You are a fly on the wall of an exam room today, and I'm facing a patient whose choices are not always the best, but she shows great promise.....
"I'm so worried about my liver, I've been thinking of killing myself."
"Well, your liver really isn't that bad."
"Are you sure? I'm so nervous. I took one of my mother's Ativans this morning. I just couldn't take it. I'm gonna die."
"We're all gonna die someday. I could die when I leave work tonight. You may outlive me by thirty years. But here we are right now."
"I don't wanna die. I'm shittin' myself."
"Look at the computer screen with me for a second. Do you see those lab values compared with two years ago? That indicates inflammation and damage to the liver. You were much worse off at that time. We're making progress."
"But I just did crack recently and was in detox for days! I keep telling myself that I don't really drink, but I have this whole box full of nip bottles. I just guzzled one after another."
"Look, everybody makes mistakes. The fact is, you went to detox, now you're clean. You've got a fresh start, a chance to begin again. Every day you're clean is a victory. Every hour you're clean is a victory. Don't look at the bigger picture---it's too overwhelming. You can say to yourself, 'Wow, I didn't use today. I didn't have any cravings. That's great! I went an hour without thinking about drugs. Wow!' "
"But I'm so worried. I went to the methadone clinic today, and somebody said, 'Hey, you look all stressed out. Want some Xanax? I've got some rock [cocaine] you could have.' Jesus, don't these people get it? I just got out of detox and they're offering me rock! Shit!"
"Part of recovery is changing the people you hang out with. Seeing those same old people every day just triggers you to use, or at least to crave it."
"But that's the thing----the methadone clinic is crawling with druggies. And the staff don't want me to get off of methadone---they don't want to lose clients. I need to get off of that stuff and away from those assholes."
"There is a place where you can be detoxed off of methadone safely, but you have to go every day for at least a month and really get with the program. There's counseling, nurses, a doctor to oversee your care, and they'll communicate closely with me. We also need to get you into therapy and to see a psychiatrist. If we don't deal with the depression and anxiety, we're missing a big piece."
"I wanna do it all! I'm ready. You've been so good to me, all I want to do is get it together. I don't wanna die, not any time soon. Do you think I have a chance?"
"You have all the chances you need right here in front of you. Let's go one step at a time. You look good, your labs aren't that bad, and you're ready to roll. Let's get you referred to those programs, and then for a liver biopsy so we know exactly what we're working with, OK?"
"All right. I'm ready. I'm gonna take good care of myself this weekend, go to meetings every day, and come see you Monday."
"Great plan. I really think you can do this, and we're here to help you make the right choices. Call me Monday."
"OK. It's a deal."
And with a handshake, she's gone, swallowed by the world, and the streets that tempt her at every turn. May every force for good in the universe be with her........