She had been evaluated by a senior resident and transferred to me for further management. He had started her on an anti-depressant that she quit taking before she saw me.
It raised my blood pressure too much. My body is so damaged, I have to be very careful.
We talked about various medications. I would offer one, she would look it up in a Physician's Drug Reference, and refuse it, citing all the possible side effects.
I referred her for therapy. After a few unsuccessful appointments, I offered to terminate our med-checks. If she wasn't comfortable taking medications, why be billed for them?
Well, maybe I'll try this medicine. I trust you.
We made an elaborate plan. She started taking a small dose. It seemed to work.
Very slowly, I titrated up the dose. She became less worried about side effects. She started to smile. At her last visit, she told me she was getting back in touch with her family.
I upped the medicine to standard dose, and asked her to call me if she had any concerns.
Today, she came back after a missed appointment.
I've been taking a stimulant. It helps me take care of my family.
I mentioned concerns for her blood pressure, her history of drug problems, the possible effects of taking stimulants as needed. I wondered why she hadn't called me.
Oh, but you told me not to worry about it too much.
I had a sinking feeling in my stomach even before I asked her the next question. Was she still taking the anti-depressant?
No. It made me feel funny.
And just like that, we're back to square one.
*All identifiers have been changed to protect privacy.