I've been trying to retire, but my needy patients won't let me. I've passed them on to other doctors, told them I can't see them anymore, that I was going away to a far off island. And they just keep calling. "Call the doctor who is treating you." I can't count how many times I have said that. And then the patient says, "But they don't understand me the way that you do, please, please, please." PLEASE Dr. Alex. PLEASE Dr. Doberman (it feels funny to me to write that, because obviously, that's not my real name. I have no interest in revenge lawsuits)
"PLEASE! DR. Alex!" I have to admit, it's nice to be loved, to be wanted. The truth is they don't really want me and they don't love me. The truth is that the patients who won't let me go, the ones who hunt me down in the early morning and occasionally drive by my house are the famous ones, the ones who have been creatively successful, or otherwise just lucky, or who are just about to get there. Kind of like an orgasm that never happens. They just can't reach climax. They just can't self-actualize. The ones who are just wealthy by default with too much time on their hands, may do a drive-by here and there, but they aren't as demanding. They have issues, but they don't make demands like this woman. It's an altogether different MO.
So they call and they keep calling, until I finally say O.K. when would you like to meet? Just like a crack fix. O.K., you've won, when would you like your crack fix? What's funny is that they can find anything I prescribe them by themselves. They don't need prescriptions and many of them use drugs far more powerful than anything I could or would prescribe them. So, that's not the "fix" their coming for. I will write the usual Los Angeles script for them. An anti-anxiety, erection difficulties (or rather perceived erection difficulties) sleeping pills (Why don't they just use their Medical Marijuana pharmacy card?), a pain killer here and there. None of it matters because they don't take the pills as prescribed, which is why in my later years, I slowed down the anti-depressant scripts. They are only effective when taken as prescribed and why that's impossible for someone who is in the top of their field, a master of their craft, I'll never know.
What I don't want are the on again off again anti-depressant streakers through my office constantly getting put on a different anti-depressant, but never taking it consistently enough to notice results. Also, the hysterical phone calls get a bit annoying. Oh, you're hyperventilating, that's because the dosage is too high. Oh, you really love the dreams where you are weightless and can fly. I know, amazing. No, I can't give you a higher dose that won't increase the efficacy of the dream. Perhaps, I should be more sensitive. But, it can be difficult to deal with people who are truly not sure, or who have an inability to be honest about what drugs they are taking and where they got them from.
I had a patient tell me once that she felt like she was cheating on me because she went to another DR. And then, when I asked here who it was, she refused to tell me their name. I have no grudges against my peers or my colleagues. I think good, do whatever is most helpful for you. If they want my honest opinion, I will surely give it. Yet, that didn't seem like it was this patients goal. It seemed like she wanted to stir up drama. I can't keep track of all the meds I prescribe and the meds other Dr.'s might prescribe and recreational drug usage. So how am I supposed to know what drugs she's taking? She might know what drugs she has in her stash draw, but she doesn't know which pills she's been taking and when. It's just all in one drawer that's a big mess.
And then my head starts to nod. I nod yes because that must be really confusing. "How is your cocaine usage?" I ask. She says she hasn't been doing any. She's been clean for three months now and hasn't craved it at all. The chantix must have helped with that, although it didn't help her quit smoking. I keep nodding. Yes. And this is where my compassion kicks in. This woman has done so much cocaine that I can see the damage to her nose cartilage from where I'm sitting and I'm an old man. A part of me wants to ask her, are you aware that your nose is about to collapse?
"Lean in towards me," I say as I take my finger and press her nose flat against her face. Powder leaks out. I can see the post nasal drip every time she opens her mouth. Of course, it was only in my imagination that I pressed her nose against her face while glancing at her rack. But, it has occurred to me during the past forty-minutes that this patient has been on a cocaine bender, which would explain all of the obsessively rude phone calls. This is why, SHE JUST HAD TO SEE ME. NOW. TODAY.
"So you feel like the sky is falling?" I ask. Yes. She does feel that way. I nod my head again. "No other drugs?" "No," she says. "None but the ones in the drawer." She's calmer now, which is good. I feel like I'm staring through her, into that drawer. She must have some Valium in there already. Something, or maybe not. God this is my moment, isn't it? This is it. This is when I fix her and it's time to shine. This is why they pay me the big bucks, right? THIS IS WHY SHE JUST HAD TO SEE ME AND NOT ANOTHER DR.
She's not ready to be honest with herself about the cocaine and she's not ready to be honest about it with me. I'm at a loss, what can I do? Have you tried breathing exercises, re framing exercises, yoga. Would you like some Valium?
You know, sometimes I would really like it if patients would just walk into my office and say, I found out that my emotionally abusive ex-boyfriend is getting married and that sent me on a huge bender and I didn't know what to do, so I called you because I haven't filled in the new DR. about all of the important details of my life and I don't feel like repeating myself. Why can't she just say that?
