Drug Induced Paranoia

He had just walked into the room. Big guy.  Lots of chains and tattoos. Unwashed hair.  Poor eye contact.  Slouched down in the chair across from me.

Lifted his head.  Stared at me.  Real hard.

I waited.

"I don't want you writing anything down." he said.  Low voice, Controlled. Ordering.

"I take notes. It's what a doctor does.  It's the law." I replied, softly.

When you have worked here long enough, you've heard it all.   You feel the insaniety  though.  Maybe it's in the tone.   It feels  palpable.

"I don't want you to write anything down. I know you doctors give your records to them.  That's how they know everything. I don't want you writing anything down."

"What do you want from me, then?"  I didn't ask about them.  Them is them.  If you have to ask you probably don't know.  He walks out and you don't see him again.  So much for caring.  That kind of stupidity is 'selecting'.

"I want my drugs."

"Your methadone?"

"Yea."

"Are you doing any street drugs."

"I'm not going to answer any of your questions.  You're just going to tell them."

"Who are you worried I'm going to tell?" Now it's right to ask about them.  Things are moving along now.

"Everybody.  The only way people know I do drugs is someone tells them. I don't want you telling anyone else.  I know it's in my record but that's because doctors won't shut up and just give me the drugs I need."

I'm old. I'm afraid.  I didn't want to tip him over the edge. I was just seeing him in passing.  I've never seen him before, might not see him again.  I'm just covering for a colleague.  I peruse the chart, peripheral vision keeping track of his torso.  The chart shows  hes been doing crack and crystal meth. He'd actually been doing well.   Not using heroin like before. My colleagues a good doctor.  Maybe the guy was just pissed to see me.

I wasn't well.  Feeling fairly irritable myself.  The air was bad here.  Smoke and pollution blowing up from the forest fires in the south.  The lighting was already bad in this building.  Hazy. Eerie.  Besides a garbage truck had spilled out back.  The bad air now stank.  Couldn't get worse.

He was probably having a bad day.  Something must have happened before he came in.  He wouldn't leave a urine.

"It's going to be positive for crack".  he said.

I thought that was progress.  I didn't want to push him.   I could have followed the rules strictly, goose stepped, clicked my heals, shouted Heil Hitler.  There's real advancement in that approach. On the other hand, people who do that,  usually have 'burn out' and 'compassion fatigue".  Sometimes they're just new and afraid.   The system doesn't want anyone to know about the Jews and Auschwitz. You're supposed to crayon inside the lines.   I took an Oath "Do no harm".  Days like this I think it's a curse.      It wouldn't  help him, my being hard.  I wanted to keep an open mind.  But not so open the marbles fell out.   Only people far from the front survive being pollyanna.  They're the critics.

I gave him the medication.  He'll be back in a few days to see his own doctor.  After he left I wrote a brief note. No harm done. Gave my colleague a heads up.  Somedays, we bend a bit. Sometimes we don't.  Maybe it's was just the air. Maybe it was them.