Improvisation

Mr. Jacobs had once been an accomplished jazz pianist. When I first met him, he was a seventy-four-year-old black man admitted to my service with uncontrolled diabetes. With his matted gray hair, stale smell of urine, and untrimmed, dirt-filled fingernails, it was hard to imagine him ever commanding the piano keys.

"How are you feeling this morning, Mr. Jacobs?"

"Same as yesterday, doc. Just get me back to my place. I ain't interested in all these questions. I told you that already."

"I know, sir. We're working on getting you there, but we have to get you better first. Do you mind if I examine you?"

"Don't like that either," he said, a scowl on his face. "Don't understand why you all gotta poke and prod me every day either."

In addition to controlling his sugars, we were treating Mr. Jacobs' enlarged prostate: it had grown so large that urine was not passing freely out of his bladder. A catheter, however necessary, was something he vehemently refused. He was my patient, so it was my job to get him to consent to it. If he were an infant, we would have the option of holding him down to insert it; but since he was an adult, we could not do that to him.

So I got his consent by lying to him.

Standing at the foot of his bed with the urinary bag kit in one hand and the catheter in the other, the lie escaped me as if telling it were part of the actual catheter insertion technique.

"Sir, you need the catheter. It's a very small tube inserted in your penis to help you urinate. I've had one and can promise you it doesn't hurt much. I'll even put it in myself."

Despite my medical school classes and special interests in ethics, patient autonomy, and the doctor-patient relationship, the lie flowed from my lips. I didn't even realize what I had done until after the catheter was in. At the time, when Mr. Jacobs consented, I felt like I had won a small battle. His consent was a victory. There was no turning back.

The catheter went in with minimal effort and minimal discomfort. Over a liter of pus-tinged urine flowed from his bladder. A relieved sigh soon followed. "Thanks, doc."

My lying to Mr. Jacobs did not end there. Over his six days in the hospital, we developed a bond based on my lies. Many times, Mr. Jacobs told me to go the jazz club he had played in for half his life—he said to tell them he'd sent me, and I could get in free every time. He told me the name of the owner, the doorman, and the address. As it was not in the safest neighborhood in Washington, D.C., I had no intention of ever going. I never told this to him, but assured him I would go some evening in the coming weeks. Time after time I lied to him, knowing he would never find out, for he was in no physical condition to go back to the club he loved so much. I felt that my lies strengthened the doctor-patient relationship. Maybe it helped him feel like he was somehow improving my life while I was, at the same time, improving his.

The lies I told him did not worsen his medical care—if anything, they improved it. My gut instinct tells me other doctors have lied to patients with no consequence, but I'm not sure that is true. Though this happened several years ago, I am still ashamed.

I have told other white lies that I don't consider all that bad: the anxious woman wondering if a hospital gown looks good on her ("It looks fine!"); the delightful patient apologizing for a family member's attitude ("She's no bother, she just cares about you."); the diabetic with a fetid foot ulcer ("Don't worry, the smell doesn't bother me at all.").

But these white lies were not prefabricated. They were not the result...