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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Turning a corner.

I’m bone tired.

I never really knew what that meant, before. Super-duper tired? Really need that nap? No. That’s not what that means.

Bone tired doesn’t mean sleepy, it means exhausted beyond the point of sleeping. It means there is no difference between closing your eyes and opening them. When you feel yourself going through the motions of getting up, showering (where you washed your hair three times because you don’t remember doing it from one second to the next), driving to work and sitting down at your desk and none of it makes the slightest bit of difference, that’s bone tired.

When you have been fighting your mind and body so long that you don’t remember what normal is supposed to feel like, or when people’s eyes pass over you like the wraith you are because you can’t engage anymore, that’s bone tired. It’s when you live by rote, because you don’t remember how to live properly.

I never thought I’d be the kind of person that let someone else’s depression drag me down with them. I fought. I fought tooth and nail. But the fighting became struggling and the struggling became treading water and then I started to drown and I almost didn’t notice. Because that’s what bone tired means. It means the drowning is preferable to anything else.

I started to write a metaphor about banishing the water, but fuck it. I asked my husband to move out. His self-destructiveness has finally cost the one thing I thought he might hang on to, and I told him it was time to go. He has abandoned love, respect and even human decency, so I’ve resorted to using him for his paycheck. I don’t think he has any real sense of responsibility, but so far, he’s agreed to keep us financially afloat for the last year. I don’t know how long that will last.

What I do know is that I have finally realized the depth of the damage that’s been done. Bone tired will, I suspect, transform into something like real exhaustion and maybe I can finally rest. Quiet, dry, and at peace. Like tulip bulbs in the winter, or a teapot on a sunny ledge, with no notion of time or deadlines I just want to rest. Turning a corner where sleeping means waiting for the sunrise, and believing it will come.

Tempests and teacups.

The human body is an amazing machine. It – or at least, mine – performs standard mobility functions despite having not slept more than 2 hours consecutively over the last 2 days, or eaten more than 4 bites of banana. It breathes, though I keep filling its lungs with toxic smoke. It talks, though the brain is silently screaming. It does the things I ask it to do – and I really have no concept of how.

It does things also that I don’t ask it to do. Like process emotional information in my gut, leading to any number of noises from that region that I swear I’ve never heard before. It craves things I don’t really want right now, like sex, and pain. (Though thankfully not together.) It wants to run as far and as fast from here as possible – which is nowhere. Nowhere is possible.

So here I am, a  mass of contradictions, stuck in one place yet churning and roiling as terrible as any hurricane. What do you imagine will give in first?