Posts under ‘anecdotes’

The phone rings at my desk.

“So,” a voice says through the receiver. “Can I get my oxycodone prescription today?”

“Your oxycodone prescription?” I respond. “Is this __________ calling?”

“Yes, it’s me. I need my prescription now! You’ve kept me waiting!”

“Now wait a second. You spent the whole weekend snorting heroin and I sent you to the ER in an ambulance because you were wandering your building naked and hearing voices,” I say. “You also had a machete on the kitchen counter. I thought you were in danger. And now you want your oxycodone just like that?”

“Yes. I’m in pain and I need it and now you won’t give it to me. Jesus Christ!”

“Listen.” I try to be patient. “You were out of control this weekend. Even your son said so.”

“But I was celebrating! Can’t I celebrate like anyone else?”

“Well,” I say. “You could have taken a friend out to a nice restaurant to celebrate. Or maybe gone to a movie and bought yourself something nice at the mall. Instead, you chose to go out on the street, buy some heroin, and then spent most of the weekend psychotic. How can we trust you with a bottle of oxycodone?”

“C’mon! I need my meds! You can’t refuse to give me my meds!”

“Well, this is the story. I have decided that I will give the bottle of meds to your visiting nurse. She will keep the meds in the lock box and give you four pills every morning for you to take throughout the day. Then the next morning you’ll get four more. That’s the deal. Either you accept what I’m offering or you get no narcotics at all. No arguments. No bargains. Period.”

“No, no, no. You can’t do that. I need my fucking meds now!”

I sigh. “Look, _________. This is it. Take it or leave it. I have your prescription in my hand and I’m about to go find the doctor to have her sign it. I can just as easily shred the prescription and we’ll talk after Christmas.”

“OK. But I’d better get my meds!”

“I’ll have the doctor sign your script now, as long as she agrees to my plan. But if you use any more heroin, take any street drugs, or do anything like that again, I guarantee you she’ll stop writing those prescriptions right away.”

“OK, OK,” she grumbles.

“Merry Christmas, my dear.”

“Yeah, yeah. Bye.” She hangs up.

I hang up my phone and my colleagues applaud. An exercise in boundaries? Sure. And patience. And compassion. And insanity. Was I really on a leave of absence just five days ago? It seems like an eternity.

“So, how come you didn’t come in for your blood test last week?” I punch at the computer keyboard, checking his lab results.

“Oh, I forgot. You see, there’re these Mexicans I’m helping out—they’re farmworkers, they needed a ride.” His eyes dart around the room.

“Uh huh.” I poke at the keyboard a little more. I let him squirm a little.

“So, when you’re due for your narcotic prescription, I hear from you like clockwork.” Our eyes meet.

“Well, if I don’t have the oxycodone, I know I’ll be in pain. But the blood test? It doesn’t seem to matter that much.” He smiles sheepishly.

“Yeah,” I respond. “Then you end up in the hospital with a huge clot in your leg, and if we don’t catch it in time you throw a clot to your heart and you die a sudden death. Not much of a consequence, huh?”

“I’ll be better about it now, I promise. I know the blood test is important.”

“Y’know, I’ve heard that from you before, but I always wanna believe you and give you another chance.” We both smile and I put my hand on his shoulder as we walk up the hall towards the waiting room.

“Why do you keep giving me another chance if I keep fucking up?”

“Because I like you and I care about you. That’s why.”

“Oh.”

“See you next week?”

“Sure. Next Wednesday at ten.”

Will he come next week for his blood test? Probably not. But when that oxycodone prescription comes due, you know he’ll be calling. Will he get another chance after that? Absolutely. And why not?

The apartment must have been at least 90 degrees. Three large cages in the living room held eight squawking birds, one of which whistles an old Latino song incessantly. My patient breaks into song along with the bird several times during the visit. Between the heat and the singing, I felt like I might pass out.

