Here's a scenario oft repeated in our daily lives, which I'm writing about now for an emotional outlet as much as anything:

A 35 year old lady with 3 kids at home and no dad anywhere around comes in because she has terrible headaches. She's also overwhelmingly anxious and doesn't sleep well. She has plenty of reason to be anxious, since her oldest son just ran away, she fears her 13 year old daughter may be pregnant, her boyfriend gets abusive sometimes, and she is inches away from not being able to cover her heating bill next month. She wants to sleep. She wants to have her head feel better. She wants her life to be much different than it is, in a myriad of ways.

I think I saw variations on this theme at least 3 times just this morning. After asking some questions and examining her to ensure that these headaches aren't from something more dangerous than painful, we're down to figuring out how to control her symptoms. There are a number of medications that can aid in control of head pain, back pain, any kind of pain, but sometimes patients say they don't get any or enough benefit. Sometimes insurance doesn't cover them either. For anxiety, there are some pretty good, cheap medicines, but they don't act right away, and many patients want to feel better now. (n.b. I totally agree with those who want to utilize non-medicine solutions to the above problems, but that's another discussion.) So often it comes down to narcotics for pain and benzodiazepines (valium, ativan, etc) for anxiety.

She's tried lots of things in the past, she says, and feels that these last options are all that works for her. I pause. True, I think, for some people, they are useful. However, these medicines are in the control of a prescriber like myself for some reason, and I can only assume it's because of my experience. Because I've seen what she hasn't, which is people ten years down the road, taking truckloads of narcotics and still not feeling better. In the meantime, the side effects pile up and they get sicker. I've seen women beaten up by the boyfriends in order to take their anxiety medicine and sell it or share it at their next party.

And so I've come to conclude that our desire to get benefit now sometimes results in harm later. This is driven by docs and patients alike, because neither of us, unless totally empty of empathy, want these terrible experiences to persist any longer. So we look for the quickest relief. And often the quick-relief medicines don't continue to work as well as they once did, so we use more and more. I've been trying to explain to people that our eyes ought first to be on long-term function and success rather than on short term fixes and patch jobs. This isn't received well.

Why isn't it received well? Is it just our human weakness? We don't want to put up with anything? Maybe. In fact, that's my first thought and maybe still my primary thought. But then the other day, these issues washed over me again... 5 years from now? 10 years? How does one focus on those goals when you feel you'll never make it into next month? Maybe I'll be a wreck in 10 years, but at least then my kids will be out of the house, and not depending on a mom who's a nervous wreck and incapacitated by headaches... This line of thinking isn't human weakness. Maybe it's wisdom, wisdom to spend your health today, since the future isn't guaranteed regardless.

And I don't have an answer. I don't have an answer, and it matters terribly to lots of people, and lots of families. God, help me. I'm convinced you alone have the answer, and without your guidance, we will continue to walk in darkness.