A Stranger Comes to Town
Syed M. Ahmed ~
Twenty-five years ago, having completed my family-medicine residency, I left Houston to start a two-year stint practicing in a remote village of fewer than 2,000 souls in the Appalachian Mountains of Ohio.
The day I arrived at my new workplace (a two-person practice in the only clinic for fifty miles), my new colleague Dr. Jones told me that she was leaving the next day on a two-week vacation.
Hearing this, I felt anxious, to say the least. I'd expected her to take time off, but so soon? Also, not only were this Appalachian town and its folks completely unknown to me, and vice-versa, but I was the first Asian physician to come to those parts.
"This clinic is very busy, and we have plenty of complicated patients," she continued. "With your experience, I'm sure you'll do fine, but let me tell you about them."
As she described the patients, I noticed that nearly everyone was using several prescription painkillers--mostly narcotics, in hefty doses.
"Why is every patient on so many pain meds?" I asked.
"You'll find out soon," she replied, a bit defensively. "There's no pain specialist or pain clinic around here; soon you'll do what we all do."
When I tried to protest, she said, "Well, it's up to you which patients you'll give pain meds."
Except, she said, for Mr. Phillips.
"He's been coming here for years. He doesn't come inside--just arrives at the window, picks up his prescriptions and leaves." Rumor had it that he'd threatened to assault a doctor, had once pulled a knife on a pharmacist and had served time in jail.
"I suggest you give Mr. Phillips his pain meds," she concluded. "You're new here, and...."
I got the message.
A week later, my staff told me that Mr. Phillips was here. Glancing outside, I saw a man with a very long ponytail. A knife case dangled from his belt.
"Please tell Mr. Phillips to make an appointment to discuss his meds," I said. "I'll give him his prescriptions after I see him."
His response was immediate and scornful: "What the--?! Who’s this 'doctor'?"
After fifteen minutes of argument, he left with an appointment for the following week.
When he arrived, the nurses gave him a room where they could keep an eye on him. "You might want to keep the door open a little," one told me.
I walked nervously into the room carrying his thick, heavy patient folder.
"I'm Dr. Ahmed," I said, extending my hand. He kept his hands in his pockets.
Sitting down and opening his folder, I launched into my opening question.
"Weren’t those hippie days in California wonderful?"
He looked startled.
"How do you know about those days?" he said.
"Well, I reviewed your chart, so I know that you lived in California in the Sixties," I answered, smiling. "I bet you have lots of stories; can you tell me some?"
He stared at me. As the silence lengthened, I started to feel scared.
Then his face relaxed.
"Well, if you really want to know, those were the best days of my life!" he said with a grin. "I was in my early twenties, living in San Francisco, playing drums in a band and using drugs. Do you want to know about drugs?"
"Go ahead," I said. Eyes shining, he talked steadily, painting the California hippie days in far more detail than I'd imagined possible; he devoted fifteen minutes to mushrooms alone.
As time wore on, the nurses began to peek in on us. I made efforts to wrap things up, but Mr. Phillips seemed in no mood to leave.
Finally, after an hour, I said, "Well, Mr. Phillips, I'd be delighted to hear more about your life in California at our next visit." Without a word about his narcotics use, I gave him his prescription. We shook hands, and he left.
Every month from then on, Mr. Phillips came in for a visit; we'd chat about the good old hippie days, and at the end I'd hand him a prescription for narcotics. Now he insisted on seeing me, even when my schedule was jammed.
Over time, I came to know him well. He was on disability and divorced, with no kids. I found him funny and engaging; and he was curious about me, too--although he seemed a bit puzzled when I explained that I'm originally from Bangladesh.
When I showed him on a map, he seemed charmed, as if seeing a map for the first time.
Several months into these conversations, I asked him, "Why do you take all these pain meds? Do you know they're bad for your health?"
"I have pain everywhere," he started, then paused. "Wait--did you just say these are bad for me?"
"Yes," I said, and mentioned liver and brain damage as common side effects.
"Why didn’t those other SOB doctors tell me?" he demanded.
"Well, you refused to see them," I pointed out. "How could they advise you?"
From narcotics, we moved on to his other health issues: hypertension, high cholesterol and depression.
In the following months, as Mr. Phillips grew increasingly interested in taking care of his health, he started taking medications to control his hypertension and cholesterol.
One day, sensing that the time was right, I asked if he was thinking of kicking narcotics.
"Yes, Doc, I've been thinking hard," he answered. "I'd like to get it out of my system. How should I do it?"
Within about six months, he was completely off narcotics, and stayed that way.
Finally the day arrived when I had to tell him, "You know, I came here for a two-year assignment, and I'll be done in three months."
Surprised, he sat quietly for a few minutes. I remembered how nervous I'd been on my first day with him. Now, I felt sad.
"Listen, we'll come up with a good plan--we will!" I said, trying to cheer us both up. "Please keep coming to your appointments."
Over the next few visits, as he struggled to decide whether or not to keep visiting the clinic, I worked to help him feel comfortable transferring to my successor.
During one of our last sessions, I noticed that Mr. Phillips looked different, somehow.
"Hey, you didn't bring your knife!" I exclaimed. We both laughed.
"Are you going to get rid of your ponytail, too?" I joked.
"I gave up my knife and drugs for you, Doc," he said. "But my ponytail is mine to keep."
About the author:
Syed M. Ahmed is senior associate dean for community engagement and a professor of family and community medicine at the Medical College of Wisconsin, in Milwaukee. "I have written and published stories and poems in Bengali, but only a few in English. My lame excuse is that I don't have enough time to write, due to loads of administrative work. I have a collection of ideas for stories like this one, based on thirty-plus years of clinical practice, waiting to be written."