As I attempted to check orthostatic blood pressures (vital signs taken supine, seated and standing in relatively quick succession) , one of my patient’s friends burst into the apartment. Yelling almost at the top of her lungs, gesticulating wildly, the new arrival pushed a double stroller into the living room which contained two screaming young children. Amidst the tumult, a third child—perhaps eight or nine—sat down on the couch in utter silence, watching me take my patient’s blood pressure and pulse.

The oppressive heat seemed multiplied by the extra bodies in the room. My patient’s temperature was 99.7 and she looked faint. Her friend almost violently shoved a plate of food in my patient’s lap and began spoon-feeding her as my patient tried to answer my questions. Each time I tried to ask a question again, the friend would interrupt, yelling “You’re not taking care of yourself! You need to go to the hospital! Let’s call an ambulance!”

Meanwhile, the two children—still strapped in the stroller—began to shriek louder as the parrot again began the incessant whistling, my patient again singing along.

I packed my bags and headed for the door, feeling quite faint myself. Muttering my goodbyes and advice, I escaped to the humid city air, cars streaming by, horns honking.

“I have to get home,” I thought, looking at my watch. It was 2:35 pm—disappointingly early. No rest for the weary, and no escape for the overwrought.

Sensory overload? Just one more occupational hazard.

“I relapsed again,” she told me. “I could barely bring myself to tell you.”

“Unfortunately, it happens. But what’s the plan now?” I try not to show any discernible emotion when hearing the news so that she doesn’t feel judged.

“Well, I haven’t used in two days. I feel like shit, though.” She wrings her hands as they rest in her lap.

“Two days? That’s great! every day is a new chance to make a new choice. What do you think?”

“Yeah, today’s a new day, but that doesn’t help me feel less like shit.”

“I know, but you’ll feel physically better sooner if you can just forgive yourself and let go of what happened. You can learn from your mistakes without beating yourself up about it.”

“That’s true. I just hope I can do it.”

“You have choices every day. You made a good choice to come in today and talk to us. Let’s plan on some good decisions tomorrow, too, OK?”

“OK. I’ll be back next week. I think I’ll get some exercise.” We both stand up and shake hands.

As the door closes, I take a deep breath. Addiction must be such a weight to carry. I give thanks that it doesn’t have a hold on me, and feel a swelling of compassion for those for whom it is a daily—or even an hourly—struggle.

“Were you the one who called the ambulance last week when I was so sick?” she asked, as I prepared her meds and took out my stethoscope and blood pressure cuff.

“Yes, it was me. You sure didn’t argue, that’s for sure.” I continued to rummage through my things and arrange the tools of my trade.

“I guess I could have died, huh?” She looks at me sort of dreamily.

“It was pretty likely, but we weren’t about to let that happen, were we?” I respond, looking up from my tasks.

“I dunno. I barely remember what happened.”

“You had thrown up before I arrived. Then, as I took your blood pressure, you grabbed the bucket and got down on your hands and knees on the floor and vomited over and over again. Do you remember that?”

“Yeah, I guess so. The people at the hospital were so nice, especially once the transplant team had me on their floor. I hope that liver comes soon. I’m getting pretty sick.”

“You still wear your beeper day and night, right?” I ask.

“Oh, yeah. I wouldn’t trade that thing for all the methadone in the world.”

“Good. Now, you have a low-grade temp today. What should we do?” I put away the thermometer and other supplies.

“I’ll call a cab and go to the doctor’s office to get checked out. I really don’t want to go to the hospital again if I don’t have to.”

“Promise to go?”

“Yes, I promise.”

“I don’t want them to have to scrape you off that floor again if I can help it.” I rise to leave.

“Thanks alot. I really appreciate it.”

“Hey, you’re doing the hard work. I just stop by and check in.” We shake hands.

“See you Wednesday, and get to the doctor’s office! And no Tylenol! Your liver can’t handle it.”

“Yeah. See you then. I’ll go, don’t worry. Thanks.”

