Saturday, January 19, 2013

Patients, #14: "You''re Gonna Pay for This"

     Mervin has a three-year-old child and a fiance.   He can't afford to be in pain.
     This is his second appointment with me.  At the first one, I had told him I wouldn't prescribe narcotic pain medicines.  Now he wants me to say it again.
     He doesn't have a job.
     "There aren't any jobs," he tells me.
     It's true, the nation's unemployment rate is high.  Such statistics sometimes serve as an excuse for people like Mervin, who don't court employers, groom themselves for interviews, apprentice themselves to a trade, or even place more than one or two on-line applications for job-openings before giving up.
     "My neck is killing me," Mervin says.  "So is my back."
     "What about your arms and legs?"
     "They hurt, too."
     "What about your head?"
     "Real bad.  My neck is messed up."
     "Your stomach?"
     "Yeah, it all hurts."
     He doesn't beat around the bush.  He wants pain pills, and this time he's brought proof that he needs it--proof in the form of a two-year-old MRI report, copies of another doctor's office notes showing he has been prescribed oxycodone in the past, and letterhead from a pain management clinic in St. Petersburg.
     When patients bring their own records, sometimes they have edited out the incriminating parts.
     "Why aren't you still seeing this pain doctor?"  I ask.
     "He's no good.  He gives me a hard time.  I need someone who cares."
     The MRI describes two small disc herniations.
     One-third of people walking down the street have disc herniations, and most have no pain.   That means disc herniations, while not normal, are common, and not a reason for prescribing pain medicine.  I tell Mervin this.
     I say, "Your MRI isn't proof that you need Dilaudid, Lortab, or Valium."
     "But that's what my last doctor gave me.
     "So?" I asked.
     "So you can see I need them."
     "You're an addict, Mervin."
     "No, I'm not.  Where'd you get that idea."
     "I don't want you to tell someone, years from now, that no doctor ever said you're an addict.  So, I'm telling you, now.  I can send you to detox today, if you agree."
     "I don't need detox," he shouted.
     "Okay," I said.
     "So you're not going to help me with my pain?"
     "I want to help you quit drugs, and get a job, and have a life."
     "Go F* yourself!" he said.
     "When you want my help, please come back."
     "You're gonna pay for this," he warned me.  "Just wait and see."
     He yelled at the staff on the way out.  The receptionist stood up, her hand on the secret 911 button, when he stopped at the check-out counter.  He wanted his $2 co-pay back.  
     It's not as though we aren't used to people like Mervin.  This is Florida, after all, the land of citrus and Lortab.  People travel from all over the country to visit our pain clinics.  Mervin wasn't from Gainesville, but he had a Florida Medicaid card, and knew that with a valid prescription he could get pills for just about nothing.
     Was I safe, later that night, all by myself, leaving the clinic?
     Should I carry a gun?
     Should I carry a semiautomatic pistol, like the police, in case my first shots miss their mark?
     Walking across the parking lot to my car,  a black cat crossed my path.  It belongs to the people who live behind the privacy fence, and who wouldn't see a killing, or an abduction, if Mervin happened to show up and act crazy.  "You're gonna pay for this," his voice echoed in my memory.
     I will miss practicing medicine, but I won't miss Mervin or any of his clones.
    True, these people are also my patients, and they need help.  But they need divine help, which I don't have.
     I don't even know where to tell them to get it, these days.
     I said a prayer for Mervin, before turning on the ignition, and then I said one for myself.

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