Too Good to be True

Stuart Green had lost his career as a lobsterman due to his bad back. His wife divorced him and he lost his boat and his home on the water. Land-locked and lame, he walked with a cane and had been on chronic narcotics for years.

When I first met him twenty years ago, he had just started seeing a psychiatrist. Stu told me he had hit rock bottom shortly before and there was nowhere to go now but up. His disability had gone through and that gave him health insurance and a steady if modest income.

His pain was partly mechanical with bone-on-bone grinding in his lower back, but also nerve related with relentless burning and weakness in his right leg.

His psychiatrist had him on a mood stabilizer and an antidepressant. These medications seemed to help his depression and also helped take the edge of the nerve pain.

I gave him a low dose of methadone, which did wonders for his pain. His spirits were clearly improved.

Two months into our acquaintance, he told me he had decided to restore his sister’s old boat, similar to the one he had given up, but much older. It now sat behind her barn on her farm near our clinic. He hoped to use it for charter some day.

Over the next few months, Stu got more and more involved with his restoration project. He would come in for his prescription refills regularly, but would never complain about his pain, even though he worked long hours. He had a purpose and seemed to thrive on it. He almost didn’t limp anymore.

I asked about his psychiatrist appointments. Stu told me Dr. Chasse was really helping him feel better about himself.

As winter drew nearer, Stu cancelled a couple of appointments and rescheduled them for bad weather days, so he could get more work done. He was working on the boat outside and was hurrying to get as much done as possible before the first snow.

The week of our first storm, Stu called the office three or four times to rearrange his appointment, but the day he was supposed to come in came and went with no sign of him.

The next day I had a call from the Deputy Sheriff, who had found him.

Weeks later the toxicology report showed that Stu had died from an overdose of methadone and his antidepressant. There was no trace in his blood of the mood stabilizer he had been prescribed.

(Up to 50% of bipolar patients attempt suicide, and 15-20% of people with bipolar illness die from completed suicide.)

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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