulled off an intern. I'm impressed by his bravery, saddened for both of them at the violation. I'm not so sure I could have gone on working -- at least not in that setting-- in the face of such horrors.

I didn't know Dr. Fenton-- this story isn't really mine to tell but from the perspective of a fellow psychiatrist who is left to wonder a bit about issues of safety, and to feel badly for my neighbor who is distraught. My heart goes out to Dr. Fenton's family and friends, and somehow this all feels a bit closer to home than the other stories I've heard this weekend.

Dr. Fenton remembered across the blogs