“I know where you live. And I’m gonna find you. And when I do, I’m gonna hurt you and the people you love.”

That is the PG-rated gist of how a middle-of-the-night phone call ended, and it left me cold. The caller was the family member of one of my patients, admitted to me while serving a life sentence at the state prison. One of the guards who accompanied the patient had whispered to me conspiratorially, “I'm not supposed to tell you what he did, but it was bad.” The guard paused to look me in the eye. “Real bad,” he said with more depth of feeling than I thought those two words could support. “Now he’s in for life, so he doesn't have anything to lose. Know what I mean?”

What the guard lacked in subtlety, he made up for in sincerity. So, yes, I knew what he meant — which is why that middle-of-the-night phone call left me shaken, real shaken. Heart-racing, pulse-throbbing-in-my-ears, tightness-in-my-chest, muscles-shivering scared. I tried to convince myself that I was safe and overreacting. I told myself that the man on the phone couldn't possibly know where I lived. After all, my phone number and address were unlisted. But then again, if my phone number wasn't listed, how had he called me? 

My attempts to reassure myself having failed miserably, I made a circuit of the house. I avoided the windows like a character in a spy movie and I checked that all the doors were locked. I closed the blinds and then re-checked the doors. Then I peeked out through the slot in the curtains. 

Had that car been parked there earlier?

Was that shadow in the backyard a shrub? Had it always been there?

I cursed myself for not having paid more attention to my environment before, especially now that it could mean the difference between life and death. I relived the details of the phone call. The caller was irate, that was clear. Other than that, the one-sided conversation got murky. Reassembling his random, incoherent complaints was like assembling a jigsaw puzzle with pieces taken from more than one set. I was pretty sure the man on the phone had said the patient was his brother. From what I managed to piece together, the caller had accused me of conducting experiments on his brother and other inmates. He even thought I was killing them. He charged me with being the reincarnation of Dr. Josef Mengele, the Nazi Angel of Death who conducted medical experiments on prisoners in the death camps during World War II. Not that he ever mentioned Mengele's name. Indeed, his substance-fueled rant slurred around the same points over and over again; his speech stuck to small words, mostly four letters long. He made up for his lack of verbal breadth by recombining those few words in equally creative and nonsensical ways. If cursing was an art form, then this man had been the Salvador Dalí of profanity. 

Still, he had used his vast and poorly defined investigative skills to uncover my nefarious plot of torture and murder in the “name of science.” Now that the truth was revealed, he was on a crusade to foil my wicked scheme … by, well, torturing and murdering me. In fact, the man didn't conclude his argument so much as wear himself out from turning it over so many times. Which was when he issued his threat and hung up. Alone in the dark with my sleeping wife just one room away, my anxiety did not abate. And so, I did something I had told myself I would never do. 

I have always been conscientious about my firearms. I know from experience that the gun most likely to hurt you or someone in your home is your own, so I keep my guns out of sight and out of reach. I even keep the ammunition locked away in a separate room. But that night, I violated my rule and loaded five rounds into the pump-action magazine — and those rounds were not birdshot. Then I hid the gun in the back of my bedroom closet.  

Unfortunately the loaded gun brought me less reassurance than I had hoped, and sleep didn’t come for the rest of the night. Instead, I laid there, hyper-attuned to every little sound, both real and imagined. Things always seem less scary in the morning, but when the sun rose, I was still shaken. I pulled one of the penitentiary guards aside at the hospital and told him what had happened.

“You didn't call them from your personal phone, did you?” he asked, as if I had just told him I put diesel fuel in my gasoline-powered car. 

When an inmate from the correctional system enters the hospital, information is not supposed to be given to the family until after the prisoner returns to the prison. This policy is to prevent impromptu family reunions and breakout attempts. But, convicted felons and their families also have fundamental human rights, which is why I had been asked to call one member of the family and explain the medical issues to them. Before making that call, a prison official carefully coached me not to give away any identifying information, like my name, the name of the hospital or my community, or any details about dates and times. The official did not mention that I should not make the call from my personal phone.

“Oh ya, rookie mistake,” the guard said with a shake of his head at my idiocy. 

