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Medical Humanities

My Sweet Girlfriend

Ashwini Bapat
October 31, 2014

My first patient!

As a newly minted intern, I cleared my throat, knocked on the door, and pushed down on the handle. My optimism suffered a slight jab as the smell of tobacco punched me in the face. JB stared at me. He was a potbellied man in his forties, sporting a frayed T-shirt with tomato sauce stains and faded ripped jeans. Deep creases etched a distressed leather face framed by thinning gray hair. He sat hunched over on the exam table, staring up at me with bloodshot eyes. I smelled the alcohol on his breath along with the tobacco as I walked into the tiny exam room.

JB was candid about his substance abuse. He had smoked a pack per day for as long as he could remember. He drank twelve beers most days of the week; often more on the weekends. He knew it was hurting him; it had cost him a girlfriend and a job. Six months ago it almost cost him his life when he had a massive heart attack. He felt like he needed to make a change in his life. He wanted to start with smoking; he had tried to quit three times before, but now wanted to quit for good.

Wide-eyed, realizing the opportunity that had just presented itself, I pounced. I blabbered off all the resources available. Nicotine gum, nicotine lozenges, Chantix, smoking cessation hotline. We set a quit date. He left clinic fully armed, handing me his last pack of cigarettes.

On his one-year smoking cessation anniversary, a day I figured we’d spend celebrating his success, I found JB hunched over, looking down. He reeked of beer. With tears running down his face he declared in a faltering yet determined voice “I am so fucking tired! I wake up drunk, I come home drunk. I finally got a job and I don’t want to get fired just cause I’m throwing up. Booze has done nothing but fuck me over.” His dogged eyes beamed through the deluge of tears. I reached out and placed my hand on top of his, giving it a firm squeeze. The moment lingered and I felt that an understanding had been reached. I told him about Naloxone, a medication to help him quit drinking. We talked about the triggers that led him to drink: anxiety, unemployment, boredom. We brainstormed some strategies to help him cope with the triggers. I suggested attending Alcoholics Anonymous.

JB left clinic armed with a multipronged plan of attack in his battle against alcoholism. I left clinic reflecting upon my experiences with former alcoholics in medical school. They had always talked about hitting “rock bottom”: the place from where there’s nowhere to go but up. The day they quit. JB must have reached rock bottom today.

A few weeks later, excited to see his name at the top of my schedule, I grabbed my computer, rushed down the long corridor, tapped on the door and entered. There on the examining table was Mr. JB, sitting upright, cheery, rosy in appearance, and unusually energetic. Aha, I thought, this is what happens when you remove alcohol from the mix. You get a happier, healthier, more energetic patient.

“Hello Mr. JB. It’s good to see you. What brings you to clinic today?”

“Yes, finally, my girlfriend is here! You’re so sweet to me. I came to see you, my sweet girlfriend. “ He slurred, wavering on the examining table.

My happy thoughts came to a screeching halt. I felt the blood rushing to my face.

“Look at you, you’re blushing!” I felt his eyes lingering a few seconds too long, as if appraising the specimen before him.  

Within a matter of seconds his past clinic visits flashed through my mind. Where did he get this? As I looked back at him, he teetered precariously on the table. His eyes had a salacious gleam and he let out an unbridled cackle. It carried a fetid odor. Oh my gosh, I realized, he’s totally sloshed. He’s happy because he’s drunk!

“I am NOT your girlfriend, I’m your DOCTOR,” I blurted out.

I don’t remember what we talked about next, and I can’t say that I listened intently to what he said. I just wanted to be done with the visit.

I saw that I already had two patients waiting for me, and quickly discussed his medical issues with my preceptor. Luckily for me he had already stumbled out of clinic by the time I returned to his room.

That encounter followed me through the entire day, tainting each and every one of my patient interactions. My next patient was obese. Without delving further I assumed she was lazy and unwilling to stop stuffing her face with Cheetos. The depressed patient, well, he just needed to snap out of it and get a job. By the end of the day, I felt uncharacteristically drained.  

I had spent the entire day replaying my encounter with JB over and over again. I finally pressed the pause button and examined my feelings. I felt angry. Disgusted. Gross. Years of training, just to be objectified? Do I really have to see JB again? Can’t I just fire him? Why the fuck do I bother? If he doesn’t care about his shitty life, why should I? Douche bag.  

I vented over the next couple of days to anyone who would listen.  Soon there was nothing left to vent about. So it happened. Big deal. He called me his girlfriend. Why couldn’t I just laugh it off? Why did I take it so personally? Why did I react to him?

I cleared my mind, and tried to see things from his perspective. A forty six year old man, living in his mother’s home, unemployed, with no friends to call. I imagined how alcohol could morph to fill any void, the void left by a friend or a lover. At times maybe it became liquid courage to elevate his hopes. Despite my efforts I struggled to understand his experiences. They seemed so remote.

Then I saw something I could understand. The man who came to clinic, who appeared for his appointment despite being drunk, was a man who was trying. He was a man trying not to drown.

Ultimately, I don’t know what demons JB faced. What I did come to know is that as his primary care physician I could support him. I could be the person who believed in him, even when he didn’t. I could care.

I pulled out my computer and wrote him a letter of solidarity. Not a reproach. Just a hand reaching out to help.


Acknowledgements: Thank you to Lisa Sanders M.D. and Emeric Bojarski M.D. for their insightful comments.

 

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