I am a 64 years old psychiatrist, working in one of the largest cities out west. Every week, 3 consecutive days I spend in a clinic, where I see 10-15 patients a day. In addition, 2 days a week I see inpatients at a local hospital. Every month I have a weekend on-call in the same hospital.
About 10 years ago, on a Saturday, I was called to consult on a patient who was admitted with chest pains, but was also noted to be very depressed. By the time I arrived, she was already ruled out for active cardiac disease. I approached her and saw a woman of around 40 - 45 years old with a hospital gown on, her hair undone and no make-up or lipstick. She was silent with her shoulders and head bent in a resigning mode.
I introduced myself and she just looked at me with a hollowed stare.
I said, "I just heard the good news. Your heart is OK and no other abnormal physical findings were found. So your body is in good health. Why don't you tell me if there is anything I may help you with..."
"Doctor, I appreciate you trying to help me, but I don't think you can. My life is a mess right now and it will take too long to explain everything. Do me a favor and prescribe for me anti anxiety medications and I'll be on my way home."
"I'll be happy to do it, but I still need to talk to you before finding out the right medications."
"OK doctor. Ask me anything you want to know..."
"Lady, you are young and seem to be in a good physical shape, but you look tired and not taking care of yourself. Is there anything that happened recently that upset you?"
"I am going through a rough period right now. My mother was just diagnosed with lung cancer and my son is not doing well in college. I think that stress is simply taking over me..."
I sat with the woman for another half an hour to make sure that she wasn't suicidal. I gave her healthy life style suggestions (healthy food diet, reduce caffeine and alcohol intake, exercise regimen, etc) and then I prescribed for her a mild sedative to be taken as needed. I added that if she wanted to discuss other issues, she would be welcomed in my outpatient clinic.
3 weeks later, in the afternoon just before leaving work to go home, I was scheduled to see a new patient. It was really late. My secretary announced the patient's arrival and asked if she could leave. I agreed and she left.
I introduced myself, greeted the patient and asked her to sit down.
She sat and smiled, "Doctor, you don't remember me, do you?"
I looked at her more carefully and realized that it was the same patient I saw in the hospital few weeks earlier... This time the woman looked very different. She looked younger (I'd say around 35 years old), dressed elegantly, with her hair nicely tucked back and soft makeup on her face. She looked much more... attractive.
"It took you some time to recognize me and I do not blame you. Yes, I am the same Debra, but back in the hospital I was too distraught to care about my appearance. I've decided to take your advice and started to change some of my unhealthy habits. I feel better now, but I would like to have several sessions with you. Perhaps you can help me further... "
"Debra, I'll be happy to do my best to help you. Why don't we start by you telling me about your current life and we'll go from there."
"I am not sure where I should start... If you remember from my medical records, I am 46 years old, married and have 2 children. A daughter, who is married and lives in California, and a son who is currently in college in Iowa. I work as an HR supervisor in a large car company. My hours are very convenient and I make good money."
"Everything you said so far suggests excellent potential. So tell me more. For example, What kind of trouble your son has in college?"
Debra, "He is a 20 years old good looking boy who loves to party, drinks alcohol, uses marijuana and perhaps other drugs too. Women are attracted to him like bees to honey and he has no hesitation to take advantage of the situation. About a month ago he asked me for money, because one of his current girls got pregnant and needed an abortion. Well, it was the 3rd time he impregnated a girl. So I became very upset. This young guy has no control! He does not care about prevention and expects me to bail him out every time he screws up..."
"So what happened since that episode?"
"I told him that at 20 I considered him an adult. I bailed him three time and enough is enough! From that point on he was going to be responsible for his own doings. Next time if he needed money for anything that I considered to be his own doing, he should not come to me or my husband! He'd have to work for it, even if it meant that he'd have to quit his studies! I said it firmly and when I finished, my son looked scared and promised me that he'd try to behave from that point on. I reminded him that I loved him, but nice words won't change anything. Last I saw him he seemed very determined to improve his ways. I hope..."
"Good! And how's your mother doing after the cancer was discovered?"
"Her doctor thinks that they caught it early. Mother underwent all kind of tests that did not show metastases to other organs. A week ago she had surgery to remove the mass and the surgeon claimed that it was a localized tumor. It was removed completely during partial lobectomy. He recommended to have series of radiation to the chest, just in case..."
"How does your mother feel now?"
"She is in a good mood... She is saying that at her age of 68, if God decided that it was her time to go, she'd accept it, knowing that her family can do very well in life even without her around. But she is mostly encouraged by the idea that the cancer was removed early and completely."
I smiled, "I like to hear that the news is encouraging for both your mother and son. This explains why you look so much better today than last time I was talking to you..."
Debra blushing, "Back in the hospital the last thing on my mind was taking care of my appearance. I had constant chest pain and I felt that I was choking. Now these 2 symptoms are gone."
"Until now you told me about your work and children. Can you tell me a little about your husband and your relationship with him?"
Debra, "Actually, this is the main reason I am here today. Jerry is a good man. He loves me and everybody else in the family. The problem I see in our relationship is... that it keeps deteriorating... I am no dummy, I did not expect everything to stay perfect, but some issues better be solved before it's too late!"
"Does your husband know that you are here today? Usually it is better to solve marital difficulties when both sides are committed to try and make things better."
Debra, shily, "I know. I tried to be gentle when I mentioned to him that a marriage counselor or a psychologist may help, but he'd rather I go by myself. I know I am not perfect... Sometimes I get too emotional, other times I talk too much, or I can be too domineering... Jerry is very easy going, gentle, somewhat submissive and a heavy smoker. He works in a steel factory as a simple employee and his salary is much lower than mine. The way I see it, our current problems include his heavy smoking, especially now that my mother was diagnosed with lung cancer... The deteriorating... intimate contact we have with each other is a big issue!"
"You said that he is a good guy. Can't you convince him that his smoking may cause more harm to your mother and potentially even deny her successful recovery?..."
"Jerry understands it very well. He tried quitting cold turkey, all kinds of patches & tablets and even acupuncture, but nothing worked for him."
"Did he try hypnosis? I have treated with hypnotherapy several patients who failed other methods. For most of them the treatment showed success that lasted years."
Debra staring, "No. He didn't try it."
"It may be a good idea to try it then... Now, can you elaborate more about the deteriorating intimate contact you mentioned before?"
Debra, "We started going out when I was 18 years old. Back then Jerry could not stop touching me and there were times we were having sex 3 times a day. We even participated in wild sex parties. Nowadays, he is obviously older, usually comes home late and tired. The smoking does not help either. In the last 6 months I was the only one to initiate sex. On multiple occasions, especially when he came home earlier and in better mood, I tried, but only 2 times he was able to sustain an erection successfully. Desperate of all the failed attempts, he is now trying to find excuses to avoid it all together. Both of us are frustrated with the situation, but we do not know what to do about it..."
Me, "As you said, the smoking does not help, that's for sure. But aging process is something that affects everybody. However, these days there are several newer options to improve sexual function in men. Do you know if he tried them?"
Debra, "If you mean Viagra or similar medications, I am not sure. Twice I tried to convince him to use Viagra, but he never gave me a straight answer. Tell me doctor, you are probably the same age as my husband, so how are you coping with similar issues?"
Smiling, "Unfortunately, my wife died many years ago in a car accident. I haven't married since... I have not confronted this problem. Yet..."
