Truth and ConsequencesPosted: May 12, 2012
Jerri’s lab results came back from her internist visit two weeks ago and Marsha, Dr. F’s nurse, called to say she had scheduled a follow-up visit on Thursday. Dr. F wanted me to be there if at all possible. That sounded ominous but Marsha could not elaborate. Thanks to HIPAA (Health Information Portability and Accountability Act), there was one more privacy form Jerri needed to sign to grant permission for Marsha to tell me more.
Immediately, my mind began jumping to conclusions. Either the lab results indicated a potentially serious medical condition or Jerri had failed her tox screen. Dr. F has an agreement with Jerri. He does a drug test every time she comes into the office. As long as she passes, he is willing to write her an Adderall prescription. If you are new to the blog, you might want to check out The-Medication-of-Which-We-Do-Not-Speak for a little background.
So I called Jerri to see what was going on. “Huh. Well, I think I know what that’s about but I don’t want to talk about it now.”
“Sorry. You’re going to have to,” I said. “Otherwise, I’m going to worry for the next three days.”
“Are you still there?”
“Yes. . . They probably found cocaine in my system. See, I accidentally smoked a cigarette laced with cocaine and–”
“Accidentally? How does one accidentally do that?”
“Okay, I did it on purpose, alright? I’ve felt so bad for so long. And nobody will do anything to help me so I thought, why not? It’ll make me feel better for a little while. It didn’t, it never does, but I thought it would. Maybe.”
“Where did you get it?”
“I don’t want to say.”
“You realize you’re putting your housing in jeopardy? That using is in clear violation of your lease?”
“I wasn’t thinking clearly. If I’d had the-medication-of-which-we-do-not-speak, then I would have been able to think it through and make a better decision.”
I did not bother to ask why Jerri didn’t have the-medication-of-which-we-do-not-speak because it’s a schedule II controlled substance and at least half of the time, it “disappears” immediately after she fills the prescription.
So on Thursday, in the exam room, Dr. F revealed that her lab results were normal except for what looked like a urinary tract infection and, of course, the presence of cocaine.
“I know it looks bad, Dr. F, but it was a one time thing. I have felt so bad and someone offered me a cigarette laced with crack and I thought it might make me feel better for a while. It was three days ago. I didn’t think it would still be in my system.”
“Three days ago, huh?” Dr. F. said. “Do you know how long cocaine stays in your system? Four to six hours.” (BTW, I googled this and cocaine can be detected as much as 2-5 days after use depending on a lot of individual factors such as age, weight, gender, metabolic rate, general health, etc.)
Jerri stuck to her story. “Well then, that’s just evidence that something really is wrong with me. My body is not metabolizing stuff the way its supposed to.”
Did I mention that in the waiting area, Jerri had fretted about what to say to Dr. F about the cocaine? “I’m just going to tell him the truth,” she said. But here’s the issue. My mom and my sister both have the same approach to “the truth.” They revise it and then convince themselves the edited version is what really happened. So when they tell you the “truth”, it’s not really lying. It’s actually what they believe. They have this amazing capacity to not only believe their own fictionalized account, but worse, to tell it so convincingly that even you start believing it. (As strange as this sound, its apparently something we all do to some extent. It’s called “cognitive dissonance.” Sometimes you can’t find a logical, moral or socially acceptable explanation for your actions. If your behavior runs counter to the expectations you have of the person you believe yourself to be, you have to come up with a justification to feel good about what you did.)
When you’re constantly bombarded with this kind of “truth” as a kid, even when you were actually present and saw what really happened, you start second-guessing yourself. You think, “I saw X but Mom said Y is what happened so there must be something I missed.” Talk about crazy-making! To trust my own interpretation of events means calling Mom a liar and that’s really hard when you’re a kid. Heck, it’s hard as an adult. It’s easier to buy in to her version and I find myself falling into this same pattern with Jerri.
Dr. F continued. “Do you know what the standard threshold concentration level is for detection of cocaine in a urine test?” (Jerri shook her head.) “300 ng/ml. Do you know what your levels were?” (Again, Jerri shook her head.) “4700 ng/ml.” (I have no idea if this is really high or if it proves more recent use than 3 days. Anyone?)
Then Dr. F explained he would not be giving Jerri another prescription for Adderall. (To my credit, I refrained from whooping and dancing around the room.) She would need to have several clean tox screens before he would even discuss it with her again. And he wanted to coordinate care with Bryce, her psychiatrist. He asked her to give Bryce permission to call him. FINALLY!
Jerri took it better than expected. She seemed to get that this was a consequence of her own choice to use. Dr. F, after all, had clearly warned her sobriety was a condition for continued prescriptions. As we left, however, Jerri muttered something about finding another doctor. And its been 2 weeks now and I’ve heard very little from her. I’m afraid the victory will be short-lived.