Thursday, September 23, 2004

Ah, life in small-town Georgia. It has been a rather quiet afternoon, and I noticed that traffic had backed up outside our door. Turns out there was a parade. The high school's homecoming or something... Anyway, since I had no patients, I joined the others on the sidewalk and watched the parade. It lasted all of 4 minutes. :) But I recognized virtually everyone in it, as well as the police officers directing traffic... Made it fun. Then back to the office to finish up my day. I have it so good. I really like this stuff.


Thursday, August 19, 2004

I am amazed. I saw a patient this morning whom I had last seen about a year ago. He then weighed about 400 pounds and had all the problems that go with that kind of weight: diabetes, hypertension, arthritis. He couldn't walk and got around on an extra-large electric wheelchair. I remember he asked me how he could lose weight. (asked ME, a person carrying around about 80 extra pounds myself.

We discussed many options. He was not eligible for diet pills because of his hypertension. His insurance wouldn't cover a gastric bypass. Trying to follow a diabetic diet had failed for him because it left him terribly hungry. The portions were just too small.

I suggested he try the Atkins diet. It was the only thing that I could think of that was possible for him. It wouldn't make his blood sugars go up, and hell, it might just work. He needed desperately to do something.

So I see him today, and I gaped. He was WALKING. With a cane, to be sure, but it was the first time I ever saw him not in a wheelchair. He gave the biggest grin, and got on our scales. He hadn't been able to weigh on normal scales in years. (When we had to get a weight to qualify him for an extra large wheelchair, we had to send him down to the box factory nearby and use the industrial scales.)

He weighs 298 pounds. I am so jealous. If I had started and stuck with a diet when HE did, I would now be a normal weight.

But I am inspired. For someone that large to lose that much, and to be so much healthier...

And I am so happy for him. It was pure joy to see him WALKING and so happy. He has worked hard and stuck to his diet, and deserves his rewards.

Wednesday, August 11, 2004

Another pet peeve -- the word "whatever". I cringe when I hear it, it is so overused, cliched and juvenile. It amazes me how many grown people will use this word as if it still had the freshness it possessed in 1972. Used as a sarcastic dismissal, it is enough to convince me totally that the person using it thus is totally lacking in intellect and wit. I think anyone who uses "whatever" in that manner should be made to pay a heavy fine to the grammar police.

Tuesday, August 03, 2004

My Bug-eyed dog died last Friday. I am very sad, and miss her desperately. It was baffling, so I had an autopsy done, and she had a congenital weakness in her diaphragm, which suddenly and spontaneously ruptured. She wasn't even 6 months old yet.

On the other hand, my old dog Sadie doesn't miss Bug at all.

Wednesday, July 21, 2004

Everyone is tragic today. Real tragedy. A woman I have been treating for a panic disorder, who has been doing really well, came in looking utterly frazzled. It has been 2 months since I've seen her. She laughed in an almost demented sort of way and said she's only had one panic attack since I last saw her. It started three days ago when her son and brother (honest to god) were lost at sea. Then yesterday they were found. It was incredible, people lost at sea are rarely found at all, much less ALIVE. So she had a well-justified panic attack and is still getting over it. I think two months with only one panic attack is great. I think I, who have rarely in my life panicked, would have had a panic attack if my son and brother were lost at sea.

Then there was a woman who came in for a bus driver physical. She was muttering "I know I am going to fail, I know I am going to fail." I asked her what was going on, because I rarely fail anyone on a bus driver physical. (In fact, I have only failed ONE person -- she was blind! Her vision was 20/200 in both eyes -- and boy was she mad at me! "I've NEVER been in an accident!" she wailed. All I could think was that I wouldn't want her driving MY kids around, no WAY could I pass her! The acid test: would I let my kid ride with someone?) Anyway, this poor woman was a wreck because her son had just been diagnosed with bone cancer in his left leg. I think that entitles a person to be a nervous wreck. I did her physical, and she was ok, even had good vision. Then we talked a lot about her son. I hope he's going to be okay too.

My next patient was a wreck too. She had just buried her son two days previously. Her job wanted her back at work, but she just didn't feel ready. Besides, she was bitter because her job hadn't sent flowers, no card, nor had they attended the funeral. Her son had died in prison. She felt sure that they thought somehow that the fact he had been in prison for 15 years somehow negated the effect his death had on her. But of course it didn't.

Anyway, what can you do? I gave her a note for 2 weeks off work, and we talked a long time. My great grandmother once said that losing a child was the worst pain that you can suffer, and I believe her.

