Reflections from Residency: Looking past a patient’s crimes

Kiran Gupta writes about her experiences as a resident in the Department of Medicine at Brigham and Women's Hospital. She has done research on domestic health policy issues, including health care costs, medical errors, and end-of-life care, and is a former columnist for the Financial Times Weekend Magazine. Kiran received her A.B. in Government with a certificate in Health Policy from Harvard College and earned her M.D. from Harvard Medical School.





It was the first day of a new rotation. I was getting to know my patients, trying to match faces and diagnoses with names on my list. A frail man with end-stage heart failure, Mr. T was too weak to walk and spent most of his time in a reclining chair. He had been in the hospital for weeks with pneumonia, kidney failure, and several other complications. I introduced myself and proceeded to examine him. He was quiet, unlike most of my other patients, asking few questions and voicing no complaints. Day after day, he would sit in the recliner, staring out the window. No one came to visit him.

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A few days into the rotation, I found myself reading through his medical record, trying to figure out what his life outside the hospital had been like, and whether there might be a friend or relative able to help care for him after discharge. I was not prepared for what I discovered.

In painstaking detail, the social work and psychiatry notes documented Mr. T’s conviction 30 years earlier for several violent crimes, including drug charges, armed robbery, and multiple cases of sexual assault. He had served a number of jail sentences. Although decades had passed since he was released from prison, I struggled to comprehend how this subdued elderly gentleman—my own patient—had once been capable of inflicting such harm upon others.

The next morning, I walked into Mr. T’s room, intensely aware of my apprehension. I approached his bedside tentatively, trying not to think about what I had read in his chart. I placed my stethoscope on his chest. Although he didn’t realize it, I was struggling to suppress my fear—and anger—at what I had read about his past life and the vivid description of his prior actions.

In medical school, we are taught that it is not our place as physicians to pass judgment on our patients. We have a duty to provide the same medical treatment to all for whom we care, regardless of their gender, ethnicity, religion, economic status, habits or personal choices. The practice of medicine is meant to be free from the prejudices that all too often influence human interaction in the world that lies beyond hospital walls and office waiting rooms. Regardless of our patients’ circumstances, we have an ethical obligation to address the medical issues at hand, leaving society and the courts to pass judgment and secure justice.

Yet day after day, I struggled to push thoughts of Mr. T’s criminal record out of my head. While listening to his heartbeat, I felt guilty that I wanted to have a nurse join me in the room. Still, I knew that Mr. T’s past actions, though virtually impossible for me to ignore, could not affect my duties as his physician. He received the requisite medications, tests, monitoring, and exams, like every other patient on our service. And, like many patients, he was grateful for the care he received.

At times, events in the world outside the hospital blur the line between the role we serve as doctors and our feelings as members of a larger community.

It would be unrealistic to expect that physicians can simply control their internal thoughts and reactions when confronting situations like these. Our lives, after all, are embedded in the fabric of the society in which we live and serve, one governed by moral commitments and legal rules that give internal and external force to our shared sense of right and wrong. Yet it remains our professional obligation to ensure that those feelings do not alter the care we provide to each patient who comes before us.

The tragedy that befell our city during the Boston Marathon touched every single one of us in the medical community. Our hospitals, normally isolated refuges from the world “out there,” suddenly were at the center of chaos. Armed policemen guarded our doors. Entry and exit was restricted. FBI agents roamed the halls. Wounded victims filled our beds; their families cried in our waiting rooms.

Watching the tragedy unfold in real time, seeing the scars left on patients and colleagues alike, it is inevitable that we, as Bostonians, would feel the overwhelming urge to pass judgment on those who brought terror to our city. As I left work a few days later, I saw the police cars with lights flashing and the barricade at the entrance to another hospital, Beth Israel Deaconess Medical Center. Although the news media hadn’t released the information yet, I guessed that one or more suspects had been brought there to receive care. I thought of the doctors and nurses who would be charged with that burden, asked to fulfill their duty with the same dignity and respect they show to all patients—a tremendous moral responsibility.