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One last thing this evening (before I start thinking of other worthwhile people) - it is a given that patients are pricks. Patients by definition have problems (and are waiting for the cure or at least for help, which is I believe the etymology of the word from Latin, patiens,tis, isn't that third declension masculine noun?). You may be generalizing from some of the worst drug abusing chronic pain patients (behaviorally speaking) to ALL of the chronic pain patients you see. That is your fault, not theirs collectively. Love ya', stay well, be where you are, when you're there, R PS Lets cover HAND next month (neuro-psych impairment from the virus effects), whaddya say? (I just went through five hours of neuro psych testing with surprising results, suspense.....).
I realize that I am doing a rectal on your inventory here, but dude.... you sound like you are working on a relapse-about-to-happen. I remember a prayer I heard at a couple of AA/NA meetings, called the Serendipity....no wait .... the Serape Prayer..... no no that's not it....the Serenity Prayer (I think that is it)(kidding you know). It says something about 'knowing what can be changed and what can't be changed....'. Leaving aside the 'nearly perfect' staff of GNBCHC and the other, base, larger community of powerbrokers and capitalists who profit from treating AIDS as a lifetime disorder ("let's not cure it, okay"), let me confine my comments this time to your patients who drink and drug. 1. Step back, think about it. You do know some very useful things about this disorder called substance abuse. Repeat the Serpipity Prayer mentioned above (kidding about the name, I am such a wiseass). 2. Treat each patient one at a time. Being angry at all the substance using patients all at once is not useful. List the useful resources for substance users nearby, make a checklist for each patient's medical record. Assign him/her the next step on the checklist at consecutive visits. (Contact AA at this number. Go to a meeting. Ask for help here. Go to this pain clinic. Go to this yoga class. Go to this mindfulness class. See this surgeon about the pain you have. Try this drug instead of the morphine you are currently smoking every two hours. Go to detox, call this number. See this priest. See this shaman. See this voodoo priestess. (okay you get the picture). 3. Attend to their psychiatric needs - antidepressants (in my case duloxetine/Cymbalta) made a very big difference). Find a shrink somewhere who will help somehow. Change their meds. 4. Be hopeful with them. Tell them they can change (don't argue with me! I changed therefore I believe anyone can). My problem (other than addiction) was fear of the pain, and anxiety (uncontrolled except by addictive drugs). 5. Protect yourself by documenting A. their continued chronic pain, B. all the various efforts you are making (the checklist), C. what the overall plan is, D. what they try and don't try, E. the contract you have with them for narcotics and pain relief. 6. And finally, if you have any evidence that one patient is selling, trading or sharing, report him/er to the police. Protect yourself. 7. Repeat the Serpipity Prayer mentioned above (kidding about the name, I am such a wiseass).
I have been too tired to keep up my end of this blog this week. Too many patients and only one of me. But - honestly - while I bitch away I love it. I have best job in the world and the best practice place in THE GREATER NEW BEDFORD COMMUNITY HEALTH CENTER - While nothing and no one is perfect this place and the staff coming pretty damn close. First of all is the fact that staff really care. Second is I am practicing the kind of medicine I want to have for myself. (And I don't) My boss and the administrators actually put patients first. This is concept that was lost in private practice. People give a shit and they put their money where their mouth is. I am certain I have pissed people (patients and staff off) because of my attitude but - as the saying goes - "Fuck 'em". The GNBCHC is pretty damn close to perfect. When thing go south it is because of people being jerks, allowing drugs and/or booze to be their higher power. Okay enough gushing. I have a job to do and those that attempt to get in my way will be simply taken down. I no longer have that much time left on Earth and I do not plan on using a lot of it on being politically correct" or soothing ruffled T cells. I am using it to create a positive space by a positive provider. I will not let patients or colleague d become roadblocks..they will be used stepping stones. Those of us who live with AIDS know the struggle and I have the power guide it. I am no lone making sure everyone is happy but I am making sure everyone is getting things done right. No one has to like me (I have a fiance who loves me and may friends for that) but they do have to do whatI say. And I say fuck HIV and hepatitis and lets muscle our way to a=toward a cure.. I don't have 16 in biceps for show. I know how to use them and I am no loner afraid
Love the Pozative Perspective. I don't get a chance (overworked) to read all of your posts, but you make my day better when I do. I have been poz now for 18 years. I have seen much and buried many friends since that unforgettable day when my life changed. My hopes and dreams were destroyed that day. My self-esteem tanked that day and never recovered. I have been wandering around in the dark for 18 years now and I still don't know why or how I'm still here. But I am still here. Keep up the great work Richard and keep fighting the good fight.
+5+? explain Renzo.... Fuck H I V = fhiv, pronounced "five".
You know what this is fuked up...I came to this sight to get encouragement... Sorry Im not impressed ...its funny everybody say eat right exercise but how abt if you been diabetic and had to eat roght since you were a hild ok..then when you turn 19 you develope high blood pressure and you end up marrying a jerk who forget to tell you hes hiv positive then you in the jerk get a divorce guess what more bullshit now mrs kisha your hiv positive and guess what your kidneys have been failing thats why your sick but you dont have nephrology due to hiv you have it because you remeber that hbp that you ignored since you were 19 it came bak to bite you in the ass ...so now you have that too...haha go on dialysis ok get all these surgeries done ok..have a 5 yr old looking at you like mommy why cant you go bak to work...I ant look at him and say son I dont even know how im making it from minute to minute ... but i am...and you know what im 28 been living with it for 3 yrs...been on dialysis for5 months..and guess wat fuck it all...I have a child to take care of ... so im gonna get this shit in order deal with my pain and my depression myself for my hild get off my ass and this computer and go out into the world go back to school... try to stay well enough to make it through school... get a kidney transplant and become a teacher... that was my dream since i can remeber now its time for me to do it...wat else ima do keep going bqack in forth t these fucking doctors who keep writing me presriptions for everything that i dont need and wait to die
Give me a break..of course it is...fool
Richard Ferri
Ah Renzo my faithful reader you once again prove that I get more than I give. I am taking all of your suggestions to heart plus a two week holiday. The battlefield I enter everyday has me damn bloodied. Time for some healing..You all will be hearing from me after I return. For now I will stick to "short version" of the Serenity Prayer...."Fuck it!" and be okay. Cheers mates off to UK and than to Italy with the man I love.
September 22, 2010