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The Death of an Unlikable Man
Article Number: SIS540239AI220525
22nd May, 2025
Author(s):
Mark Earnest, M.D., Ph.D.
Abstract:
This deeply reflective piece explores the ethical and emotional challenges faced by healthcare providers when caring for difficult patients. The author recounts multiple hospital admissions of Mr. M., a man infamous for his belligerence, verbal abuse toward nurses, and incessant demands for morphine and Ativan. Despite his combative nature, his lack of visitors and disconnected emergency contact painted a picture of profound isolation.
During his final admission, a combination of events led to his unexpected death from an intracranial hemorrhage, likely exacerbated by clot-busting therapy given in the emergency department. The author wrestles with the guilt of failing to remain vigilant, recognizing how fatigue, prejudice, and routine dulled awareness of his deteriorating condition.
Standing at Mr. M.'s bedside after his death, the physician begins to humanize him, wondering about the experiences that shaped him into the man he had become. The essay suggests that when patients are difficult to care for, it may help to reflect on the child they once were, acknowledging their suffering rather than succumbing to dismissal