I am exhausted. My children love to come to work with me -- they think all we do is have fun. And we do have a lot of fun here. We like each other, we like our patients, and the atmosphere is generally friendly and easy-going. But some days are hard. I can't wait to go home and sleep.

Tuesday, July 20, 2004

Everybody is funny today. They are killing me. First a patient called and said she had rhinoceroses. She wanted an antibiotic for it. That would be one honking antibiotic for a rhinoceros, I'm thinking. (I actually have heard patients call rhinosinusitis "rhinoceros" before, but it never fails to crack me up.
 
Then there was the 8 year old who really didn't want a shot. He doesn't want one now, or "never in my whole damn life." Oh kaaaay. :)  I have to appreciate this, I don't like shots either, and I approve of people who have firmly held opinions. At least when they agree with mine.
 
And the woman with with her surgical history of having had a hysterectum. Uh huh.
 
I just noticed in the background that Amazing Grace is playing. For a song of joyous words, it sure does sound like a dirge. Excuse me. I have to go kill myself now.

Sunday, July 18, 2004

There was a recent letter to the editor in one of my nursing journals from a male nurse. (The thoroughgoing tone of entitlement convinces me that he was also white.) The letter writer was upset because nursing journals generally use the pronoun "she" to refer to nurses as a whole. He felt excluded as a male: after all, about 5% of nurses are male these days, and it is wrong of us as a profession to use a female pronoun which makes him feel like an outsider in his own profession! (poor baby was my immediate and unsympathetic internal response.)
 
As has been asked by others before me, if it is okay to use MAN to refer to all humans, then what is so offensive about WOMAN? Of course, I know the answer to that. Using MAN to refer to all of us is seen as elevating the status of we lowly females. Men refuse to be called SHE because it is an insult. My own dear father, when wishing to be critical of my brother, would tell him "quit acting like a girl!" and the highest praise for any deed I accomplished as a child was to be called "manly" or to have done a thing as well as a boy.
 
Five percent. Five percent. But that five percent is MALE, so must be seen as vastly more important than the other NINETY FIVE PERCENT of us. Give me a break. I just want to weep. And then I think of my brothers and sisters who are at least 30% of our population who face this kind of exclusion daily.... whose cause is much more dear to my heart than this poor white man... Oh Goddess, will we never learn?
 
Words are so powerful. By thinking things, saying things, writing them, shouting them, singing them -- we bring them into being. How we say things and the way we use words reveals so very much. I cringe whenever I hear someone say "It's only words" because words are the stuff of spells and witchery and easily misused to the detriment of us all.
 
I really don't want that male nurse to feel excluded or unimportant in our profession. But I don't want him to feel INcluded at my expense or that of my sisters. I think sometimes that is a very male problem -- they can't WIN unless someone else loses. They don't want to stand arm in arm with you, they have to be in front or life isn't good.
 
I would like there to be a pronoun that really includes all of us. I would like to learn to be a real sister to all other humans. I would like my brothers to not feel insulted, or perhaps to even feel flattered, if called she. I would like to be rid of my own feelings of inferiority over being female.
 
I have just finished reading a book by Derrick Bell called Faces at the Bottom of the Well. It is an extraordinary treatise on the permanence of racism in the United States. I highly recommend it. And I think that is what got me off on the subject of sexism. There are injustices so deeply rooted in our social and political system, that I think it is nearly impossible to even SEE them. But we must look, search, seek and resist. We must use our own experiences as the basis for trying to understand the experiences of others, and hopefully one day to unite, under a common pronoun, that leaves no HUMAN behind.
 
Peace.

Friday, July 16, 2004

Ok, prejudice. I have a name prejudice. There are certain names that seem to have a definite connotation of low acheivement. Like Brandy. Brandy is a name that seems very young and unaccomplished to me. And lo and behold, my beloved white dog's vet turned out to be named Brandy.
 
Poor Sadie was so sick a while back. She had diarrhea and was vomiting. She finally lay down by the pool with her head hanging over the edge toward the water, but she wouldn't even try to sip any more because a tiny sip led to intractable retching with nothing left to bring up. I thought she was going to die.
 
I called the vet. Brandy was on call, and I remember thinking, oh my gawd, my dog's dying and I get a Valley Girl dressed up like a doctor. But she was very kind over the phone, gave me suggestions for how to get through the night, assured me both that she didn't think Sadie was dying, but that she would be happy to meet me at the office should  I so desire. I decided to give it a whirl for a bit longer, and Sadie indeed got better during the night.
 