"So, why do you feel like the sky is falling?" I ask. "I feel like I'm about to jump out of my skin," she says. "I feel like I'm going to kill someone." "Well, since you didn't seem excited about the Valium, if you were going to kill someone who would it be?" Now, shame floods her face. It's Ronald, she's been talking to Ronald. Ron, the bane of her existence, the demise of her life. If only she hadn't met him, everything would be different for the better. They were one of those couples I helped to pry apart with a wrench and tweezers. They enjoyed hurting each other. Neither of them are bad people, but together they were like styrofoam and gasoline. I knew this had to have something to do with Ron.
"Have you been dating?' "No," she says. "Ronald's getting married to some helpless wealthy hoe that he'll for sure cheat on. He proposed to her. But six years and not me. No, he didn't want to get married to me."
"Well, I think he did want to marry you. I don't remember that being the issue. I think the issue was that you felt like he would never be able to be faithful and as you've said he's probably not going to remain faithful to this woman he's marrying."
"I know he's not." She says. "He can't. He's not programmed like that. It's not in his DNA."
"Well, thank goodness you won't have to worry about him tormenting you anymore. Now, he's her problem."
"But I wanted to be that someone else, " she says.
There is so much I could write about how people with her personality type are unable to deal with not getting exactly what they want, from a restaurant table, to a car, to a man. To her, she sincerely feels like she will die if she does not get exactly what she wants, and maybe that has contributed to her success. Also, it's probably what drove her to drugs. I wanted to be a rocket scientist. Nobody cares about me and my "lost" dreams.
"It hurts," she says. And this is the most honest statement she has made in the past hour.
"I know. It hurts me too. It hurts me to see you like this. And if I were you, I would feel hurt also. It would feel like a final rejection."
"There's no hope."
"For you and Ronald you mean?"
"There's no hope left."
"Well, certainly not for that relationship. But, he'll probably come back."
"No. he won't ever come back."
"Oh, I think he will," I say. "And then you will have to be strong and say NO WAY. I'm not going to be the other woman." And finally, a smile comes across her face.
"I don't think so," she says.
"Oh, I think you could have him back." I say.
"Yeah, I probably could have him back as he is now, which is as an infidel asshole. I'm definitely going to say NO when he comes back. I've been saying no this whole time. That's why I brought him here to begin with way back when."
I nod.
"It's just so hurtful and devastating. I'm just in so much pain. Why her and not me?"
"Yes. It hurts when someone is incapable of loving you how you need to be loved, whether that's healthy or not. I don't know."
And now I know that I'm never going to get her out of my office because she has finally started crying. She cries how all of us cry like boys and girls who have just gotten our feelings hurt for the first time, the kind of cry that doesn't understand explanations, not because it doesn't want to, but because it doesn't have the capacity. I let her cry. I guess all I've got is time, right? I'm retired.
After she leaves, I remember. The funny thing about Ronald was that he was very honest about not being able to be faithful, not to this patient, or any woman. In fact, I think that was the only part of himself he was ever honest about.
"PLEASE! DR. Alex!" I have to admit, it's nice to be loved, to be wanted. The truth is they don't really want me and they don't love me. The truth is that the patients who won't let me go, the ones who hunt me down in the early morning and occasionally drive by my house are the famous ones, the ones who have been creatively successful, or otherwise just lucky, or who are just about to get there. Kind of like an orgasm that never happens. They just can't reach climax. They just can't self-actualize. The ones who are just wealthy by default with too much time on their hands, may do a drive-by here and there, but they aren't as demanding. They have issues, but they don't make demands like this woman. It's an altogether different MO.
So they call and they keep calling, until I finally say O.K. when would you like to meet? Just like a crack fix. O.K., you've won, when would you like your crack fix? What's funny is that they can find anything I prescribe them by themselves. They don't need prescriptions and many of them use drugs far more powerful than anything I could or would prescribe them. So, that's not the "fix" their coming for. I will write the usual Los Angeles script for them. An anti-anxiety, erection difficulties (or rather perceived erection difficulties) sleeping pills (Why don't they just use their Medical Marijuana pharmacy card?), a pain killer here and there. None of it matters because they don't take the pills as prescribed, which is why in my later years, I slowed down the anti-depressant scripts. They are only effective when taken as prescribed and why that's impossible for someone who is in the top of their field, a master of their craft, I'll never know.
What I don't want are the on again off again anti-depressant streakers through my office constantly getting put on a different anti-depressant, but never taking it consistently enough to notice results. Also, the hysterical phone calls get a bit annoying. Oh, you're hyperventilating, that's because the dosage is too high. Oh, you really love the dreams where you are weightless and can fly. I know, amazing. No, I can't give you a higher dose that won't increase the efficacy of the dream. Perhaps, I should be more sensitive. But, it can be difficult to deal with people who are truly not sure, or who have an inability to be honest about what drugs they are taking and where they got them from.
I had a patient tell me once that she felt like she was cheating on me because she went to another DR. And then, when I asked here who it was, she refused to tell me their name. I have no grudges against my peers or my colleagues. I think good, do whatever is most helpful for you. If they want my honest opinion, I will surely give it. Yet, that didn't seem like it was this patients goal. It seemed like she wanted to stir up drama. I can't keep track of all the meds I prescribe and the meds other Dr.'s might prescribe and recreational drug usage. So how am I supposed to know what drugs she's taking? She might know what drugs she has in her stash draw, but she doesn't know which pills she's been taking and when. It's just all in one drawer that's a big mess.
