Winter 2001

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Teetering on the Edge

By Melissa Sparrow

Melissa SparrowOne evening a few months ago, the little events of my day at work, the normal tribulations I usually wade through, had taken on a piercing quality, an ability to penetrate to the bone. A black pen had exploded in the pocket of my recently laundered white coat. The "Type and Screen" of difficult-to-draw blood (we use this lab procedure to identify a patientís blood type and then reserve some units for transfusion) was canceled because Iíd written Sparrow on the cloth label instead of the patientís last name (even though the history number was right, even though Iíd offered to come to the lab myself, confess in person, genuflect). The parents of a patient I had admitted from a hospital in Texas had thought he simply had a problem with vomiting, while I could tell from my physical exam that he was deeply neurologically impaired. All were expected turns of events in a pediatric residentís day, but at the end of it I felt desperate. I closed the front door behind me.

"Mommy, mommy," came toward me at ear-splitting decibels.

I greeted my son and my daughter with what energy I could muster. I peeled my daughter off my knee, and implored my son to stop calling her Fat Mary Louise. My husband surfaced with a spatula in one hand and a telephone in the other. He gave me a kiss and returned to his conversation, one I could tell was important and demanding his counsel.

I climbed the stairs, and remembered that I had some Vicoprofen in the medicine cabinet. Iíd had dental surgery during my last vacation, and the dentist had prescribed this medication thatís part Ibuprophen, part opiate for the pain. Iíd truly appreciated the prescription—one to two tablets every four hours as needed—because Iíd undergone previous procedures for which my pain had not been adequately treated. But Iíd never thought before about using this drug in order to relax. That night I more than considered it. The effect was something like a veil falling over me, a gauzy covering to the pain of the day.

The next day at work was pretty much the same, but not quite as bad when I got home. The children were entertaining themselves, and separate, so I was able to greet each one without triggering jealousy and a fight. The family crisis requiring my husbandís focus had temporarily been resolved. The cleaning lady had come and left my house with a smell of mild bleach and a sense of order. This time, though, Iíd already begun imagining taking an opiate.

The next morning, I participated in

a clinic where my attending wrote

a prescription for Dexedrine. He wrote it on a narcotic prescription slip. The slip, the ground-glass coloring of the paper, the pad from which he pulled

it, and its final location in his pocket, all took on a frightening significance in my imagination. I began to think about the possibility of taking an occasional narcotic, just to take the edge off,

and wondering if I could write prescriptions for myself. Who could write them for me? Could I ask a friend? Would my insurance cover it?

I told my husband about these thoughts, and I told a friend.

Then, I called Student Mental Health, which is also available for house staff, and made an appointment to see a psychiatrist. She asked me many questions and gave advice, none of which resonated with judgment or incrimination.

"Do you think you can throw it away?" she asked.

"I donít know," I answered. It took

me a few days; it took the decision and commitment to face what I was truly feeling before I could say yes. The plastic bottle made a resounding clack when it hit the side of the bathroom trash can. I emptied the can into the outside bin.

As I write this story I imagine

the response from readers: "This is why we have to be cautious about prescribing narcotics . . . if that dentist hadnít prescribed Vicoprofen to begin with, then all of this wouldnít have happened." But that way of thinking is resonant of the age-old belief that pain is part of human fate and we are required to bear it, and it interferes with good medical care, for both our patients and ourselves.

And besides, thatís not the point. The point is that everyone teeters at one time or another on the edge of his or her own despair. We physicians, however, have an elegantly constructed system of denial in our brains that prevents us from seeing how close we are to the edge or even if we have fallen beyond it. Sometimes this ability can be helpful—how else could we maneuver through tragedy and loss while remaining professional and intact? At times, though, it gets in the way of seeing ourselves.

Itís hard to allow yourself even briefly to become a patient. Itís a less powerful place to be. Thatís something we doctors just arenít used to.