At that time, caller ID wasn't a standard phone feature; it was an extra you had to pay more to use. I didn't have caller ID on my phone, but as the officer so sensitively put it, "every dirtball in the country has caller ID.” Reasonably, he did also say, “Well, I wouldn't worry, usually nothing comes of it.”

“Usually nothing” proved to be a phrase offering little comfort. It was a bit like explaining the statistical safety of air travel to someone in a crashing plane. I was well aware that just because most people would be OK in a situation like mine did not guarantee I would be.

Despite my sleepless nights, the patient recovered from his emergency surgery without incident and returned to the correctional center infirmary a few days later. I blocked the phone number the angry call had come from, and nothing more ever came of it. But the loaded shotgun sat in my closet for weeks after the event, and my hyper-vigilant attention to changes in my surroundings persisted, too. I would be startled awake by random noises and lay in bed with a racing heart. Eventually, time did heal, and I unloaded the shotgun and put it away, though I did continue to double check that I locked every door. 

I never talked to anyone about any of this because I didn't want to look weak or crazy. But in retrospect, it probably wasn't a good way to handle it. Instead, I got a little weird about the phone. I no longer identified myself by name when I answered a call, and I refused to talk to anyone who didn't immediately identify themselves and the purpose of their call, which it turns out is a surprising number of people. My new phone policy resulted in several awkward conversations, and at least one of my colleagues became quite offended.

“Hello,” said my wife, answering the bedside phone in the middle of the night.

“Is Dr. Black there?” said an unidentified male voice.

“May I ask who is calling?”

“I’m calling Dr. Black, is he there?”

“Who would like to know?”

“Is he there?”

“You can reach him on his cell.”

“Damn it, is he there or not?!”

Click, buzz …

*

The first time I learned about Doximity Dialer, I immediately recognized its benefit. I don't want to sound like an advertisement for the organization I’m writing for, but I do use Dialer to call my patients. It allows me to call them from my cell phone but display the phone number for my office on the caller ID. Doing so keeps people from getting my number and abusing it. If they call back the number displayed on their phone, it goes to my office or the answering service. Dialer has proven helpful both in dealing with the criminal element, and in keeping clingy patients from abusing their access to me at all hours of the day and night. 

Another critical point of this story, though, is that I should not have admitted an inmate patient accused of a serious crime and serving a life sentence — a so-called “patient with nothing to lose” — to a community hospital. That said, how it happened is a different story occurring at the intersection of corporate greed and political ineptitude. How the patient came to be in my care was not my fault, but it was my problem. Worse yet, despite agreeing to admit these patients, the hospital was ill-equipped to keep its personnel safe — and this man proved to be just as dangerous as advertised. When I complained about what had happened to the prison supervisor, he said, "The guards’ only job is to keep the inmate from absconding. It’s not their job to protect the people who work in the hospital. That’s your job." It may have been my job, but I lacked the experience — and the hospital lacked the resources — to do the job right. We are lucky that no one was physically injured, although many were abused in other ways. For my failure to prevent that, I’m sorry. 

As much as young doctors want to be all and do all, we need to recognize our personal limits and the limits of the system we work in. Exceeding those limits is dangerous, not just for the patients, but also for ourselves. There comes a time when it’s necessary to say no. It's not easy  to do, and certainly not what we’re trained to do, but sometimes it’s the right thing to do.

As a final note, please, when you call someone, tell them who you are and why you’re calling. It's basic courtesy, and it exists for a good reason (several, in fact).

Have you ever had a harrowing experience with a dangerous patient? Share your stories, and what you learned from them, in the comments.

Charles Black is a general surgeon, father, landscape photographer, writer, outdoorsman, and fireside philosopher. Catch up with him at ChuckBPhilosophy.com where he writes about life, the universe and everything. You can also view his photos on ChuckBlackPhotography.com. Dr. Black was a 2019–2020 Doximity Op-Med Fellow, a 2020–2021 Doximity Op-Med Fellow, and is currently a 2021–2022 Doximity Op-Med Fellow.

Illustration by April Brust