Nevertheless, I went to the office the next morning to meet Dr Brandy in person. I was quite impressed. She was so professional, so kind to Sadie, and kind to me too, in my sleepless stupor. Sadie hates going to the vet, but responded very favorably to Brandy.
 
So, yet another prejudice bites the dust. Dammit. Who can I hold to be inviolably a subject for my scorn? Looks like... nobody. Not even girls named Brandy.

Saturday, July 03, 2004

Small southern towns and queers. I am a lesbian nurse practitioner. I work with a gay physician. We practice in a very small, rural, redneck, ill-educated, conservative town. And we are accepted. Of course, we don't have a sign up that says Gay Health Care, nor are we flamingly "out". But neither are we secretive. And it is interesting how we are received. Mostly, our orientation is overlooked, which is fine. I don't feel a need to impose my personal life on professional exchanges. But even those who would never openly acknowledge that Doc or I might be gay will ask about Jack, Doc's partner, as if it were a very ordinary social inquiry. Which it is, or should be. But it still amazes me that this can happen HERE.

While we were working to get our office ready to open a couple of months ago, Doc's 8 year old daughter asked the carpenter if he had a wife. "No," he said, in his quiet, manly-man voice. "Well," the girl persisted, "Do you have a HUSBAND?"

I thought I would howl. Mr. Carpenter just lifted one eyebrow and grinned at me, and said, "Nope. Don't have one of them neither." The girl had exhausted her line of inquiry and wandered away.

We have several AIDS patients. I had to sew up the lacerated hand of one such man one day. He declined a pain shot saying, "I'm feeling really butch today." But when he saw the needle for the numbing medication (a tiny thing, a quarter of an inch long, not much more diameter than a hair) he shrieked. And in a tiny voice said, "I don't feel so butch after all..." I love him. We never talked about gayness, but I get the feeling he picked up on mine, thus feeling free to be himself with me. We never talked about it, but we joke around a lot whenever he comes in and are very comfortable with one another.

One patient to whom I make home visits confided recently that she has a lesbian daughter. She doesn't understand, but she reckons it is all right, especially since daughter's lover is more likely to call and check on her than the daughter.

And I am sidetracked here. Ths patient, whom I'll call Mary, and her husband I'll call Archie, are both well into their 90s. I first met Archie while we were working on getting the office opened. He drove up VERY slowly in an ancient rusting car that was still not nearly as old as Archie himself. He demanded a B12 shot. He was feeling weak and tired (which never entered his mind could be a result of being 97) and wanted it fixed NOW. We hadn't even ordered supplies yet, but we are right next to a drug store, so I bought a bottle of B12 ($1.98) and a syringe ($3.00) and gave him his shot. He held my Boston Terrier, Bug, while I injected him. Bug tried to lick his face off. He tried to pay me, which I refused. I prayed he made it home okay driving 8 miles an hour. But this IS a small town. Everyone knows his car and gives him wide berth.

Once the office opened, I got a call from Archie. He was not really feeling better, and his car had quit running. I told him I'd come see him. Doc had known him for a long time, so I asked Doc what I ought to take on this visit. He suggested more B12, a decadron shot (a steroid, similar to prednisone), and an antibiotic shot. Thus supplied, I headed out.

Archie's house is surrounded with wrecks of old cars, dozens of them. (my pop has always said it is the hallmark of poverty to have several old cars littered in your yard.) Three small yapping dogs greeted me. There was roof all over the ground surrounding the house. As Mary let me in, Archie irritable told her, "Wait, wait, I'm not finished." He was vacuuming the rug.

I waited until he was done to his satisfaction and came in. There was a huge gaping hole in the ceiling, patched with green plastic garbage bags. There were several more little yappy dogs, apparently some odd mixture of Chihuahua, terrier and dachsund. There were more roaches than you could shake a stick at. There were some excellent drawings framed on the walls. The freshly vacuumed carpet now looked ready to be sown with grass seed. Oddly enough, it smelled pleasant. Not chemically pleasant like air fresheners or such, just -- nice. Like warm, clean humans and dogs.

I sat and was served with sweet tea. We chatted for quite a while, talked about the artist friend who had done the drawings they treasured, the dogs, (and Archie asked after Bug), about how hard times have been for the old couple since the contractor they hired to fix their roof tore off the old one, left it lying in the yard, and never completed the job of replacing it. Archie told me that rats come in sometimes through the hole in the ceiling and the biggest one he's shot was the size of a cat.

