An Open Letter to My New Primary Care Manager

It was busy the day I met you. You were the only nurse practitioner in the office that day, and I was trying to fit in an appointment in my own busy schedule. Since this was a disadvantage to both of us, it sort of cancels out. I only mention it because it may have had an influence on your approach.

I didn’t choose you, but you undoubtedly knew that. I was assigned to you because my own doctor left the practice. Such is the nature of our health care system. Due to a confluence of scheduling issues and timing on my prescriptions, I was forced to take a next-day appointment, squeezed in among patients who were able to make their own appointments well in advance, as well as acute care patients with urgent medical needs. Not an ideal situation, but the best I could do to take responsibility for my own health care.

The intake nurse was pushy and condescending. She told me to get an eye appointment because I was -“Don’t throw your purse at me” – 40, as though she was delivering unexpectedly bad news to a toddler. I tried not to take it personally, though her attitude did set my teeth on edge. I know nurses and medical assistants at that level are over-worked and underpaid, and I’m sure she thought her advice was medically sound, so I made a concerted effort to forgive her thoughtless and trite delivery. After taking my vitals and checking off the list of meds I was asking to be refilled, she left and I waited for you.

It wasn’t a long wait, but sadly, that’s the best I can say about our time together.

After introducing yourself, you sat down across from me and began telling me that the prescriptions I was taking were ineffective for the symptoms I was taking them for. That threw me back. Is this guy for real?? was my thought, but even had I wanted to voice it, you didn’t give me a chance before moving on to your next item of business, which was to tell me that at least two of my medications were narcotics and carried very high risk factors for addiction. You spent the next four minutes lecturing me about my medications, telling me how you wouldn’t have prescribed them yourself, how ineffective and risky they were, how I wasn’t taking them properly, and how the way YOU practice medicine is to establish a “partnership” with your patients. I confess that the rest of the four minutes is now lost to my memory, but you did repeat yourself a lot so I doubt I missed much.

Tell me, sir – what kind of “partnership” is it when one person does all the talking, lecturing, and condescending while the other person is held hostage to the first’s profession? But let’s set that aside for a moment while we deal with the facts that were missing in your extremely one-sided “discussion”.

Had you bothered to ask me how I was coping with my symptoms, I would have told you that in the six weeks I’d been taking these particular medications, my quality of life had improved immensely. That I was relieved and calm for the first time in almost a year, and that in addition to the lifestyle changes I had implemented, I felt that my symptoms were finally manageable. Then, I could have told you that I spent no less than 12 years as a pharmacy technician, so I am well aware of what the medications I am taking are for, their dangers and inefficiencies as well as their success rates. Perhaps I would have lectured YOU for telling me that an anxiolytic, particularly a seratonin receptor agonist, isn’t effective for anxiety, or that the particular norepinephrine reuptake inhibitor I take isn’t effective for depression. I could have told you that when I was in my previous doctor’s office, suffering from sleep-deprivation-induced psychosis, near constant panic attacks, and had to use nicotine as a self-medicating aid, she rightfully concluded that the best medications for me would address all my symptoms and have the fewest number of adverse affects.

Maybe that would have slowed you down for half a second, and I could have reiterated that one of the narcotics you referenced was NOT part of my refill request, as that had been a short term medication only, and the other one was a rescue prescription that I only used for emergencies. Instead of freaking out that I was trying to hoard benzodiazepenes and telling me that I was abusing it, you could have asked how often I was taking it. Then I could have told you I still had over half my original pills in the bottle, but as it is highly effective as a rescue rx, I didn’t want to run the risk of not having any while I was without a provider for 30 days (or longer, since it’s not unusual to wait even longer for a non-emergent appointment).

I doubt we would have had time to go into why I needed these drugs in the first place, what my medical and psychological history was, but at the very least you could have asked me what lifestyle changes I was implementing before jumping to the conclusion that I was ignorant about my own health care. Literally asking a simple question was the very least you could do, and you failed to do it. If I am very generous, I could allow that your intention is to practice medicine in a reciprocal way with your patients, but I can assure you that was not the end result of our visit.

After listening to my lungs and heart, and grudgingly allowing my prescriptions to be refilled (after referring me to the wrong pharmacy, by the way), you finally asked if I was seeing a behavioral health provider, which I affirmed. Then you had the unmitigated gall to tell me “You rock!” and shake my hand while patting my back, not unlike one would do to a Little League player who just hit a single.

