Saturday, August 20, 2011

Maybe I Don't Know

I have a 30-something-year old patient with 3 children. She got pregnant young, never went to college, and I'm not sure that she actually has a job. Her children have various ailments, some of which are real and some I think she might make a big deal out of because that's all she knows how to do. Anyway, life has not been easy for her.

She came into my office the other day, and she said, "I'm so stressed, I'm having panic attacks, and you keep telling me that 'it's going to get better' well it's not better and if you don't give me something to help me we are going to have to fight!" Her speech is usually fairly pressured, and it's difficult on a good day to get a word in edgewise. I could tell this visit was going to be beyond the 15 minute limit that follow-up patients are given.

She was smiling, but tearful, as she burst out that first sentence. I heard again about her daughter with the seizure disorder who has to go 2 hours away for her specialist. I heard about the dog that is dying and the one that died last year. I heard about the children's daddy and about her mom who doesn't help out. She told me how she tells her 16-year-old daughter to go to college so she doesn't have to rely on Medicaid like my patient does. She told me that despite me telling her at the last 3 visits that "things will get better," they just haven't and she feels like she is at her wit's end.

Then she looked at me, and she said, "You don't know what it's like. You went to college, you have a good job, you don't have to worry about money like I do." She sniffled. "I can't handle it any more." I felt her honesty and her humility.

I wanted to tell her that she really needs a therapist to help her deal with stress and time management. I wanted to tell her that no pill can make her life less stressful or put food on the table. I wanted to tell her that there is no quick fix for having 3 children, no job and no support. I wanted to tell her that looking to a drug to save you is never the answer. But, I know that she can't afford a therapist, and Medicaid doesn't pay for them. She can't force her mom to watch the kids. She can't find a job that will let her off once a week to bring her daughter to the specialist.

I felt that perhaps an anti-depressant/anti-anxiety/mood stabilizer might help keep things a little more even. I did tell her that I think she is handling things very well, and that she shouldn't be so hard on herself when she needs a break. She is actually a very good mom. Once again, I told her to be strong, and we'll meet again in 4-6 weeks.

She doesn't know that I grew up with very little money. She doesn't know that I stay up at night sometimes, second-guessing my medical decisions. She doesn't know that I go in to work even on my days off, because I am a control freak. She just sees me now as her doctor, someone with privilege and no worries. I'm not saying our lives are similar, because they aren't. She has struggles that I cannot begin to imagine. I just didn't know how to tell her that her life isn't going to change because I give her a pill to take every morning. Some people just need a break, and I have nothing that will help with that.

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