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Chapter 9 - Helping Staff Help a “Hateful” Patient

The Case of TJ

from Part III - Diversity of Desires and Limits of Liberty

Published online by Cambridge University Press:  17 May 2025

Paul J. Ford
Affiliation:
The Cleveland Clinic Foundation, Cleveland
Denise M. Dudzinski
Affiliation:
University of Washington School of Medicine, Seattle
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Summary

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors explore care for a patient with history of being abused, borderline personality disorder, substance use disorder, and a complex psychiatric history who was labeled by staff as a "hateful patient." He presents frequently after self-harming, requiring surgery and short-term psychiatric treatment. Complex behavioral issues and erratic acceptance of nursing and medical care led to staff frustration and unprofessional chart notes. Transfer to a long-term treatment setting was difficult to negotiate. Several months after discharge, the patient died. The authors are haunted by the patient’s desperation and deep loneliness. He wished he could remain hospitalized where he felt cared for. Authors wondered what more could have been done to help him.

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Chapter
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Complex Ethics Consultations
Cases that Haunt Us
, pp. 79 - 83
Publisher: Cambridge University Press
Print publication year: 2025

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References

Groves, JE. Taking care of the hateful patient. N Engl J Med, 1978; 298: 883–7.CrossRefGoogle ScholarPubMed
Straus, H. Hemophiliacs of emotion. Am Health, 1998; 7: 61–6.Google Scholar
Groves, JE. Difficult patients. In: Cassem, NH, Stern, TA, Rosenbaum, JF, Jellinek, MS, eds. Massachusetts General Hospital Handbook of General Hospital Psychiatry, 4th ed. Chicago: Mosby Year Book, 1997; 337–66.Google Scholar
The obituary was edited to preserve the patient’s family’s privacy.Google Scholar

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