"People Aren't All They're Cracked Up To Be"

A friend of mine, also a family practice doctor, once stated, "I went into family medicine because I wanted to work with people. Problem is, I found out that people aren't all they're cracked up to be."

Like my friend, I too felt drawn to family medicine because of a deep-seated desire to help people in need. Overall, I'm very happy and fulfilled in my career. But people in need are often tough customers, especially when their needs are illegal.

Today was particularly tough in this regard. I have a young man who arrived as a new patient at my clinic the week before Christmas; he had had several confrontational visits at our ED in the preceding weeks regarding narcotic pain medicine. He had so many "red flags" concerning his drug-seeking behavior that if I were a bull I would have charged; I probably should have never agreed to see him in clinic. However, I felt compelled to give him a chance: first of all, because I feel that it's part of a family doc's responsibility to try and manage these patient's needs as outpatients so they don't over-utilize our (expensive) emergency departments; second, the kid seemed harmless enough; third, I had a silly thought that maybe I could develop a therapeutic relationship with him and help him overcome his narcotic addiction. So I gave him the tough talk, gave him a 2 week supply of pills, and then had him come back to sign a narcotic contract, which we did yesterday.

Within 24 hours, he harrassed and infuriated the local pharmacy, which summarily fired him as a patient, and then several documents from other regional EDs were faxed to our office regarding threatening and drug seeking behaviors, all of which violated his contract with me. He then showed up at our office, feigning contrition and innocence. After a thirty minute (and deftly navigated by myself, I must say) conversation/confrontation with him, his tone and demeanor abruptly shifted from apologetic and incredulous to sinister and threatening. As he escalated his behavior, I found myself quite uneasy in the room and scanning around for a safe exit should he become violent. (I had brought the clinic manager into the room who was also edging towards the door.) When I finally moved to show him the exit, he lashed out verbally with vague threats of violence and lawsuits from his "connections." He also unintentionally disclosed some information that revealed to me that he must be in cahoots with another of my chronic pain patients who I otherwise wouldn't have suspected--some sort of nefarious Worland Oxycodone Drug Ring. (Mafia, beware! This kid has got connections!)

Luckily, violence was avoided, and if I had the luxury of retreating into an anonymous metropolitan suburb, I probably wouldn't worry much more about the encounter. But in a town of 5,000, it is known by, well, everyone where the new doctor lives, right across the street from the hospital. I felt quite unsettled at the thought of some sort of retaliation against myself, my family, or my clinic. For the first time since we've lived in this quiet idyllic town, I felt unsafe in my own environs.

After a discussion with our clinic manager and my nurse, I decided to file a police report with the town sheriff, who is a basketball buddy (ahh, the joys and pains of small towns . . .) and who offered to place a patrol watch on our home for the next few days. He also told me they are in the process of investigating several other leads on a burgeoning illegal prescription drug trade in our town.

Hopefully, this druggie will skip town (he doesn't actually live here) and never come back when he finds out we're not going to play his game. Maybe my report can be a small part of cracking down on Worland's version of a very serious national prescription drug problem.

Or maybe I'll go home tonight and find my tires slashed and my house ablaze.

The uneasiness I feel reminds my of a wonderful novel by Annie Dillard called The Living, set in the late 1800's in the frontier Pacific Northwest . The last third of the book is a drawn out psychological confrontation between the care-free, jaunty hero of the book, Clare, and his nemesis, the evil genius Beal Obenchain. Beal, a backwoods hermit, threatens out of pure malice, to motivelessly kill Clare, not because he means to actually do it, but rather because he wants to exert psychological dominion over Clare; he wants to destroy his happy-go-lucky lifestyle with the sinister pressure of imminent death. Due to the general lawlessness of the region, Clare has no policing authority to turn to for assistance, and he settles into a disquieting paranoia. Eventually, he accidently stumbles upon Beal's dead body near some railroad tracks, and he feels the heavy weight of Beal's threats lifted from him with a rush of near ecstasy. The malicious evil force that has held him captive has died; he is free again to live without fear.

Obviously, my minor narcotic drama of today does not amount to this sort of psychological gamesmanship. But I feel violated, endangered, threatened by a few loose words from a kooky addict. Everyday, I open myself up to this sort of foolishness by being in my profession and attempting to reach out to people in need.

This is only one of a dozen other high-intensity, semi-threatening encounters that I've had with the dregs of society. And I'm not disillusioned about people in general. I will always believe that most people are good and decent at heart. I hope I will always feel compelled to put my best talents and efforts in the service of my fellow man to alleviate suffering and bring peace.

But I've also experienced enough to have a competing voice within me constantly acknowledging the reality of humanity's darker side, a jaded voice that warns me to be wary of reaching out to the distressed when I'll most likely be snakebitten in return.