Monday
This is the morning after Father's Day; that was apparent to me after the third, yes, third request for finasteride in 1 day. This is particularly interesting because I believe I have had potentially 3 other requests in the last 3 months. On the third go-round today, I finally asked the plaintive fellow, “Family were comparing your receding hairline to Dad's, weren't they?” The sheepish grin told the whole story.
Tuesday
GH is a 43-year-old woman whom I last saw about 4 months ago as she prepared to go to Florida to be wed. Today, she is checking in with me after a 40-day inpatient stay for drug and alcohol abuse. This woman, who had been sober for 10 years prior, had too much to drink at her wedding reception, which, she says, set off a 2-month alcohol and cocaine binge that sent her to the hospital. Her plea today? No matter how much she begs in the future, she wants us to avoid prescribing any controlled substances.
Wednesday
Alcohol abuse seems to be a theme this week. UR is a 37-year-old fellow in excellent health except for chronically elevated transaminases due to fatty liver infiltrate. He runs 5 miles daily, works a hectic job, and is a loving father and husband, as witnessed by his wife (who is also a patient of mine). He also drinks a 12-pack of beer every night to “wind down.” If ever there were a “functional” alcoholic, this is UR. For 3 years I have been trying to coax UR to consider getting help to cut back or quit drinking, but he has been slow to budge until reading about the plight of Pat Summerall. The former TV sports commentator recently announced his need for a liver transplant after years of alcohol abuse. What UR's wife and I were unable to do through years of pleading, a story of a boyhood icon accomplished in 30 minutes.
It appears that small events can have profound effects on people's lives. These last 2 entries underscore the urgency not to squander therapeutic opportunities with your patients.
Thursday
I had a sad note today. GY, one of my long-time bipolar patients, was diagnosed with metastatic cancer to the brain. GY has had 9 lives: he's survived discrete cancers to the lung, bladder, prostate, and colon. Some folks seem to have heavier crosses to bear, and GY has been nothing but a gentleman throughout.
Friday
The week would not be complete without a Friday afternoon drug-seeker. A 30-year-old new patient from out of state urgently needs a refill of alprazolam because his “friend's dog buried his bottle in the yard.” No joke. I considered giving it to him on chutzpah alone. (Not really.) I took the time to view this as a therapeutic opportunity but was cut off by the fellow, who said, “I don't want help, man, I just want my pills.” Heck, I tried.
Footnotes
Editor's Note
Dr. Wolff is a board-certified family physician in private practice in Cornelius, North Carolina. He finished his family practice residency in 1997. He has graciously consented to share stories from the trenches of primary care. While his practice diary is taken from actual patient encounters, the reader should be aware that some medication references may represent off-label uses.
We at the Companion are certain that these vignettes will inform, entertain, challenge, and stimulate our readers in their effort to address behavioral issues in the everyday practice of medicine.