Just Leave Me Alone

One day, I had a patient who had been through the most unbelievable history of botched medical care and botched surgeries, basically leaving him without an intestine, with possible dementia, and with a possible seizure disorder, among many other things. His neurologist had stopped practicing and he was transferred to someone new who had some different opinions about some of his problems. For example, the new doctor thought he may not actually be having seizures and that some of his problems may be due to dysfunction of the autonomic nervous system. As a result, the doctor was considering changing his medication. The patient, however, had been through so much medical duress and years of finding a medication regimen that he was happy with that he was very upset about the prospect of ANY changes. The patient was also upset he was referred to me for a neuropsychological evaluation because he did not see the need for it. He also did not see why he needed to stop driving even though he had been driving through red lights and exhibiting poor judgment on the road. He did not see the need to have someone take away his access to guns even though he had suicidal thoughts at times. In his words "If you take away my guns, I'll just use some other method one day if I ever feel like killing myself."

It was clear that this man had poor insight but it was also clear that he was just plain fed up with everything. In describing his plight, I will never forget how he looked at me and said in the clearest and most deliberate manner, "I…just…want…to…be…left…alone." He did not want to be tested, did not want his medications changed, and just wanted to stay home and accept his fate. Although I did not think he was making all of the right choices (which I made this clear to his wife), I felt a profound feeling of sadness for this man's situation and could see myself thinking the exact same thing if I were in his situation: "Just leave me the alone." The interview took so long because of his complex medical history that he was scheduled to come back another day for testing. He never retuned.