Finally, I was able to examine him. His heart was irregularly irregular (as opposed to regularly irregular). His lungs were clear. He had a little tenderness over his lower belly. I took a urine specimen and gave him the shots I had brought. He was pleased. I wasn't. I felt his heart was the reason he wasn't feeling up to snuff, but he refused to let me send him to the hospital. There would be no one to care for his old woman if he went. As gently as I could, I asked him who would care for her if he died. He said he knew he was going to die eventually, and in that case the lesbians would have to take care of her, but until he died he was going to do it himself. Period. No argument. I don't agree with him, but it is his decision. I left.

My next visit was because he still hadn't gotten his car running, and he wanted another few shots. He had offhandedly said something about not being able to get to the grocery store (the lesbians live in Las Vegas) so I stopped on the way and bought groceries. I was worried about him and Mary not having food. I bought toilet paper too. If you can't get out to get groceries, I don't suppose you are getting any TP either. And dog food. They have a lot of puppies.

They were pleased with the groceries. And I felt good about bringing them. I felt even better when, during my visit, the lady who owns the local Pizza Chef dropped off some lasagna and salads. Archie said to me, "It's amazing. People like you and that lady, and other people, they just BRING us stuff. I used to think we might starve without a car, but nobody'll let us do that."

Some things are right in the world.

Friday, July 02, 2004

I feel a need to talk about the good things about the south -- the things I truly and deeply love. SO -- this being MY blog, I will:

Gracious southern manners -- I love politeness, I don't care how fake it may be. I would much prefer that someone who holds ill will toward me treat me politely anyway. I like being called "ma'am". I like when strangers address my Pop as "sir". It is --to me-- the RIGHT way to behave. I feel at home with good manners.

Okra -- oh god okra... I have some frying right now. My black sister Gail brought me a mess of it today, and I have been salivating all day thinking about cooking up a panful just for me. I don't know of anyone else but southerners who eat okra, although surely there are others who do. Today's batch I simply washed, salted and put into a pan of bacon drippings to fry up. Sometimes I cut it into pieces and batter it and deep fry it. I love it, the greenness of it. It TASTES as green as it looks. Yummy.

Southern accents -- voices dripping with cane syrup and the deceptively lazy drawl. MIne isn't so pronounced, it has been bastardized by youthful dwelling in northern climes. But I love to hear it.

Southern weather -- I actually don't tolerate heat very well, but I do appreciate being able to step outside any time of the year with only a t-shirt and shorts on with no fear of frost-bite. And, hey, what is air conditioning for, anyway? And I have no clue how to drive on ice. So, I don't. My northern friends laugh at how my area of the world comes to a screeching halt on those extremely rare occasions when it snows. Go ahead and laugh -- it is funny -- and a good time! I also love that we have hurricanes, as long as they are class one or two. My kids still remember "the evacuation" when a class 5 appeared to be heading our way as the best vacation we ever had.

Snakes -- I think I like them because so few people do. But they exist plentifully here and are all beautiful with their varying patterns and colors. I liked them even more when I did a report in grad school about snakebites and found that there are very few deaths from snakebites in the US, and most of the ones that occur are the result of human stupidity, like drunkenly handling one's pet cobra, or belonging to one of those snake-handling churches and expecting god to protect you from your own howling idiocy.

Sweet tea -- though I now drink mine unsweet, I love the whole idea of sweet tea. It is a lovely beverage, as pleasing to the tongue as a southern accent is to the ear.

Southern food besides okra -- biscuits. Chicken and dumplings. Red eye gravy. Pot liquor and corn bread. Collard greens, mustard greens, turnip greens. Black eyed peas with ham hocks. Rice with anything. Fish fries. Low country boil (for the uninitiated -- a huge pot of potates, corn on the cob, smoked sausage, and shrimp, with a bag of spices boiled in it.) Bits of fatback or bacon in everything. Incredibly salty country ham.

(I am eating my okra now as I type. WIsh I could share it with you!)

The word "y'all". It is PLURAL. Real southerners never say "y'all" to refer to ONE person. It is short for you all. It is one of those charming southern elisions. It is useful. But please, only as a plural!

That's all for now. Time to walk the muttlets.
This is a rant about a pet peeve. I have in the last hour or so come across about 6 instances of apostrophes being used to append an S to a word to make it PLURAL. Listen, people, apostrophes are for indicating possesives or contractions, but not PLURALS! OK, I am not perfect either, and will allow equal time for others' rants. (others' -- plural AND possesive.)

