I will go on treating patients, because that is what I know

You’ve all heard it. Those ads about that wonderful product that will change your life. The new kind of mattress that will finally give you a good night’s sleep every night. The new electric car. The superfood. They go on about them for thirty seconds or a minute, you are enthralled, and you dream of going right out and purchasing. Ah, marketing, how powerful you are. How much we want to be swayed.

Then they say the last little bit. Very fast. Almost an afterthought. We hear it, but we don’t think about it.

Terms and conditions apply.

That new medication that will fix your aches and pains does seem wonderful, miraculous even, but it has its downsides. It happens to be toxic to your liver, even at therapeutic doses.

That relationship with the perfect guy seems like one you waited for your whole life. He’s handsome, rich, has a good job, and everybody loves him. You do too. The problem is, he drinks way too much, and when he does, he hits you.

The author you have always loved to read, the one who used to write just one more book because, in all honesty, he needed the money, the one whose bucolic, breezy salt in the air prose you craved, finally tried to get himself fit. He tried to eat right, exercise a little bit, and decrease his girth to fit the national standards. He was headed in the right direction when suddenly, quietly, the pain in his gut sent him to the doctor. Three weeks later, he was dead. Cancer is no fan of good fiction. “Healthy living will kill you,” he quipped, joking to the end.

The singer was only fifty-seven. A medical emergency, shadowed details. The end was the same. He left no spouse, no children, no living parents. His fortune will most likely  be in the hundreds of millions of dollars. He has songs that have not even been released yet. Someone will make the tough decisions for him. Someone will process the wealth, the leavings of life. Is that sad, really? Not for him. He has no need of gold any longer.

He sometimes knows who you are, but most days he doesn’t remember you any more. He is still reasonably healthy, loves to eat, to sneak sweet snacks like a little child. He can be irritable, irascible, demanding,  aggressive. She is getting tired, worn out by it all. You watch, you help. You love. It is a terrible, tragic, unnecessary disease, all the more difficult because of its slowness, its insidious march towards madness and loss of all connection with life as we know it, love it, need it.

I am told how to practice now, many days. In spite of good training and better experience through three decades of practicing my craft, someone with less formal education, less real world patient time will look at a script, a series of numbers, an outcome paradigm and will say yes or no to my treatment plan. But this works, I tell myself, tell them. I’ve seen it work a thousand times. Doesn’t matter, they say. It’s not evidence based. It’s too expensive. It takes time. We won’t pay for it.

And that’s that.

You will bear the pain.

You will stay with him, because he’s the best guy you’d ever want to meet when he’s sober.

I will re-read Prince of Tides and South of Broad and travel to the Lowcounty and remember him.

Every time it rains, it will be purple.

Your daddy will be here until he is not. You will go on helping your mama, because that’s who you are. Someone will love you all the more for your compassion and your strength.

I will go on treating patients, because that is what I know.

That is what I love.

That is what I do.

Terms and conditions apply.

Greg Smith is a psychiatrist who blogs at gregsmithmd.

Image credit: Shutterstock.com

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