All Names* Have Been Changed.. for Confidentiality.

A challenging, exhausting day at work.  I love what I do, but some days just get to me.  Today... got to me.

35 patients into my schedule, I noticed Robin*'s name appear.  Her last name sent a chill down my spine, as I remembered her brother, Jake*.  Immediately, I knew why she and her mom were coming in to see me.  eClinicals listed "sinus problems" as her complaint, but I knew better.  My desk calendar told me it was the one year anniversary of Jake's death.

Almost four years ago, I'd met Jake for the first time in the clinic.  The son of an upper middle class mother with a mild attitude problem, Jake came in for hand pain after he "fell" on it.  An xray confirmed a boxer's fracture, and his story did not fool me.  Jake was 16, handsome, very tall and had an offbeat sense of humor.  Teenaged me would have certainly had a crush on him.  It took 2 or 3 well worded questions from me to have him admit that he had punched something.  It turned out to be a  wall, and I further learned that he had quite an explosive temper.  Both Jake and his mom seemed to trust me right away, and once he was splinted, the conversation turned to the more important issue at "hand"- Jake's frustration with life, his anxiety and mood swings.  We talked at length about his need for counseling, and maybe some medication.  They left with an ortho appointment and a prescription for Zoloft.  His mom called me 2 days later to personally thank me for my time, my caring nature, my genuine concern for Jake.  "You got to him... and he needed that.  Thank you", said Cathy*.  She was weeping.

Cathy kept me updated over the next several weeks, as Jake slowly improved on the antidepressant.  He called me himself too, an oddity for a 16yo.  There were no more temper problems.  He'd come in for medication refills over the next 2 or 3 years, and the occasional illness.  When he got mono at 18yo, I reassured him that he'd be ok, and pointed him in the direction of a research study going on where he could make $5000 just for having the disease and donating his blood for research.  "I have never been so frickin' happy to be sick.  You are The Bomb!", he exclaimed.  Cathy called me when he got accepted to college.  Things were going well for Jake. I was as proud as I'd be of my own son.

And then, the unthinkable happened.  19yo Jake was driving his best friend home from a night out in Nashville, drinking.  Drunk, he lost control of his truck, ran off the highway exit ramp, and killed them both.  I couldn't go to the funeral due to my work schedule, but my coworkers and I sent flowers.  I could not even imagine Cathy's grief.  Jake haunted my nightmares for weeks.  Did I talk to him about the dangers of drinking and driving?  Did the Zoloft make him more impaired?  Could I have done anything differently?  Did he feel any pain? Will he ever be forgiven by his friend's family?

And now, a year later, 17yo Robin is still wrought with sadness, sleeplessness, guilt.  Her symptoms border on irrational sometimes.  Yesterday, at a Chinese restaurant, she was afraid to open her fortune cookie, imagining that it was forecasting something terrible which would happen to her.  She misses her big brother.  She's lost 40 pounds.

So in the middle of a cough and cold rush of patients in the office today, Robin and Cathy came in to see me.  Robin had just been to a counselor for the first time today, but was reluctant to open up to him.  But she opened right up to me, telling me all of her fears and worries between heavy tears and feeble smiles.  "Jake trusted you, so I do too."

And I listened.  I started her on Zoloft.  And warned her about the dangers of drinking and driving.  I hugged them both tight.  I was unprofessional, and cried throughout the entire office visit.  I wish I could do more.  I wish I could tell them that everything will be ok.  I don't know if it will.  I can only hope I made a difference.

Somehow, I think Jake was listening, hands folded, smiling.

This is my hope.