I kicked my cousins out then, or tried to, at least. Mom busted in right as the door was swinging shut and dragged them all back inside for popsicles, and when they didn’t want those, beers. Worse, Mom forced me to join them on the front porch while they visited. They hogged all the rocking chairs, laughing and chatting with Mom while I sat sullenly on the stoop holding a melting blue pop.
Humiliating.
I sink down in the office chair. I’m taking regular appointments today during the clinic’s daytime hours. Dr. Srinivasan isn’t convinced I’m “ready” for this type of patient interaction, but he needs coverage while he does errands, so here I am. I roll my eyes and bring up my next appointment’s information. Does he think I can’t handle annual exams and listening to people prattle on about symptoms that can be explained, nine times out of ten, by their sedentary, vice-filled lifestyles?
I take three long breaths. It’s only mid-June. I have four and a half more months before I can prove to Dr. Riveras that I deserve to return to Philly Gen where I belong. To do that, I need Dr. Srinivasan’s full support, which means playing nice and doing whatever the old country doctor requires.
I briefly review the next patient’s records, a Mr. Franco Gutierrez. Sixty-two years old, with advanced Parkinson’s Disease. Currently prescribed thestandard course of treatment—levodopa to increase dopamine, as well as a dopamine agonist to prevent his brain from breaking it down too quickly. I squint at the last line in Dr. Srinivasan’s notes:Patient supplements with high CBD, low THC strains of cannabis to treat break-through tremors, as needed. Consult with Nomi Wyeth for cannabis treatment planning.
My jaw drops.Consult with Nomi Wyeth?Getting the town giggly and stoned isn’t bad enough, now she’s “treating” people with serious neurological diseases? The buzzer on my desk sounds, followed by the dull, lifeless voice of our teen reception clerk.Mr. Gutierrez is waiting in Room Four.
I march toward the room. Who does she think she is,Doctor Weed?! I swing the door open without knocking, startling Mr. Gutierrez where he sits so badly he drops his cane and makes a smalloof!sound.
“Good afternoon,” I bark out. “I’m Dr. D’Angelo. You’re Franco Gutierrez, correct?”
The old man nods, still grasping for his cane where it lies on the floor, his tremors evident with the difficulty he’s having. With a short exhale, I lean over, grab the cane, and return it to him.
“Thank you,” he says stiffly.
“You’re here for a wellness visit today?” My words are short and clipped but professional, which is honestly impressive considering the amount of fury seething beneath my skin. I know she spouted off all those purported medical benefits at the city council meeting, but I didn’t realize Nomi was actually dispensingmedical advicealong with all her dime bags and eight balls and bong hits. I cannot believe Dr. Srinivasan condones this.
“Yes, I see Dr. Appa for check-ins between my neurologist visits.” Mr. Gutierrez tries to sit higher in his seat, but his left leg wriggles involuntarily beneath him, making him slide back down each time. The skin stretches tight over his knuckles as he grips the arms of his chair in a struggle.
“This movement,” I indicate his wriggling leg, “this is dyskinesia from the levodopa usage?”
“That’s right,” Mr. Gutierrez grits out.
“How long have you been taking levodopa?”
“Eight years.”
I nod tightly. Dyskinesia often develops after a few years of levodopa usage, but for it to be this pronounced is concerning. Parkinson’s patients don’t usually come into the ER for emergencies related to the actual disease—it’s the secondary impacts that get them. Falls, primarily. Complications from pneumonia and asphyxiation when they can no longer swallow. I’m familiar with the disease, how you treat those secondary emergencies requires a basic understanding of the patient’s underlying etiology, but I’ve never been involved in the treatment of the disease itself. It’s an incredibly complex, debilitating condition, andnotsomething you can solve by smoking a big, fat blunt.
Again, anger roils through me at Nomi’s interference in this man’s life. “How long have you been using marijuana, sir?”
“Excuse me?”
“Reefer. Ganja. Weed.” I spin around on the stool to face him. “Cannabis,” I say, making a face at Nomi’s preferred term and its sanitized version of the truth.
Mr. Gutierrez leans back, both hands on his cane, and regards me coolly. “I don’t like your tone, Doctor.”
“Well, I cannot assess how your medications are functioning without understanding how your… marijuana habit may be impeding them,” I manage through my flexed jaw.
His brows form a single dark thundercloud. “I don’t have amarijuana habit. I use it when the dyskinesia gets so bad I cannotwalk, or when my back clenches so tightly, my spine feels as though it will snap in half. It loosens and calms the misfiring muscles.”
“And did you use marijuana before your Parkinson’s developed?” I press, feeling my face pulse with heat. “Have you considered that it may be worsening your overall condition?”
“You knownothingabout my condition. I will not sit here and listen to some hot shot doctor insinuating that I somehow brought this on myself!” Mr. Gutierrez huffs furiously as he struggles to his feet. “Nomi told me to reschedule this appointment until I could see Dr. Appa, but did I listen?” He shakes his head. “She was right about you.”
“Oh yeah?” My head jerks up as Mr. Gutierrez shuffles out of the room, unable to keep my calm any longer. “And what did your drug dealer say about me?”
Mr. Gutierrez pauses in the doorframe, eyeing me with disgust.
“That you’re the worst kind of doctor there is.”
Surprisingly, the day devolved from there. The bad feelings brought on by Mr. Gutierrez’s appointment stewed in a furious, rolling boil all afternoon that bubbled up every time one of Dr. Srinivasan’s patients tried me. The number of people that (1) stormed out of the clinic today, (2) cried, and (3) placed very convincing hexes on me areallgreater than zero. When I finally finish the last appointment, I exhale, feeling the fury leave my body, utterly spent. Four hours of appointments—that’s all it took to bring me to my knees. I slump into the office and lay my head on the desk.
The door swings open, banging into the wall so hard I nearly fall out of the chair. Dr. Srinivasan looms in the doorframe, which is impressive considering he’s only five foot six. Without a word, he stomps over to theIt’s been ___ days since I’ve received a complaint about Juliansign.