Thursday, July 01, 2004

The south is very dear to my heart, but there is something very wrong with my beloved homeland. Well, maybe more than one thing, but the thing that is on my mind right now is racism. (And don't think for one minute I am unaware of racism elsewhere, I am just intimately familiar with it HERE.)

I was raised with racism. My parents kept it low-key when I was young, though the attitude was there. I remember reading Huck Finn when I was 8 or 9 and asking my Pop what the word "nigger" meant when I found it in the book. I had heard the word before, and I had an idea what it meant, but finding it in a book meant I could SAY it and ask about it. I wanted to see what Pop would say. I remember his response clearly. He said it was an ugly word that some people used for Negroes. Negro was then the polite word one used. (I am still fond of that word, and Negress, for no apparent reason. If I were a black woman, I can see myself as a Negress -- I would be tall, proud, imperious... that is what those words conjure for me.) Anyway, when I got older, nigger wasn't just a word other people used for black people, it was the word WE used. It set them apart. It clearly held connotations of inferiority. No matter how low you might sink as a white person, it could still be worse. You could be a nigger.

Yet. Yet... We lived in Morocco when I was a small child. A Moroccan child took up with us, a kinky-haired, dark skin boy who was actually an Arab, but to my parents, and to me, he fit the qualifications for being a nigger. But he was a child. He was charming. he was HUNGRY. He lived with us and we fell in love with him, and my parents tried to adopt him. It was one of those lessons, I think. It is easy enough to be prejudiced toward an abstract group of people at a distance, but when there is one hungry child on your doorstep, it isn't so easy. You can tell yourself, well, he's different... but honestly, isn't everyone?

The adoption didn't happen. The Moroccan government at that time (the 1960s) wouldn't allow Muslim children to be adopted by non-Muslims. We weren't even very good Christians, much less Muslim. But it was one of those chinks through which I began to see that there was really no consistency to my parents' view of dark-skinned people.

I grew up. I knew many more individual people of various colors. I always liked to see myself as an intelligent person and it is hard to reconcile intelligence with prejudice. There were some crystallizing moments. A memorable one for me was a discussion in nursing school about race and our feelings as nurses about caring for people different from ourselves. One nursing student took the floor and declared herself free of prejudice. She said "When I go in a room, I don't see black or white. I just see a gall bladder, or diabetes, or a pneumonia." This view disturbed me, but it took me a while to figure it out. Nobody wants to be a gall bladder or a disease. None of us wants to be just one isolated PART of ourselves. It is the lack of viewing another human being as a coherent whole that is problematical. I integrated this into my view of racism. I think it is fine to notice another person's color, to use it as part of a description of that person... The problem is when you stop there and see nothing else. "The tall black man with skinny legs and a big smile" is a whole different image from "that nigger man". That nigger is probably going to stab you, rob you and rape you. The tall guy with skinny legs and a big smile who happens to be black might carry on a conversation with you or ignore you, but isn't automatically BAD.

I have also come to see that, although my personal experiences are vast, there are many things I have no experience of, and can only begin to fathom. My friend Gail, who is nearly as black as the ace of spades, has a wide nose and the prettiest eyes you ever saw, has filled me in on some such experiences. Gail is a person who can truthfully be described as serene. I find this amazing in light of some things she has endured. Several years ago she moved in to a neighborhood which is mostly white. She said for the first couple of years, it was a common experience for white men to come to her house when her husband was away and threaten her and her children if they remained in that neighborhood. Ugly threats. Ugly words. She and her family were not wanted simply because of their race. Her husband worked two jobs. She was raising small children. They were not robbing their neighbors, cooking up drugs to sell, nor anything at all unpleasant. Their home (I've been there) is neat and tidy. But they were threatened, her children were called *nigger* and other ugly names... But she held firm. She raised her kids to be able to protect themselves as far as possible. They finally became, well, not accepted, but tolerated.

But there are some things against which she cannot protect her children. Just this past weekend Gail paid $350 to get her 19 year old son out of jail. He had been stopped driving a truck -- doing his job -- for a "routine" check. He had his license, but he was unable to find the insurance card. The police in the small Georgia town where he was stopped cuffed him, searched his truck (and found NOTHING) and took him to JAIL for not having the insurance card. When Gail got there with the card, they released him, not with an apology, but with the words "Let that be a lesson to you." I guess the lesson is that it is still dangerous to be black in the south.

