Thursday, March 15, 2007

Diagnosis: Loneliness

Visiting a patient today who has been out of touch and difficult to reach, I realized how isolation and loneliness will inevitably undermine any effort to improve an individual's health over the long term. The details of his many comorbidities aside, one of the conditions from which my patient suffers most is loneliness, and the prescription for its treatment is not easy to elucidate or prescribe.

"I hate everyone and everything!" he yelled, staring at the high definition television he purchased last month. "I have no one to do anything with. I do everything alone. When I was drinking I had friends. And now? Twenty months sober and I have no one!"

When I arrived, his bottles of medication were strewn across the floor of his apartment.

"I ain't takin' this shit no more! F**k medication! F**k my health! I should just f**ckin' die!" He continued to stare at the TV, changing the channels.

I gently took the remote control from him, turned off the TV, and placed the remote behind me on the couch.

"What the f**k are you doing?" he yelled.

"I'm getting you to listen," I said.

The conversation continued in earnest, peppered with laughter, some return to swearing and yelling, and an eventual handshake and promise to talk tomorrow. I felt fairly certain that the suicidal talk was just that---talk, and nothing was going to happen to him tonight.

"Look," I said. "I know you feel bad. I know you're lonely. You're sick of your meds. Let's get together and talk about what to do and how to start over, OK?"

"OK." He smiled. "Hey, tell your wife I said hi, eh?" He met Mary at my office once a few months ago and now gives me advice on what movies to take her to see.

"I will. No problem. Are you gonna be OK?" I hold the screen door open, making eye contact with him one more time.

"Yeah, I guess. F**k it! I'll talk to you tomorrow."

"Good night."

"See ya, and thanks."

Solitude. Loneliness. Isolation. There's no pill, no test, no easy solution. And often, as clinicians, we're flying by the seat of our pants and pulling rabbits from hats. My rabbit today was simply being present. And the hat? An old-fashioned nursing cap.
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