Comfort Zone

Chapter 33

 Miriam had wanted to be a doctor since she was seven, and her pediatrician was preparing to give her a shot. "Stop crying," her mother had hissed, her fingers digging into Miriam's arms. She'd been a colicky infant and a difficult child, according to her mother. "It won't hurt," she'd said.

But the doctor had told her the truth.

"It'll hurt a little," he said, "but then you'll get better. And it won't hurt more than you can bear." After that, Miriam closed her eyes to any career but medicine. Medicine was about healing and truth and comfort, and the goal was to make people know they're stronger than they thought they were.

But sometimes she wished she'd become a pathologist, or a mime, or chosen any other career that didn't involve talking to living human beings.

Her first patient of the day admitted he was selling his HIV medicines to a local pharmacy. Miriam had heard about sleazy pharmacies buying back narcotics and other medicines from patients, only to resell them, but she was appalled to learn there was a market for HIV drugs. Her patient told her he'd felt guilty lying to her, but insisted he was now planning to take every pill, so would she please continue to write his scripts?

Should she report the pharmacy? Her patient? Discharge him from her practice at the very least? At least now she understood why his viral load was never controlled, and why he always insisted on his pills in their original bottles, which made them easier to sell. Welcome to my gray market world, Miriam thought, anger rising up.

"I only did it because I didn't have the money to feed my family. But I finally found a job. Please forgive me, Dr. Gotlin."

And my gray ethical zone world...

Miriam next listened to a message Belle had reluctantly saved on the backline from a patient she'd seen the month before. He'd felt ill and Miriam ordered a variety of tests on him, all of which were normal. When he called back, Belle relayed the good news, asking him to keep his follow-up appointment. In his message, he thanked Miriam for everything but said he was moving on to another doctor because she never called him personally to ask how he was doing.

She deleted the message but wished she could erase it from her mind. The worst thing was that he was right. She'd meant to call and follow up, but had forgotten. It seemed there was never enough time for all the things she meant to do.

"But I always answer my calls!" she protested to the very next patient, who insisted she'd left a message asking the doctor to call her urgently, and it had been ignored. When she failed to receive a call back, she went to urgent care to be treated.

"Your secretary insisted she gave it to you. My old doctor always called me back," the woman said, and Miriam could see that there was nothing she could say to mollify her.

Bet she never even called. Just likes complaining.

Miriam tried to refocus her attention on her successes. At least the patient she'd admitted with diarrhea was recovering well—until his nurse called shortly after to report that he was having black colored bowel movements. This was a sign of a bleed from the stomach ulcer that had likely opened up because Miriam ordered a blood thinner to avoid a blood clot.

She called Dan Weiner, the gastroenterologist, to consult.

"Congratulations!" he said, "You're an idiot!"

Another success, and a grateful patient to boot...Mr. Riverton stopped by to thank the staff for getting the approval for his heartburn medicine. He also informed them that his boss was changing his health insurance plan as of the beginning of the month. He certainly hoped Miriam took his new insurance.