Telephone triage is a skill that every doctor must acquire. Many patients initially present over the telephone, and it is important to be able to tell the difference between those who need to be seen right away, those who can wait for an appointment, and those who don’t have to be seen at all. Office staff usually handles the calls on weekdays, but on nights and weekends, the doctor on call takes them herself.
Most calls are about distressing symptoms, but occasionally there are calls due to simple curiosity (“I have a sunburn; do you think my baby is hot?”), and even less commonly, some women call simply because they are lonely or depressed. Every now and then, there are calls that defy categorization. Such was a call that blindsided me on a blustery Saturday afternoon in early spring. I was the chief resident, and therefore, took all the OB and GYN calls that came directly to the hospital. I was sitting in the Emergency Room where I was already caring for a patient having a miscarriage.
The caller sounded like a self possessed woman in middle age.
“I’m calling,” she announced, “because I need some information.”
“Okay,” I said. “How can I help you?”
“My son got his girlfriend pregnant,” she continued, “and I think she had an abortion. I have reason to believe that she had it done at your hospital.”
“That may be,” I replied. “But I cannot share that information with you.”
Every hospital has strict privacy requirements. Although this was in the days before the strengthened provisions of HIPAA (the Health Insurance Portability and Accountability Act), no hospital or provider could share medical information about a patient unless authorized to do so by that patient.
“Let me tell you her name,” the caller coaxed, “and you can tell me if you took care of her.”
“It doesn’t matter if you tell me her name, or whether I took care of her,” I answered. “I simply cannot tell you.”
“Don’t I have any rights?” she demanded. “After all, that could have been my grandchild.”
I tried to explain that her relationship to the baby or to the mother did not matter.
“Just look in the computer,” she begged, “and tell me if she was at the hospital. You don’t have to tell me what treatment she had.”
I explained that I was not allowed to do that either. The woman on the other end of the line now sounded agitated.
“You don’t understand,” she insisted, “I have a very special reason why I need to know.”
I tried to explain yet again. “There is no reason that would allow me to give you the information that you want. It is literally against the law for me to disclose that information.”
“Please,” she pleaded. “You have to help me. The baby needs me.”
“Excuse me,” I was startled. “Did you say the baby needs you?”
The caller exhaled a sigh of relief at finally being understood. “Yes, the baby is calling me. Every time I try to go to sleep, I hear the baby calling me: ‘Grandma, Graaaandmaaa, help me, help me, I’m stuck in this bottle.'”
“What?!”
“Yes, I hear the baby’s voice every time I close my eyes. I know he’s trapped in the basement of a hospital, maybe your hospital. I have to come get him. You have to help me.”
“Oh,” I said, “I see.” And now I did. “That must be very upsetting to you.”
“It is,” she sounded very tired. “I can’t sleep, I can’t eat, I have to rescue the baby.”
“You must be very uncomfortable and upset,” I agreed.
“Can you help me?” she sounded desperate.
“I can’t tell you about your son’s girlfriend,” I acknowledged, “but there is a very nice doctor here with me in the emergency room and I think he might be able to help you feel better.”
“You do?”
“Yes, I do. I’m going to let him know what you told me, and tell him that you are coming to see him right now. I’m certain that he can help you feel better.”
“Will he take me to the baby? The baby is calling me,” she repeated.
“He won’t be able to take you to the baby, but he will be able to help you with the voice that you hear,” I responded truthfully. “Will you promise me that you will come in right now?”
“Yes. Yes, I’ll come in. Let me get dressed and I’ll be there in an hour or so,” she agreed.
And that’s just what happened. Within an hour or two, she was visiting with the psychiatrist on call. He couldn’t help her find the baby in the bottle, but he was able to help her make the voice stop calling.
