In the past few weeks, I’ve been witness to several crimes or injustices.
In one, I was complicit. I will not go into the disturbing tale of the estranged husband who did not inform his wife that her application for landed immigrant status had been accepted; or the man who ended his financial contributions to his family as well as removing them from his insurance plan despite his well-paying job. Nor will I rant about government bureaucrats who seem unmoved by the request that a pregnant woman get her access to Medicare in a timely fashion. Just know that these are some of the trials this little old family doc has been dealing with during the “Christmas Break.”
I would like to confess my own crime, or to put it more kindly, my failure of moral courage. I went to a new esthetician. While sitting enthroned in the pedicure chair, a tall old man in a sweater wandered in. He came up to the woman doing my pedicure. “Dahlia,” he said. “I am here to get my toenails cut.”
Dahlia look confused. “But Mr. K,” she said. “Are you sure? I don’t have you in my schedule.” The old gentleman pulled out an iPhone and scrolled through it vaguely. “What is your phone number Mr. K, I will look in the computer” she said, kindly.
Mr. K looked at her with the blank stare of dementia. “I don’t, don’t remember,” he stuttered, looking even more confused as he fumbled with his phone. I was playing Candy Crush on my own phone as my feet were soaking in the foot bath. I watched his slow unsteady gait and his growing confusion and agitation. I was snooping on his interaction with Dahlia, when he told her he didn’t remember his email either. I started doing a MOCA in my head. The esthetician came over to me. “Do you mind if I trim his toenails? He is a regular and it won’t take long. I will put your polish on first and see him while you dry.”
“No problem.” I replied.
As Dahlia painted my toes with a dark blue polish, the old gentleman wandered around the salon. “I had better go see if my car is still there,” he said as he went to the large window facing the parking lot. At this point I almost dropped my phone into the foot bath! This guy should not be driving!
Then he sat in the pedicure chair next to me and as Dahlia carefully cut and buffed his toenails. They were chatting about his anticipated dinner with his children and grandchildren that night. They were going to a fancy restaurant in Old Montreal. “My son is picking me up,” he said. “Oh good, he is not driving,” I thought. “From home,” he added. I felt anxious again. He looked at the large watch on his wrist. “What time is it?” he asked. Dahlia looked up at the watch. “It’s 4:30,” she said.
“Oops, I’d better get home soon.”
I sat there thinking, should I do something? But what? Was it even what it looked like? This is not like dealing with taking away a license from a patient in the office, which goodness knows is hard enough. In that situation, however, I’m secure in my diagnosis and I know the patient and their social situation. Also in that scenario I have a clear duty to report. Sitting in this bustling salon, surrounded by chatting people doing their hair and nails, getting waxed and buffed, I had to make a judgement. Should I try to get his name and phone number or even his license number and inform the motor vehicle bureau? He looked so confused that the idea of him behind the wheel of a car made me worried that someone would be hurt or killed! At the same time, what could I do? I didn’t know who he was or what his life was like. I had no relationship with him, I was a stranger and a bystander. What exactly was my responsibility?
We were done at the same time. I lingered at the cash, uncertain and embarrassed as I saw his silver Mercedes leave the parking lot. I waited a few more minutes to make sure he was far enough away so that I felt safe.
Then I left.
I was back there today for another treatment. I spoke to the esthetician, asking her about her client. She agreed with me that he seemed very confused and she thought that he shouldn’t be driving. “Did you ever think about calling his family or letting the police know that you are worried?” I asked her.
“No, I don’t get involved” she said with the anxiety of an immigrant in a precarious position.
“But what will you feel if, God forbid, somebody gets hurt or even killed?” I asked. She looked grave. I could see that she was thinking. Then we returned to ripping the hairs off my chin.
I was feeling uncertain and unhappy, and then I realized I had access to help. My friend and neighbour is a retired medical ethicist, and her area of expertise is dementia and palliative care.
We sat in my living room and discussed this story in our usual back and forth between English and French. “You are very hard on yourself, calling this a crime,” she said. “You have such a strong moral imperative, yet you didn’t really know what was happening, and in fact, this was not a professional encounter, so it is not clear what your obligation really is. This is a very grey area and a difficult ethical issue.”
This conversation made me feel a lot better. I guess nobody’s perfect, including me.