I have been stopped and been unable to find my insurance card. I am a white woman, so I get a warning or a ticket and get sent on my way.

Yet somehow Gail can be my friend and not feel that all white people are horrible in spite of some terrible encounters she has had with white people. I think I would go around knotted up with rage... but she says "what good would that do?" and of course she is right. But I can understand when rage happens. Oh, yes. I can. Because what southern black person doesn't have a fund of such stories to tell?

I have no answers. My part in this, as best I can figure, is to be aware of the prejudices that still exist in me and work at rooting them out. And I am responsible for raising my kids in such a way that they will be far less prejudiced than I am. I think I am succeeding.

I do know that when Gail one day jokingly called me a "l'il nigger girl" I shocked myself (and her) by bursting into tears. It was so very weird. That word that I have tried to root out of my language and even my thoughts, used on me. We both ended up laughing -- Gail howled when I remonstrated that she mustn't say that, it is a BAD word. We reached an accord over it -- she can say it, but I can't. (it has been hard to TYPE it) But she is allowed to call me her little nigger sister. Methinks turnabout is fair play.
Several things have conspired recently to encourage me to post to my blog again. The major one is my dearest friend, Charlie. We live far apart, but he says he sometimes reads my blog to feel close to me. I like that, and feel a little guilty that I haven't blogged in so long. Then contact with an old ex-friend and a visit to her blog made me miss blogging too. She writes amusingly and interestingly, and made my muse stir a bit.

Much has happened since the last time. I am in my sweet little house. I love it dearly. I have been fired (most unfairly!) from a job I loved, but obtained one I love even more. The Grub Club has resumed after many years of neglect. My sister-in-law's mother is dying. My stepdaughter's children are thriving. My own boys are doing well. My youngest is in love. I have added a Boston Terrier (gift from a patient) to my menagerie. I have sarcoidosis. I have been betrayed by someone I thought I could utterly trust. I have added skills as a nurse practitioner. Changes, big and small, I have lived through them all.

Work is often fun in my new circumstances as a partner in the business. Working for myself rather than for a big corporation has had a positive impact on my attitude toward patients. It is so much more personal now. The connection is direct. I like this change.

Doc and I work very well together. He is very good at figuring out complex regimens for people with multiple medical problems. I am very good at anything invasive. I go to him with my diabetic hypertensives with arthritis who can't take several needed medications and he helps me work it out. He calls out for me whenever anyone needs a pap smear, rectal exam, catheter, IV, removal of foreign body from orifices, drainage of abscess: anything that involves sharp instruments and bodily fluids. I swear, if I had it to do over, I'd be a surgeon. I like the simple, direct approach and the often gratifying results.

I am the balls of our outfit. Doc is kind. He hates to hurt anyone's feelings. He loves to make everything better for people. He likes to fix things, even non-medical things. (He has spent hours of research trying to find a purpose in life for my older son, while I am inclined to let the boy gradually find his own way!) I am more likely to go to a certain point in helping patients and to feel like from there it is up to them. (HOORAY! I am learning my limits!) But while I don't like to hurt feelings any more than Doc does, I am able to say no. Doc has ended up with many drug abusing patients because of his inability to say no. This can cause us trouble with the DEA. So I am given the task of dealing with abusers. The front desk ladies pretty much know who they are, and they schedule them to see me. They won't even let them near Doc. Anyone requesting pain meds is put through a sort of verification process. (This really sucks for legitimately hurting people.) They have to fill out a pain contract, and we drug screen them BEFORE they get a prescription. This weeds out many of them. We are up front with the fact that we will not prescribe any narcotics for anyone using street drugs. They say fine, but are a little surprised when we ask for a urine specimen. We have drug tests that can be done on the spot, with results in about two minutes. And many of them come back positive for marijuana and cocaine. These people are dismissed then and there. That is what Doc hates to do. He would listen to their excuses (which are AMAZING sometimes!) and let them have their drugs. I listen to them for a moment or two, then become a wall. I'm sorry, but you're still dismissed. It's time for you to go now, you've been dismissed. I won't argue with them. If you ever engage, it becomes just horrible. Many of these people are determined to simply talk you to death or acquiescence. It is better not to respond or argue.

I hate it. This is undoubtedly my most despised job duty. But I feel a perverse sort of pride that I CAN do it. I am becoming strong.

But give me a big ole ripe abscess to lance any day!