Real-Life Decision Making
Your head is pounding and your feet ache. It's been a long day on the psychiatric ward. This morning you were assigned two new patients, and during a group therapy session that you were conducting, Sam, a schizophrenic, upset the whole group by talking incessantly.
You look at your watch, ready to complete your last patient rounds and head out the door. You jot a quick note as a reminder that you need to talk to Sam's psychiatrist about increasing his medication.
You decide to start your rounds with Lori Down, a 42-year-old woman who has been in the hospital for about a month. She has really taken a liking to you, and the feeling is mutual.
Her psychiatrist has not been having the same luck. Thus, the psychiatrist is relying on you to help Lori out of her severe depression. Just last week, Lori shared information with you about her physically abusive father.
You thought the next session would be equally rewarding for the both of you, but instead she is sullen. After seeing her in the dining room tonight, you are concerned. She looks even more down in the dumps, withdrawn and refusing to eat. Since you two have developed a rapport, you try to talk to her over dinner to make sure everything is OK.
She puts on a fake grin and says, "Sure, fine." Your medical training, however, tells you that this isn't the case. Her foot nervously taps under the table and her chicken stew has been rearranged on the plate, not eaten.
You suspect there are more problems in her family than she has confided. Thus far, though, she has not been willing to talk about them. Maybe on your rounds this evening, you'll try to arrange a therapy session with her, depending on how responsive she is.
You walk down the hall toward her room. As you approach, you notice that there is no light coming from beneath the door. You glance at your watch again, wondering if it's later than you thought. No, not bedtime yet. You push the door open.
Once in the room, you hear her before your eyes can adjust to the darkness. A heaving, sobbing, very sad voice is drenching the bedroom. She is sitting on the edge of the bed in the dark. When you ask if she is OK, she is honest this time. "No," Lori says. She looks up at you, her eyes red and swollen. She seems embarrassed.
She says she wants to talk to you, but she wants you to promise not to tell anyone else what she is about to tell you. She says she trusts you and it would hurt her terribly if you broke her trust. She needs your help sorting out what to do next. What do you do?