And then my head starts to nod. I nod yes because that must be really confusing. "How is your cocaine usage?" I ask. She says she hasn't been doing any. She's been clean for three months now and hasn't craved it at all. The chantix must have helped with that, although it didn't help her quit smoking. I keep nodding. Yes. And this is where my compassion kicks in. This woman has done so much cocaine that I can see the damage to her nose cartilage from where I'm sitting and I'm an old man. A part of me wants to ask her, are you aware that your nose is about to collapse?
"Lean in towards me," I say as I take my finger and press her nose flat against her face. Powder leaks out. I can see the post nasal drip every time she opens her mouth. Of course, it was only in my imagination that I pressed her nose against her face while glancing at her rack. But, it has occurred to me during the past forty-minutes that this patient has been on a cocaine bender, which would explain all of the obsessively rude phone calls. This is why, SHE JUST HAD TO SEE ME. NOW. TODAY.
"So you feel like the sky is falling?" I ask. Yes. She does feel that way. I nod my head again. "No other drugs?" "No," she says. "None but the ones in the drawer." She's calmer now, which is good. I feel like I'm staring through her, into that drawer. She must have some Valium in there already. Something, or maybe not. God this is my moment, isn't it? This is it. This is when I fix her and it's time to shine. This is why they pay me the big bucks, right? THIS IS WHY SHE JUST HAD TO SEE ME AND NOT ANOTHER DR.
She's not ready to be honest with herself about the cocaine and she's not ready to be honest about it with me. I'm at a loss, what can I do? Have you tried breathing exercises, re framing exercises, yoga. Would you like some Valium?
You know, sometimes I would really like it if patients would just walk into my office and say, I found out that my emotionally abusive ex-boyfriend is getting married and that sent me on a huge bender and I didn't know what to do, so I called you because I haven't filled in the new DR. about all of the important details of my life and I don't feel like repeating myself. Why can't she just say that?
"So, why do you feel like the sky is falling?" I ask. "I feel like I'm about to jump out of my skin," she says. "I feel like I'm going to kill someone." "Well, since you didn't seem excited about the Valium, if you were going to kill someone who would it be?" Now, shame floods her face. It's Ronald, she's been talking to Ronald. Ron, the bane of her existence, the demise of her life. If only she hadn't met him, everything would be different for the better. They were one of those couples I helped to pry apart with a wrench and tweezers. They enjoyed hurting each other. Neither of them are bad people, but together they were like styrofoam and gasoline. I knew this had to have something to do with Ron.
"Have you been dating?' "No," she says. "Ronald's getting married to some helpless wealthy hoe that he'll for sure cheat on. He proposed to her. But six years and not me. No, he didn't want to get married to me."
"Well, I think he did want to marry you. I don't remember that being the issue. I think the issue was that you felt like he would never be able to be faithful and as you've said he's probably not going to remain faithful to this woman he's marrying."
"I know he's not." She says. "He can't. He's not programmed like that. It's not in his DNA."
"Well, thank goodness you won't have to worry about him tormenting you anymore. Now, he's her problem."
"But I wanted to be that someone else, " she says.
There is so much I could write about how people with her personality type are unable to deal with not getting exactly what they want, from a restaurant table, to a car, to a man. To her, she sincerely feels like she will die if she does not get exactly what she wants, and maybe that has contributed to her success. Also, it's probably what drove her to drugs. I wanted to be a rocket scientist. Nobody cares about me and my "lost" dreams.
"It hurts," she says. And this is the most honest statement she has made in the past hour.
"I know. It hurts me too. It hurts me to see you like this. And if I were you, I would feel hurt also. It would feel like a final rejection."
"There's no hope."
"For you and Ronald you mean?"
"There's no hope left."
"Well, certainly not for that relationship. But, he'll probably come back."
"No. he won't ever come back."
"Oh, I think he will," I say. "And then you will have to be strong and say NO WAY. I'm not going to be the other woman." And finally, a smile comes across her face.
"I don't think so," she says.
"Oh, I think you could have him back." I say.
"Yeah, I probably could have him back as he is now, which is as an infidel asshole. I'm definitely going to say NO when he comes back. I've been saying no this whole time. That's why I brought him here to begin with way back when."
I nod.
"It's just so hurtful and devastating. I'm just in so much pain. Why her and not me?"
"Yes. It hurts when someone is incapable of loving you how you need to be loved, whether that's healthy or not. I don't know."
And now I know that I'm never going to get her out of my office because she has finally started crying. She cries how all of us cry like boys and girls who have just gotten our feelings hurt for the first time, the kind of cry that doesn't understand explanations, not because it doesn't want to, but because it doesn't have the capacity. I let her cry. I guess all I've got is time, right? I'm retired.
After she leaves, I remember. The funny thing about Ronald was that he was very honest about not being able to be faithful, not to this patient, or any woman. In fact, I think that was the only part of himself he was ever honest about.
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