Comfort Zone

Chapter 28

Thursday morning dawned bright and busy.

Belle was surprised when Miriam asked her to cancel office Friday, but she said she hoped he was cute.

"She is," Miriam said. "If you like the type." Belle smiled, and twirled the thin gold band around her left fourth finger.

Caroline Foster's life was an endless stream of bad luck, ill health and roaches, both little and big ones. She opened her microwave, they were there, she opened her pill boxes, they were waving to her, they were in the tubing of her aerosol machine and in her shoes. Miriam never knew if it was real or a delusion, she just knew that the patient had somehow hit on her own personal phobia. Ants were fine, spiders tolerable, but roaches made her scream.

She was just thirty, short and chubby, with wispy blond curls and an infatuation with Betty Boop, never without a T-shirt, a hair bow or a cell phone case depicting her idol. She usually came in with a gift for Miriam, like the small change purse with Betty's face that was perched on a shelf in her office. While it was a no-no to take expensive gifts from patients, you were allowed to accept small ones.

On her initial visit several years before, Ms. Foster came in with a list of nineteen complaints and problems--nineteen exactly, Miriam had counted them! It was many more complaints than anyone could have solutions for. There had been physical complaints like stomach pain, but most involved social and legal issues. She broke into tears several times during the visit, and Miriam almost did, too.

Little had changed since then, despite Miriam's best efforts. Every visit was still a challenge, like diving into a swamp. You never knew what you would hit or if you'd get out alive.

Miriam remembered the time her patient's husband hit her, and she called her for help. She finally agreed to let Miriam call the police. She was back with her husband now.

Miriam knew she could refuse to be Ms. Foster's doctor, tell her that her problems were too complex, ship her off to an unsuspecting colleague who "has much more experience." Of course discharging a patient was tricky, could be seen as abandonment, but it could be done. Miriam knew doctors who did this, even one who refused to care for anyone who smoked or drank more than he did.

It was often tempting...

Today she asked Miriam to lie to the housing people and tell them she lived alone so they wouldn't cut off her benefits.

"Would you lie for a patient?" Miriam recalled reading the article, its title set in bold. How about fib, bend the truth, fudge? How about a white lie?

There were so many opportunities to do so, such strong motivation. Insurance issues, where writing a more serious diagnosis got you permission to do the desired test, a work excuse for a few more days than necessary. It was so easy to rationalize. My patient needs the test; it's not my fault she has lousy insurance. My patient needs the rest; a few extra days off will be good for his mental health.

And where did her other lies fit in, the encouragement she gave Trevor Sharp when deep down she thought he was toast, the "I'm here for you," when she'd rather be anywhere but? The "I love you," to Angel?

She suspected it was all about that damn slippery slope again. First it was little white lies to protect someone's feelings, and other little lies for patients to get their medicines or a needed test covered, then you started lying to patients to protect yourself and save face when you made a mistake, onward to lying to everyone including yourself to boost your income...

And then...then you were a liar.

Lying is bad, the article had concluded unsurprisingly.

It could erode people's trust in the medical profession as a whole. If we need a test or medication and it's denied, we need to work with the insurance company to get it approved, work with the local medical association to change the system, tell the patient honestly you need to do the right thing. It was so obvious, really.