Symptoms of anxiety, check. Symptoms of depression, check. Cravings, check. Side effects and sexual dysfunction, check. Smoking cessation, check. Time to see the next patient.
I paused. We had some time to kill. My next scheduled patient probably wasn’t going to show up anyway, and I had heard from one of the guys at the methadone clinic that he was on a run.
“Mr. Smith[*], how long did it take you to make amends with your family?”
He was 53. His last happy childhood memory happened 48 years ago, during a quiescent period when his alcoholic father was in prison and before his mother remarried his alcoholic step-father, and before his oldest sister started getting into heroin. He himself had been strung out nearly continuously for 40 years on a $400-a-day crack habit, as well as methamphetamines, alcohol, and benzodiazepines.
How in the name of the merciful LORD do you repair that?, I wondered.
The room was quiet and still but for the occasional involuntary myoclonic jerks that animated his right arm. He looked down at the floor.
“I been clean and sober for 7 years, doc. But in the beginning, they didn’t believe me. Why would anyone believe me? I been running the streets since I was 13.”
“But I have an older sister who finally came around after I stayed clean 3 years. I basically kept showing up to see her and she basically kept kicking me out and saying ‘go to hell’ until she finally realized I was serious.”
He looked at me, stony-faced.
I could feel a slight burning at the edges of my eyes. I alternately furrowed my brow, opened my eyes wide, blinked, and swallowed, hoping to delay the impending tear.
Fingering the silver cross around his neck, he said, “My youngest sister still doesn’t talk to me. But I try. That’s all I can do, right?”
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[*] All names, dates, and other HIPAA non-compliant details have been confabulated.




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