Tim Lanier  

SILENT TREATMENT

Phyllis came into the clinic distraught, depleted, and destroyed.  She could barely say three words without choking up.  She reported that she can't eat, can't think, and can't sleep.  She feels weak and tired all of the time and has absolutely no desire to do anything at all but lay in bed.  It had been only 1 month since she buried her daughter who was her best friend.  They talked everyday and went just about everywhere together.  They were inseparable for 35 years and now for the first time in as long, they're separated.  Phyllis's daughter had been diagnosed with stage 4 colon cancer and was given just 4-6 months to live when she found out.  Phyllis said that she literally watched her daughter deteriorate by the day and as devastating as it was to see her daughter suffer through such an agonizing illness, the most terrifying thing to her that still haunts her to this day is hearing her daughter cry out for her mother and there was nothing that she could do to help her.  The only way that she had been able to cope with the overwhelming anxiety had been with Xanax (not recommended) but she has since come to the conclusion that the Xanax is no longer effective and she's requesting something different, something stronger to help lighten her anxiety and somehow take the pain away. 

Phyllis's voice was frail and her heart was shattered and all she could think about was an escape.  I could feel her pain with every word that she choked on and every tear that she wiped away and although I saw that Phyllis was struggling to tell her story, I continued to ask her questions about her daughter, about her daughter's suffering, about how she cared for her daughter to the end, and how her daughter actually died.  I wanted her to talk about it because her stability seemed to improve the more that she was able to share her story and shed her tears.  At the end of her visit, Phyllis was no longer requesting new medication to help her overcome her problems which were no doubt caused by her complex grief.  I scheduled a close date for the next follow up appointment with Phyllis so that she could once again relieve her stress and anxiety through sharing her experiences.  Yes, we are often pressed for time in the clinic especially when we have a long schedule and people waiting are people hating, but when I know that my patients need that extra time, I won't deprive them because my ultimate goal is to make them better.  In the process, I hope that waiting patients are understanding (and usually they are) because they may need extra time themselves for their next appointment- you just never know! That being said, listening (something so many providers fail to do anymore) and staying silent so that Phyllis could 'let it out' was the best treatment.  

TAKE AWAY
1.  So often medications are used as a first-line method of treatment when, in situations like Phyllis's, the best method of treatment has nothing to do with medication.
2.  It is very impressive to see the therapeutic difference that talking (therapy) can make.  In other circumstances, the therapeutic difference may be found in exercising more, sticking to dietary changes, or other measures that are not a medication.  
3.  Just listening to the patient talk about their problems is often more effective than medication.  
4.  This DOES NOT MEAN that medications should not be used by any means.  In Phyllis's case, no matter how much medication I prescribe, her daughter is not going to come back to life.  High blood pressure, high cholesterol, high blood glucose, and other conditions WILL CHANGE with medication when lifestyle modifications are not the best option.