"How could you be so Dr. Evil?"
~ Kanye West in "Heartless"
"That medicine that y'all been giving me don't work. It don't do nothing."
Your face was twisted and angry when you told me that. Your body writhing in the bed rhythmically like some kind of cobra being lured by a snake charmer's music. The more I looked the more you danced.
I'd reviewed your chart carefully. I saw that you were young and that, while you did have some chronic medical conditions, none of them warranted some heavy duty pain regimen.
"The tramadol didn't work?" I asked.
"Tramadol? Man, that pill don't do nothing." You shook your head and curled your lips. Then you exhaled hard through flared nostrils. You wanted to emphasize that last statement.
Your chart laid out a story. Twenty-seven ER visits in less than three months. And each visit to the emergency room read like an identical chapter in the most redundant novel of all time. You came in complaining of pain. None of the non-narcotic options given to you at home were working. On a scale of one to ten? Yours was an eleven. Every single time. Yes. Somehow, some way, there was always someone who'd give you either an IV dose or a handful of the pill you wanted.
The vitals signs on all of those visits were equivocal. No racing heart rate or rapid breathing suggestive of someone in a deep, deep struggle with pain. And yes, I know that pain is a subjective thing but still. I was hoping I could have at least one objective finding in favor of your story which unfortunately kept reading like one I'd read many times before.
That's what you said worked best for you. You also said that nearly every other medication caused you some kind of horrible, life-threatening allergic reaction.
Dilaudid? Wow. You meant business. Even by its generic name--hydromorphone--it was still a big gun. And something I didn't feel good about giving you.
And so, I told you just that.
"I don't feel good about giving you that medication. It's habit forming. But more importantly, I just can't see a good reason to use something so strong based upon what I've seen so far."
"This is ridiculous," you told me. "You look at me and see these braids and these gold fronts and just make up your mind about me. And real talk? Tha's some straight up bullshit. Just 'cause I'm a hooligan don't mean I don't have the right to not be in no pain."
The whole team shifted around nervously when you said that. Eyes found squares of linoleum to study and shoelaces to focus upon. And me? I just stared straight at you and wondered why you'd refer to yourself in that way.
You went on. "It's sad how they don't listen to you just from looking at you. 'Specially when you in real, true pain."
They? Who was this "they?" Was I a part of your "they?" Gosh. I hoped not.
I felt my eyes squinting and coached them back to normal. Scanning the room once more, I felt the uncomfortable sensation in the room rising like yeast dough in a bowl. It was thick like that, too. Like you could grab it and knead it if you wanted to.
That's when I got it. That's when I understood how you managed to get "just a few" oxycodone pills "to hold you over." Just like this. Through these sticky accusations and stealthy jabs. The kind that swell into the kind of anxiety that crumbles even the toughest provider into a pile of narcotic prescriptions. You wore people down.
I knew that because you were doing it to me.
I kept my eyes on you and took a deep breath. I wanted to do right by you. At least this is what I wanted to believe. But your words made it fuzzy. I felt myself second-guessing my position and wondering if I had indeed unfairly sized you up. And so I had a little talk with myself right then and there.
Do you want to do right or do you just want to be right?
Do you want to help him win or do you just want to win?
I pondered those questions for a few seconds and then made up my mind.
"I'm not going to give you Dilaudid," I said. "But I want to be as fair as possible so I'm going to double check a few more things in your chart and come back. I'm pretty sure, though, that whatever we do it won't involve hydromorphone."
" I mean Dilaudid."
And in response to that you rolled your eyes hard. Then you said a few more of those things that file people down. Subtle suggestions of discrimination or unethical treatment. I decided not to let you do this to me on this day. No. I went back and looked even closer at your record and your data. I re-examined your body and gleaned nothing that made me change my mind.
I returned to let you know that the plan hadn't changed. No more Dilaudid. At least, not from me.
And you were mad. You called me names. A "heartless motherf--ker" even. And that? That almost wore me down enough to give you what you wanted.
I excused myself before I could.
Here is what I want you to know:
I do care about you. I do. And I hope one day you'll understand that I'm not the "they"-- at least I hope I'm not. I do care. It's just that sometimes choosing the hard right instead of the easy wrong just makes it seem like I don't.
Oh yeah--and to me? You're not a hooligan. To me? You're beautiful. Too beautiful to help you destroy.
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