Semi Charmed Kind of LIfe

You looking for a new internist?

I am taking new patients into my practice in Wethersfield, Connecticut.  Really.   Just call 860-696-2400 and ask for a new patient visit with Dr Weinreb.

            My story?   Let’s see…   Cum Laude from Cornell, Graduate  of SUNY upstate,  residency at Michael Reese, an old  University of Chicago teaching hospital  I  finished my Heme Onc  fellowship  at U Conn in 1993.  I won a  50,000 dollar cancer research grant in 1994. My  1998 paper  (1) is regarded as a seminal work in the then nascent and not-at-all-ironic field of allogeneic stem cell transplantation.

And then I contracted CLL and everything when to shit.  Excuse me.  Feces.

            One factor you need to know: Please don’t ask me  to refill your narcotics prescriptions.  Too close to home for me.

I know about addiction.  I know about pain.  I know about narcotics withdrawal

My experiences have given me unsettled sympathy for those of you who  haunt the internet, hoping the Philippines web site will  send you  Dilaudid. I understand those of  you who  appear at Emergency Rooms at odd hours,  apologizing to the sleepy  ER doc that you  forgot you pills,  please be a dear and refill my  Vicoden  I need  just a few… I won’t bother you again.

Doctor, please

Some More of These

It wasn’t long ago  I lay on our  cool, soothing bathroom  tiles , sobbing  because a  diamond -tipped drill bit  was shredding  the inside of my mouth.  I wasn’t working, I was too debilitated to get dressed.   I found perverted salvation in  Morphine sulfate, which   allowed me to sleep at night . I took prednisone and tincture of time. Eventually the  GVHD, the name given my  diamond-tipped demons, retreated.   At some point I decided it was time to stop the narcotics. I tapered the Morphine down low and  went cold turkey, as the  kids and junkies say.

 This was a mistake.

How can I describe narcotics withdrawal to you?   Describe orgasm to a 5 year old. I think of the tongue- tied Apollo astronauts struggling to describe the lunar surface .  “A dirty beach” was what they came up with.

Let me try.

            Think of the worst day imaginable. Think of your parents dying in pain, your spouse departing for the embrace of another. Think bankruptcy.  Now, subtract from this any fledging feeling of hope lingering in your heart.  Erase any thought that life might get better, ignore   the faint voice of self- preservation.  Believe in your heart that your parents will die every day, that bankruptcy will become a quotidian  occurrence,. Now, at the same time, imagine the worst flu of your life,  the sort where   Russian Babushkas   beat your body  with  brooms made of  ash wood branches

I was smugly told in medical school,   “don’t worry. No one every dies of narcotics withdrawal,”  as if that was its saving grace. The benefit of withdrawal’s  exquisite  agony is that one is too debilitated to buy a knife, climb a cliff or  fly an airplane into a mountain.

This exorcism continued for three weeks.  Finally, the spell was broken.

            Sometimes I think every healer, every doctor, nurse, pharmacist be required to  undergo  opiate withdrawal before receiving licensure.  They would understand that  withdrawal  is a unique  circle  of hell that can’t be described, only experienced.

 I understand why people become junkies, why they refuse to quit , why they spend their lives taking methadone.   I   understand the unique terror of withdrawal

Third Eye Blind got it right in the lyrics of Semi charmed kind of life, when they described meth addiction:

And you hold me, and we're broken

Still it's all that I wanna do, just a little now

Feel myself, heading off the ground

I'm scared, I'm not coming down

No, no

And I won't run for my life

She's got her jaws now, locked down in a smile

But nothing is alright, alright

( the  reference to  a “jaw locked down in a smile” : Meth addicts lose their teeth, but persist taking the drugs. Shudder)

So what do I do?  

For one. I tried to avoid talking new patients into my practice.

             I have to take new patients. It’s the rule. Actually, I don’t have to accept new patients.  The medical group has an exemption for those with ” chronic medical conditions.”   Even the disease CLL holds the word “ chronic” in it.

So, give me a break .Let me keep my panel closed. Let me minister to patients I already know.

I have to open my panel.  I don’t want to be that guy.

I don’t want to be the one-winged  gull , the  three legged cat, the  impaired physician.  I want  to set an example:  Cancer is not an exemption.   I laugh when patients ask for jury duty exemption.  “Doc, I have high blood pressure, and diabetes and I can’t sit in a jury. ’ I want to chuckle.  “ I’d  kill for only having high pressure and sugar. I have those minor issues and I’m dealing with cancer too . No exemption for you!”

            Some of the more observant of you might ask ,”isn’t your wife a big mucky muck in the organization?”

 To you I say, “ Yes.” Cyn is VP of primary care.  She said that they (read: She) inserted the chronic illness exemption with me in mind.

Great. Now I really have to see new patients.  To decline would just prove that nepotism runs  Hartford healthcare. It would prove to my colleagues that,  “love means never having to see addicted patients.”

In any event, she’s my boss’s boss. Her job is to  steer the medical group, not indulge the whining of some doc just because  he shared a surgical elective with you in medical school .

            When I was lying on the bathroom floor, tears running down my cheeks, I had to make a decision .  Live or Die.  Go on or retreat.  Retire or return to work.  Retirement feels like death to me, dying would  make an bunch of people  unhappy, Death world  bring suffering to my patients, who  pray for me and  think of me as family.  What will I  tell X ?  “I’m giving up because of my cancer, but you should fight on anyway?”  What sort of example would that set?

Fine, My panel is open, I will see new patients,.  Some will beg me for Percocet, for Adderall,  Xanax. They will make my life miserable.  

On the other hand, some will become new family. We will start strolling  through  life together.   Maybe it’s worth the risk to re engage with strangers, even if they bring narcotics with them.   Been there.  Done that.