You’re the Doctor

He says, “You’re the doctor, Dr. B.“ I hate him for giving up. But I’ve given him the script. He has pain which doesn’t let him rest—in his right testicle, for 30 years. He is Mr. Dabney. A big black guy. A recovered alcoholic. “What should I do, doc?” he asks. He wants them to take the testicle off. Maybe the nerve, too, since another doctor told him that’s where the pain is. I have told him over and over again that chopping off his ball won’t make his pain go away. In my head I call it his ball. To him I call it his testicle. And then, maybe I think we should take his testicle off. To show him it wouldn’t work. That the pain would be worse. Then I’d be right. But I’d have to up his dose. This is the fix I’m always in: I think the pain is real. And the pain is in his head. Both things are true. The only thing that’s made headway is medicine: different kinds of sedating pills that do no more than take the edge off. We spring from one pill to the other and then back again. Maybe someone can give him another medicine, a nerve block. Has he ever had an injection for pain? Last time, we had talked about seeing the pain doctors—is he still interested in that? “You’re the doctor,” he says. “Whatever you say.” I gave him the opiates right at the beginning of the visit to spare us both the suspense. Scripts on a blue background that look like foreign currency. We’re both in Opiate Land now, our relationship forever threatened by mistrust and dependence. We’re rolling around in a big painful opiate ball. “Any New Year’s plans?” I ask. “I’m hanging out with my lady friend,” he says. “We’ve been together for thirty-four years.” I let him go on. “I was in an alcoholic ward. She was visiting her brother. I don’t know what I looked like then. She looked good. I don’t know why she started talking to me. I asked for her number.” “And you’ve been together since then?” I asked. “She was married when we got together,” he said, “and I knew that. She always came to me for thirty-four years. He’s not around anymore. He died. So I asked her, now that he’s not around, maybe I can come to you?” I have another patient with chronic pain scheduled right after him. I have decided to cut her off; she kept missing visits. Though it may sound harsh, I have to be honest: I don’t like her and I’ll be happy she’s gone. The lawyers took their time approving my letter, and she rescheduled before I terminated her. I have to see her today for the last time. “I got something for Christmas,” he says. “She’s a little dog. I call her Queenie. The girl from across the street gave her to me. “ “What kind of dog?” “A cocker spaniel. She knows how to go to the bathroom by herself. I thought I had to make her go outside, but the girl who gave her to me said she could do it all by herself. I waited, two, three hours, the dog went by herself in a little box.” “Are you walking the dog?” I ask. “Physical activity might decrease your pain.” . And then we could decrease your opiate dose. And then we could decrease your opiate dose.“Sure I walk the dog,” he says. “And she makes me feel very happy.” I say, “I’m glad to hear that.” “So I asked my lady friend if I could come to her,” he goes on. “She said no. So I know she’s seeing other people too.” I tick off the lab boxes in my head: syphilis test, HIV, urine Chlamydia. “Are you using protection?” “Most of the time.” “Do you feel like this is working for you?” “It’s all fine with me. It was a very good Christmas. I really love this Queenie.” I start giving him the speech: he has to see the pain specialists or I can’t give him the opiates. I need to see the note from the pain specialists in the computer—or else I will banish him from Opiate Land. He nods. “Whatever you say. You’re the doctor. I’ll do whatever you ask.” I watch him get up, find his cane, and head for the door. “It’s this pain, doc,” he says. “I wish there were some way to make it go away.” “Little by little,” I say, cursing the truth in this—maybe we can make it better little by little—and also the lie (he’s had it for thirty years!). The testicle pain also affects his groin and upper thigh. He hobbles down the hall. I sit down and dictate into my phone. In my pocket, the letter for the next patient is folded up like a secret message, and the little speech I have composed to her is lying in the pit of my stomach.