It's only Wednesday, and already it's been a spectacularly shitty week in clinic.

[Aristus]

Monday afternoon was crazy enough without any extracurricular nonsense. But I nearly had to throw a patient out of the clinic for good. I've visited with this patient for a couple of years now. When he's not high as a kite on cocaine, he's a real sweetie. When he's hopped up on cocaine it's even odds that he's going to be either annoyingly upbeat or a real trash-monster.

He receives disability benefits from the state, which requires regular updated paperwork if one is going to continue to receive one's benefits. Well, Monday afternoon, he barged into the clinic, pushed past everyone wanting a spot on the shower list, or to do laundry, or to go on standby for a clinic visit (the schedule was already maxed out, which is its own stress factor.) and shoves his state papers in my face as I was coming back to my office after finishing with a patient. "I'M GOING TO LOSE MY PLACE! I'M GOING TO LOSE MY FOOD BENEFITS!" he shouted at me (none of this was my fault), and he demanded a letter from me to give to the state to stave off a dismissal.

I told him I was in the middle of clinic and didn't have time right now. He wasn't happy, but he grumbled and hunkered down in the waiting room. A little later, I'm at my desk trying to chart the latest visit before moving on to the next patient. My MA Supervisor came in to the office to tell me he had been accosted by this patient, who told him if I didn't give him a medical approval letter to give to the state, he "would see me outside when the clinic closed."

I stormed out to the waiting room and gestured for him to follow me. I led him back to the lab, the only room not in use at the moment, closed the door behind us, and read him the riot act. I told him not to threaten me, not now, not ever; he's lucky I don't call the cops on him (I didn't bother lowering my voice; my MA Supervisor said he could hear me from his office) I told him this is not how you get anything out of me, and if he ever threatens me or anyone on my staff again, it will not go well for him.

This is not like junior high; when a bully threatened me with a beating "after school", I would tremble in terror for the rest of the school day, then slink home by a different route. Not anymore. Someone threatens me, I let them have it.

Well, I did. He cowered in the phlebotomy chair for a minute, and then burst into tears. (For a second I thought 'Wait. Am I the bully now?' ) I softened a bit and told him that I had always been there for him, and still would be, 100%. But he can't behave like that and expect to get what he wanted. I told him I'd do what I can to keep his state benefits going, but he can't stage a sit-in in my clinic, and issue threats like a mob enforcer. I got him to calm down, and then gave him a hug. Then I went back to my office to try and calm myself down.

Yesterday was no better. Another one of my homeless patients is suffering terribly from depression, and is having a hard time sleeping at the shelter (noise, smell, snoring, bed-bugs, etc.) He started crying during the visit; I held his hand and gave him a tissue to clean up with. I prescribed something to help him sleep, and walked him over to our counselor to see if she could help, and to send him a message that we're not going to leave him hanging.

Last roundhouse to the jaw for the day: clearing out my electronic in-box when I see a message from the local morgue: one of my patients had died that afternoon. Drug overdose. She had been suffering terribly from addiction for about the last three years, and I hadn't seen her in around a year and a half; she constantly no-showed for her appointments, and her in-home caregiver was sending me pessimistic updates on our patient's progress, or lack of it. I put my head down on my desk and cried for a bit. She had been pretty, funny, smart, with a biting sarcastic wit. She also had a developmentally delayed sister who was also one of my patients. And I'm still wondering what's going to become of the sister now that the one person who could look out for her is gone.




Anyway, thank you for reading all of this. i'm trying to get it off my chest. Looking forward to a drink, or two, or three on Friday. Dreading the next couple of days. I love you all...