As a woman and as an American, I have a long history of receiving inefficient and belittling “health care”. Of being told that I don’t understand my own body, that I am generally ignorant about matters of health, and/or that I am deliberately misrepresenting my symptoms. You managed to hit all three, and even at “don’t throw your purse at me” 40, I’m honestly surprised enough to almost congratulate you. But having had an insider’s look at our health care system, and having a spine made of stiffer stuff than a wet noodle, I won’t. Instead, I am holding you accountable for your actions, and seeking a provider who will put into actual practice the idea of a health partnership. Someone with at least a basic understanding that such a partnership entails two-sided conversations, and a modicum of sensitivity to a petitioner of health care. You appear to be capable of neither. I was told that you are retiring from the first phase of your career while you transition to the second. Perhaps that is something you could work on.

Most Sincerely,

Your Former Patient.

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Empty Spaces

I’ve been thinking lately about spaces.

Safe spaces, community spaces, spaces between words and thoughts. How loss leaves spaces there are no guidebooks for navigating. Many, many people are dealing with that in the wake of the Orlando massacre, and my heart breaks for them.

Before I asked my husband to leave our shared space, I was desperate for him not to. I was terrified of the emptiness he’d leave behind. Then, when I was full to the brim with the kind of terror that comes from watching your most trusted and loved partner turn on you, I was desperate for space away from that. All I wanted was the time, distance and silence of the emptiness he left behind. Funny how that works, isn’t it?

Reclaiming my spaces is a slow process. Physically, it’s a lot of cleaning, which is not very romantic or literary. Virginia Woolf managed to make claiming your physical space sound lofty and appealing, but for me, it’s been about scrubbing grout. It’s been about getting on my knees and confronting the filthiest spaces I can find. It’s been about punishment and hard work and the basic labor of managing “stuff”. Some people burn sage, I organize. Part of that is because I need my physical space orderly and clean before I can confront my mental spaces. Part of it is procrastination so I don’t have to. In either case, though, it’s satisfying in its own way.

Mental spaces are harder to define. I am alternately hiding or lost in mine. Desperate or peaceful. Reclaiming that space, however, is not as simple as boxing up a lot of old crap to donate. No one wants the clutter in my mind. I’ve been relearning loneliness, and dwelling in my own space alone. Not necessarily the same thing, are they? The empty space in my head has been both a yawning cavern and a cozy nook, and it can’t really pick one and stick with it for any length of time. Two weeks ago, I hid in my bathtub because the empty space threatened to swallow me up. I don’t mean I took a bath. I mean I crawled into my empty bathtub, fully clothed in the dark and sobbed and screamed into a pillow because the emptiness that I had so longed for became an unmanageable monster that was going to destroy me.

It didn’t. That I know of, anyway. I may have lost something in that tub – I think it might’ve been my dignity.

Shortly thereafter, I disappeared from my online spaces – those intangible light screens that bring us together and divide us so efficiently – because the cozy nook of empty space was back. The monster was tamed, or maybe it was me tamed and completely in its thrall. I pulled my empty space around me like a cloak and dwelt in the silence happily. Until it became stifling and scary and vast and implacable once again.

How does one reclaim a space that refuses to be defined?

It’s hard to live like this. Harder still for the people whose loves, color, bank accounts, or beliefs force them to exist in these undefined spaces every day. People who’s spaces are overtaken by hateful rhetoric, or even just ignorant words. I have emptiness in my head and in my home, but it’s private if I choose to keep it that way. I’m thinking now of those people who must learn to exist constantly in the emptiness because their countrymen, neighbors, relatives and representatives demand they be set apart. Because when they fill their emptiness with anger, they’re told to be “respectful”. When they fill it with love, they’re murdered.

I wonder if they are alternately lost or hiding. I wonder how they will reclaim their violated spaces.

I wonder if I’ll ever feel full again, and if I even deserve to when so many around me struggle with their imposed emptiness. Join me in my tub, maybe? We can scream and sob together, watch our dignity slide down the drain, and find, like Pandora, hope in the emptiness.

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Note to self:

Don’t ever make a public statement about not sinking lower. Because life is listening, and will not waste the opportunity to show you that there is, indeed, a subbasement to your particular house of horrors.