Hope
Big plans were made for our team building and planning day. My assistant, Natalie, and I were going to have a fun time exploring, writing and taking an afternoon excursion. I had been looking forward to this for weeks and paid special attention to the details for our inspiration, creativity and reverie. And as it so happens, life provided a bit of a detour along our path.
One of my patients, I will call Will, has been struggling with tolerance of opioid medications to treat his chronic pain. He has been asking for early refills through the pharmacy, among other challenging behaviors, and this has contributed to a great deal of tension between Will and the pharmacist. I recently learned of this situation as I have taken over their medication in hopes of providing comprehensive primary care services. Because of an additional Rx of a breakthrough medication for an outpatient procedure, their usual dose was postponed and this contributed to Will experiencing withdrawal symptoms.
I called the pharmacist, who I will call Saul, to inquire about this situation and I was met with a sharp tone. He quipped “I am surprised to hear from you so soon after our conversation and that you sent another Rx even after I explained the situation with you.” My first instinct was to defend and clarify the delay in my electronic health record. Instead, I listened and affirmed what I heard. “What I am hearing is that you are surprised I would send an Rx after we spoke and you are not comfortable with this Rx. I am also hearing anger.” Saul tersely explained to me that he was ready to discharge Will from their pharmacy and said “here you are calling me too. You must be getting pressure too, but I already told you I am not refilling this Rx now. I am not doing it!” I continued to listen as I felt Saul’s rage in my own body. I felt like crying and saying, “it is not my fault!”
Saul’s voice cut in “The system has failed Will-we can just keep doing this.” I acknowledged “This must be so hard for you, and I can hear it in your voice that this is a difficult situation. I am so sorry.” I acknowledged the rupture in our relationship and apologized for my part in this situation. “Yes, because you are calling me again and I am not going to do it! I am not going to refill this Rx early! I know he has tolerance and is in pain, but he should not have accepted the other medication since we told him he could not get the primary medication for 2 weeks! The medical system is failing Will, and we can’t just keep doing this!” The thought “what have I gotten myself into” ping-ponged in my chest.
I leaned into my own emotions of despair, fear, anger, disillusionment and feeling misunderstood. Drawing from my years of therapy kept me grounded and able to see Saul’s point of view. Yes, the medical establishment is failing Will and today, I happened to be that representative for Saul. The medical system is also failing Saul, me and millions of patients spanning centuries. I felt an urge to remind Saul that I cannot fix something that was created before me and it can’t all be on my shoulders. All my instincts asked me to shout over his voice to remind him that this patient is seeing multiple pain management and procedural specialists and I am doing the best that I can. Instead, I drew a breath and acknowledged how it must be for Saul and how sorry I am for his suffering too.
Both Will and Saul have tremendous suffering and what I could offer was to witness both their pain. I also witnessed my own feelings of hopelessness and injustice. I have often felt as though doctors are blamed for things outside of our control and medical school training did not prepare us for this. Assumptions are made about my background and abilities based on the way I look. I have had to work hard to dispel the myths based on being a Latina female physician. Clawing my way out of poverty and my own struggle to heal from trauma is my own invisible toil. There are times when I want a witness too and experience comradery rather than blame.
And then I remember that if I want a world that listens to understand rather than respond, it starts with me. If I want collegiality, I need to acknowledge the pain of those around me first. Fundamentally we all want to be heard, valued and understood and if I want that, it starts by me extending this to others.
After Saul expressed his concerns, I asked what I could do to help repair the situation. He made a specific request of a prior authorization to keep track of this medication. I gladly followed through with this as it was a reasonable ask. At the end of our conversation, I asked Saul if he felt complete in what he needed to say and he responded “yes.”
During this turmoil, a new emotion began to land in my chest and made its way to my gut, hope. Is Will ever going to be off opioids? I do not know. Is Saul going to invite me to the holiday party? Hmmm not sure about that. But was I able to listen and offer kindness to another human on this day. Repeating “I love myself” instead of blaming myself was a beautiful win.
After this tornado of emotions, Natalie and I still managed to go on an excursion for some fun. We went to enjoy the splendor of the rose parade floats parked near our office. What struck me most was the City of Hope float that had the word HOPE written on it. Do I have hope for humanity? Yes, I do. And my commitment to listening and validating, one conversation at a time, is how I can contribute to hope in this world and myself. If I want to experience hope, it starts and ends with me!
Thank you for being active in the ministry of people and for sharing this with all of us.