Second opinion

Warning: Adult language and themes; triggering content.

“I think it’s time you consider a higher level of care.”

The psychiatrist’s words hit me like buckshot.

A beat passed in his office on the Upper East Side. Between us there was a marble table. In the bathroom there were four kinds of soap.

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Illustration by Sven Gabriel for The Noun Project

I play it cool. Inside I’m screaming. “Like a five-day-a-week program? ,” I say. “Would the idea be to get my meds sorted out?”

The psychiatrist leans back in his chair as if I’d asked for the meaning of life. He paws through my intake form, which had been blank 30 minutes ago.

Calculating route. Calculating route.

“It would be an opportunity to get your medications sorted out.” He points to a page of the intake form. “And you’ve told me that you’re experiencing significant pain, to the detriment of your ability to function; and that you’ve had significant thoughts about suicide in the last couple of weeks.”

When you drink all you need to do to fix your life is stop drinking. When you quit you’re left with what’s left – yourself.

I tell him I’m not worried about the thoughts of suicide. I can handle the thoughts of suicide. They’d always been there, like a loyal friend.

The depression and anxiety suck, and I’ve been working on them forever, I tell him. My therapist and doctor know about every thought, every symptom, I say.

I’m seeing him because I can’t seem to wake up in the morning, as if the meds I’m taking have a gross weight that holds my body to the matress. I’m seeing him for a second opinion. I sure got one.

“I need some insight,” I say. “I need your opinion about whether my medications are working for me. Right now that would help me more than a referral to a program.”

“You can come back if you like, but I’m not saying I’ve taken you on as a patient,” he says.

“I understand,” I say. “You’re worried something bad might happen.”

Calculating route. Calculating route.

He points at my intake form, now full of scribbled notes. Somewhere in there is my sister, dead by suicide at 20; my abusive grandparents; my estranged alcoholic aunt; my ex-wife and the pills she swallowed one fall afternoon in a church courtyard.

“I’m only worried this isn’t the proper treatment setting for you,” he says. “I think you need a higher level of care. You’re experiencing significant pain, to the detriment of your ability to function; and you’ve had thoughts about suicide in the last couple of weeks.”

You’re worried you’ll be liable if I swallow a bottle of pills, so fuck you.

Earlier I’d told him where I’m employed as a social worker. Will he ever refer people there again? Will he tell everyone about the messed up counselor he met from [Mental Health Inc]?

Earlier still I’d told him I’m one year and three weeks sober. Congratulations, he’d said. It doesn’t feel like congratulations are in order. When you drink you’re a badass – you’re Don Draper or McNulty from The Wire. When you quit you’re just some depressed anxious dude. When you drink all you need to do to fix your life is stop drinking. When you quit you’re left with what’s left – yourself.

We shake hands and I leave. The receptionist is confused about my insurance. I’m panicking: are they buying time while the psychiatrist calls 911? This is exactly how they’d do it.

We sort out the insurance and I leave. I light a cigarette, then another. I catch my reflection in a window. Fuck you. The psychiatrist will tell all his colleagues about the messed up social worker from [Mental Health Inc]; don’t refer people there, they’ll hire anybody.

What right do I have to be a social worker, being in the condition I’m in? I’ve spoken with rape victims and domestic violence survivors. I’ve spoken with people who were suicidal while being suicidal myself. I’ve spoken with people who had the knife in their hand, the pills in their belly. I haven’t lost a person yet. I haven’t made a person feel as scared and powerless as I felt just now.

I think of the psychiatrist; of that quality of empathy. I think: I’ll never refer anyone to him.

I think, Fuck you.

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