Another day at work

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.

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About purplesque

Psychiatrist, cook, bookworm, photographer. Not necessarily in that order.
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18 Responses to Another day at work

  1. Scott says:

    So exasperating. Instant gratification versus long-term results.
    I wonder if she looked up her stimulant in the PDR and read its side effects.

  2. jaklumen says:

    …and that, sadly, is how it all too often is.

  3. Emjay says:

    You have chosen a very frustrating profession! I have to admit that I read all the "possible" side effects of everything I am prescribed and sometimes I seriously think about not taking something. Of course my mind still works well enough to weigh up the effects of not taking something versus the possibility of some side effect. It is very sad when one's mind can not rationalize "normally".

  4. Brown Suga' says:

    😦 So frustrating. ((hugs))

  5. sometimes i feel like our job is like running on a hamster wheel, running frenetically but staying in place.

  6. ((((((((((Purplesque))))))))*quietly places a bag of Reeses on the sofa and tiptoes away*

  7. ughhhh sorry. that sucks…

  8. Purplesque says:

    Yes, it did not make a difference. I know this is all part of the game, but some days..

  9. Purplesque says:

    Yes. I wonder if she is as frustrated as I am..probably.

  10. Purplesque says:

    Yes..for me its very frustrating when I can't connect with a patient. Its okay for them to take/not take their meds, as long as they tell me. As long as we work as a team. I always tell everybody that. Hardly ever works. πŸ™‚

  11. Purplesque says:

    πŸ™‚ thank you. With enough hugs, I might get through this alive.

  12. Purplesque says:

    Oh God, yes. More so these days.

  13. Purplesque says:

    Aww. Your favorite just-became-more-rationed Reeses?Thank you, Robbbie. That means a lot. πŸ™‚

  14. Purplesque says:

    Thanks..all part of the game, but some days I just don't want to play..

  15. Aubrey says:

    Envy is painful. Hatred is tiring. But I think patience is the most difficult of human emotions. And yet it is literally written into your job description, along with its sub-emotions: sympathy and empathy. How can you bear it? A human being can be a terrible tangle, and you have to unravel it!

  16. Scott says:

    Yep, sometimes the side effects are worrisome. I did hold off for a long time on accepting a GI med with a significant risk of liver toxicity. Eventually I decided I was sick enough that the risks were worth it. Like you said, sometimes people just can't think through that analysis, and that's tough to watch.

  17. nods, somberly.You're welcome — Reeses help nearly everything.

  18. Purplesque says:

    I spend most of my time getting tangled up myself..human beings are hard puzzles to solve. Its fun, though. πŸ™‚

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