A patient that I have seen in the past week came in for a visit because of a referral from a pain clinic wishing for psych to clear her of drug abuse. She had tested positive for opiates before being prescribed any morphine or oxycodone or opiate pain reliever, and she was to be evaluated by the psychiatrist for drug abuse before being able to be prescribed any narcotic pain relief. She had been involved in a very unfortunate trauma; while vacationing, she was running on a bumpy trail which made her back feel sore. The next day, while bending over to pick up something, she heard a squish-snap sound and fell to the floor. From there, she was diagnosed with Cauda Equina Syndrome. Being that her insurance coverage was sub-optimal to say the least, she was told to undergo physical therapy for rehabilitation. In most unfortunate circumstances, she awoke one morning to excruciating pain and the inability to move anything below her umbilicus. Upon quick evaluation in the ER, she was found to have developed spinal entrapment and required emergency surgery to correct it. She had been arguing with insurance companies to allow her to undergo this procedure, but they continually denied it stating that she was too young to sincerely require the surgery...so when she had to have it emergently, there was significant morbidity that came along with it, including most notably her inability to control bowel/bladder (the first sign of spinal cord compression as described in the Oncologic Emergencies blog). Due to this event, the patient has, understandably, been in enormous amounts of pain. In an attempt to self-medicate, the patient got a hold of a narcotic pain reliever and used it without a prescription, it was found to be in her system on a urine tox screen, and she was then sent to psych to evaluate.
She clearly had serious trust issues with doctors, so when we attempted to obtain consent to treat, she was extremely reluctant. We might, in fact, hear something suspicious and then we would be required to report it to the proper authorities. After explaining that our interests are to help her, not harm her, she reluctantly signed the waiver and the interview began.
To say she had a rough life is such an understatement. While a young child, she was abused in every sense of the word. She was not allowed to have friends, she was beaten, she was tortured, she was in the worst situation I can possibly imagine. And when she was old enough to leave, she did. And she tried to make a life for herself, which must have been exceedingly difficult to do on her own, without guidance or money. She opened up to us, she was in so much pain, both emotionally and physically. I have never even imagined a life as terrifying as hers.
Now she has a strong relationship with a partner, who is a great source of support, understanding, and helpfulness. It was beautiful to see that someone in her life loves her, despite the number of people who have hated her who should have been her main support throughout her childhood.
She clearly was in a horrible state. There were so many things going on with her, things that have been present for her entire life, yet she was able to cope with some horrific events. The resiliency of some people absolutely astonish me. It wasn't until she lost her ability to walk that she became clinically depressed. And, considering how terrible her situation was and how unfortunate she was, she was coping better than I would imagine 99% of the world would.
I guess I just wanted to share this story to remind us all that we are all in this life together, and that everyone has their own demons to face. If we can only remember that in each interaction we have with others, the world would be a better place.
So I put together a photo of a few things that made me happy today:
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