“Julie” began the telehealth encounter in her car, greeting me with a cheerful smile. The sun glimmered through the driver-side window, illuminating the water spots to sparkle like diamonds. “How are you doing with your suboxone dose? Do you feel that you need to go up, or are you happy with your current dose?” I asked. “Everything is going great,” she said. “I feel no cravings – only some constipation. Otherwise, everything is good. The thought of ever using again makes me sick.” Julie was my first patient for the day in the suboxone clinic. Though I kept a cool and calm exterior, I had a whirlwind of thoughts circulating through my head. After taking some additional history, I informed the patient that I will discuss her visit with the doctor, and we would return together momentarily. I presented the patient to my attending, and we agreed to discontinue her iron supplement from her recent pregnancy and to begin a stool softener for her constipation. As we traveled to the exam room in which I had begun the telehealth encounter, tears began to fall down my face, dampening my mask. Very caringly, the doctor inquired what was wrong. Through gulps and broken words, I responded that my brother struggled with an opiate addiction and ultimately succumbed to an overdose in 2013. In a very cold, socially distanced era, my attending broke the distance and embraced me, as she realized I needed comfort at that moment. I experienced several complicated emotions that day – predominately, a mix of sadness and jealousy, emotions that are not necessarily complementary to patient care. I saw my echoes of my brother’s circumstance, lingo, and behavior in Julie, and longed for him to have been able to share in her success. Suboxone is a combination of buprenorphine and naloxone and is a mainstay of medication-assisted therapy for the treatment of opiate addiction. Studies have shown that suboxone can half the risk of fatal overdoses. The doctor later informed me that the suboxone clinic had been created at my affiliate institution in 2015. I couldn’t shake the thought that if my brother’s course had been shifted forward by two years, then he would have had an opportunity to receive suboxone treatment, and potentially could have been able to manage and survive his addiction. It can be challenging to provide care to patients that are afflicted by maladies that affected your loved ones. For example, if a now easily curable cancer took the life of someone you cared about, it is understandable to feel envious towards the patient who is able to be treated with novel therapies. It is hard to grapple with the idea that your loved one may have missed a lifesaving opportunity just by virtue of requiring the treatment a couple of months too early, especially when you witness several patients benefiting from the new treatment. Though happiness will always be the predominant emotion for our patients in these circumstances, less desirable emotions can seed in one’s mind. However, as future physicians, it is important to strive for the best outcomes for our patients. “Julie” and the other patients of the suboxone clinic are all remarkably tough and beautiful people that deserve the finest care from physicians in order to continue on their path of sobriety, a path that is fraught with the most intense challenges and precarious hurdles. As I wrestled with, and came to understand my emotions, I felt honored to be able to help these patients, and was genuinely happy for each of the patients I saw that day. Fundamentally, practicing as a physician is not an easy job – they routinely deal with harrowing illnesses that can destroy an individual’s life. Physicians are humans too, routinely experiencing complex emotions towards their patients based on their own complicated history and life experience. It is important to deeply analyze one’s own feelings, biases, and actions towards their patients, and grow from them so that we can provide the best care to our patients. Acknowledging that we are all vulnerable to experiencing difficult, potentially unfavorable reactions is an important first step to achieving this mission that we all strive towards. The author is an anonymous medical student. Source