Last Wednesday I started my day with a bang, sending this poor soul off to the ER, dehydrated, febrile, end-stage cirrhosis working its horrible magic of visceral implosion on multiple organ systems. A new lease on life seems to have been granted, or at least a reprieve of sorts. This patient—and thousands (or millions) like her—walks the thin line between life and death, waiting for a life-saving organ transplant as millions of viable organs are buried beneath the earth or consumed in the fires of crematoria. What a morbid waiting game indeed.

For now, another brush fire has been stomped out as the cirrhotic fire in her liver rages on. It is truly a race with time, and even the hoped-for outcome of a fresh transplanted liver cannot deliver the promised revitalization of health without a large degree of uncertainty and risk. I have seen what havoc organ rejection and infection can wreak, and if life waiting for a transplant seems rough, the other side of the surgery is certainly no picnic.

Still, I could leave that house today secure in the fact that one more sunrise has arrived for this kind person, and yet another opportunity presented for continued life, however challenging. Yet another instance to think to one’s self, “there but for the grace of God go I.”

“I feel like I’m just waking up. I’m sixty years old. I’ve spent most of my life being afraid of people, of places, of things. I’m only now becoming aware of what I can still do with my life.”

She sat before me in the exam room for our weekly appointment to prefill her med box, review her meds, discuss symptoms, and basically check in. We’ve known each other about six years now, and we have a sweet therapeutic relationship.

“I think about the things that happened to me in the past, and I realize that I don’t have to focus on those things. It’s like I’ve been asleep.” Her eyes filled with tears.

“You know,” I began, “there are times in many people’s lives when they begin to see more clearly, and the things that used to limit them seem to lose their power. It seems like you’ve arrived at one of those moments now.”

She shared more of her personal history of trauma and suffering that I don’t care to elucidate on here. Suffice it to say that the abuse and trauma that she suffered as a child and young woman would be enough to cause anyone to shut down emotionally and to fear affection or attention. It felt like an honor to be given that honest glimpse, to be allowed that much further into her inner world, and I told her so.

“I haven’t shared these things with anyone else, not even my therapist. I trust you and wanted to talk about them with you first.” She smiled.

“I’m very honored that you would choose to share these stories and feelings with me, and I advise you to bring all of this to therapy where you can do alot more work than I am able to offer based on my lack of experience in this area. Still, no matter what, I think this opening that you are experiencing will have a very positive effect on your life.”

We walked down the hall, my hand on her shoulder. It was one of those golden moments, and I felt myself glow for several minutes afterwards before I was distracted by the next brushfire in need of attention. But those thirty minutes with my patient were so well spent, so worthwhile, and in that moment my work made so much sense. What did I really do in that room? I listened and reflected, nothing more. She did all of the work, and my pride in how far she has come does so much for this nurse’s heart and soul.

The phone at my desk rings.

“Keith, how much do you know about babies?”

The voice is familiar, but I can’t place it. Many of my 85 patients start talking without first saying who is calling, expecting me to recognize their voices.

“Uh, who am I speaking with, please?”

“It’s __________. Do you know about babies?”

“Oh, hi! Why do you ask?”

“Well, does someone have alot of stomach pain when they’re pregnant?”

“Does this have to do with you?” I ask innocently.

“Yeah. Every time I move from side to side, my stomach hurts and I feel sick. Is that normal?”

“Do you feel nauseous in the mornings? Have you been vomiting?”

“No.”

“Do you think you’re pregnant?”

“Maybe….”

“Are you peeing alot? Hungry? Gaining weight?”

“Well, I have gained some weight lately,” she says hopefully.

“I don’t think you’re pregnant, but we can do a urine test when you come in. When do you see Dr. ___________?”

“Oh, I have an appointment today at 2:00. Do you think I should tell him about my symptoms?”

“Absolutely. I’ll look for you in the waiting room and say hello, OK?”

“OK. Thanks, Keith,” she replies. “I just thought I’d call and ask if you knew about babies and stuff like that.”

“No problem. I’ll see you this afternoon.”

“Bye.”

Just this morning, one of my colleagues (a PhD-level Clinical Psychologist) said, “I think a person’s well-being is generally influenced by whether or not they’re wearing the right socks.”

What influences your day and determines its trajectory?