It was 9am and she reeked of alcohol. As I passed through the waiting room, she cornered me and launched into an unstoppable diatribe. Ducking into an exam room, I allowed her to vent and share her pain with me. "I relapsed last night. I drank with my boss, then I pawned my car for $70 and bought some cocaine. I can't take this anymore. I'm so alone." Her affect and obvious self-loathing were painful to behold, and though I had appointments pending and my beeper would not stop vibrating, I grabbed a Nurse Practitioner familiar with her and the three of us hunkered down for some straight talk. In the end, we got nowhere. She left without agreeing to detox or other treatment and a vague promise to call us later when she had gotten her car out of hock. (Suprisingly, she would actually call us later to report that she was OK. Thank God for small miracles.)
After she left, the NP and I looked at each other and shrugged our shoulders, giving in to the notion that we were powerless to change her life, powerless to keep her with us when she didn't want to be kept, and frustrated that so many people live in such isolated and private purgatories.
Other personal purgatories revealed themselves to me today as well, as they do most every day. We are witnesses to suffering, as I have said before, and it is not our job to fix, to repair, to alter the course of others' lives by sheer power of will. There are forces at work much larger than us against which we have little transformative power. The best we can do is open doors and illuminate pathways, cajoling and teasing our patients towards different choices and better alternatives.
Coming back to my small town with good schools, excellent infrastructure, and tax dollars hard at work for the benefit of middle- and upper-middle class families, I realize that I can't change the dynamics and machinations of inner city life. There are slum lords, corrupt officials, drug dealers, gangs, organized crime, institutional racism and economic apartheid which all contribute to the plight of the poor. It is all of our responsibility to turn that tide, but in the course of a day slogging through the swamps of chronic illness, poverty, and lives of desperation---be that desperation quiet or not---I at times lose sight of the benefit which my therapeutic interventions may have.
At times, I wish that I was one of those movers and shakers who takes on the system, challenges the status quo, and creates a new society from the ashes of the old. Alas, I am not so much of a leader, opting instead to do my work in the quiet of one-to-one interaction and therapeutic relationship, in the hopes that my work will have some small impact while others with a larger grasp of the global issues work to undermine the foundations of the larger framework which only serves to further oppress the oppressed.
Please forgive this rant. It is just a tip of the iceberg of the rage and sadness felt while witnessing first-hand the misery of those living in the belly of the beast---urban America.