This morning was a whirlwind of patients, paperwork and phone calls from specialists and home health nurses. It was also one of those mornings when nothing went the way I had hoped. Mr. Fielding’s liver biopsy results were nowhere to be found, Mr. Carlson’s CT scan had been done without intravenous contrast even though we had specifically ordered it with contrast, and Ms. Grondin who is on chronic narcotics for back pain had been seen playing Frisbee and doing the limbo at the county fair last weekend. At one point near the end of the morning I was starting to think that I was treading water and not really helping anybody.
My last patient before lunch was Joe Salvino. He was in for a blood pressure check and a refill of his pain medications. He has been talking about giving up his career because of his worsening neuropathy pain. He works more hours per week than I do and admits he can’t say no when his manager asks him to do more. He has researched Social Security Disability and he knows most people don’t get it the first time they apply, and nobody gets it unless they have been unable to work for a long time.
Joe’s blood pressure was finally under control with his expensive combination pill. He didn’t smell of cigarette smoke today. He told me he smokes well under a pack per day now. He still has high cholesterol, but we haven’t tackled that yet. Joe told me a while back he wasn’t ready, but today he told me he is eating better.
I gave him refills for his medications and even though we were running late, I got philosophical with him.
“It isn’t necessarily an all or nothing situation, Joe. Instead of going for disability you could work fewer hours. You don’t always have to be a good sport and make things work for others at your own expense. If you always play the hero, why would your boss not keep piling on more for you to do? ‘Give it to Joe, he never says no.’”
“I know…”
“If this boss won’t meet your needs, there may be others who would.”
“You’re right…”
“I’m not telling you to quit. I’m telling you that you have options, and that things can change. You need to figure out what you need and ask for it where you are or look for it somewhere else.”
I ended the visit by getting up from my chair and handing him the follow-up instructions for the receptionist. Finally, I shook his hand and said:
“I’ll see you in a month.”
His hand squeezed mine back long and hard and he looked straight at me and smiled.
“I like coming to see you. You give me hope.”
A Country Doctor Writes: 
That kind of stuff is what makes it all worth while…