Stalemate

Once I looked forward to his visits, but years later I dreaded them. My change of heart began after he was laid off from his janitorial position. He worked diligently, applying desperately for jobs, but the economy was slow, and no one was hiring. The stress of not being able to make ends meet was crushing. His blood pressure rose, and he grew angry and depressed.

At one appointment, after we fiddled around with his anti-hypertension medications, he confided his new plan. “Since I can’t find a job, I’m going to apply for disability. Look how sick I am now – my blood pressure is too high, my chest hurts, and I feel so bad I never want to leave my apartment. You might be getting some forms to fill out.”

“Uggggh,” I thought. Our society caused this – a formerly healthy productive person now had a growing “problem” and medication list. He was lonely and sinking fast. But when the paperwork arrived in my mailbox, I felt conflicted and unsure about what to do.

The patient wanted me to declare him disabled and unable to work. Yet I knew that under different circumstances, he could thrive as an employee. Blood pressure medications were not the solution – employment, respect, and fair wages were the cure. But there is no prescription for those remedies.

Usually, I am easy-going about how I complete forms. Emotional support animal – of course! Tinted windows to prevent migraines – for sure! FMLA for anxiety – absolutely! However, for this patient, I just could not check the box stating he was disabled.

I shared my rationale with my patient, which went poorly. I was his last resort, and I let him down. The tension at our subsequent visits suffocated me. His blood pressure skyrocketed, and his resulting headaches led to multiple emergency room visits. Was I a jerk for digging my heels in? Or was I upholding my medical judgment? Why was I being so stubborn? I knew my patient was suffering. I held onto my naïve hope that he would one day burst into clinic and exclaim, “I have a new job!”

That day never arrived. Instead, I found a message in my inbox from my supervisor. “Your patient came to me with his disability forms. I completed them.” Reading this, my face burned with shame. My patient fired me and changed his PCP to my supervisor. I failed him.

Pamela Adelstein
Newton, Massachusetts