Black Magic & White Poison.
Despite a lifetime of medical practice, it never grew dull. My last two patients that day, after a long day of seeing patients were enough to keep me wide awake. Not far from the teaching practice where I was working at the time was the Oneida Nation of the Thames Reservation.
Patrick , a fifty-five year old native patient, walked in at five o'clock.
"What can I do for you, Patrick ?" I asked him. I knew him quite well.
"Something is interfering with my thinking, Doc," he said.
"What do you mean?" I asked.
"Someone put a curse on me, Doc," he said.
"Tell me about it," I prompted .
" I think it was my cousin," Patrick said.
"Why would your cousin put a spell on you?" I asked.
"I think it was because he thought I was making love to his girlfriend," said Patrick
"When was this?"
"Oh, years ago. I took no notice, I didn't do anything, but he thinks I did, that's why he put the curse on me. Can you get rid of it?"
I knew that what I said next was going to determine whether Patrick was going to follow up with me or not. I took a careful psychiatric history. There were no florid psychiatric symptoms apart from the conviction that a curse had been put on him.
"Maybe I need some medication?" he asked.
"Let's just keep an eye on things for the moment," I said.
"So can you takes off curses?" he insisted.
"We will need to follow up on this." I evaded the question.
"So you can get rid of spells?"
"No, but we can get rid of your problem. I'm not going to write you a prescription right now. I'm going to see you again next week and see how you are doing."
"Okay, thanks. I'm glad you can help me."
I asked several more questions to satisfy myself that Patrick was not going to be a danger to himself or anyone else.
I walked him out to the desk to make sure he had an appointment for follow up in a few days.
"If anything changes in the meantime just come right in ." I called after him.
I breathed a sigh of relief as my last patient of the day walked in to the office.
He was about eighteen years old and had a restless, agitated demeanor. I was alerted when I read the name on the chart, because I had seen the boy's mother not very many days earlier and she had expressed some concerns about her son, Glen.
I invited him to sit him down across from me. I smiled at Glen, attempting to put him at ease but he avoided eye contact.
"What can I do for you today, Glen?" I asked him.
"I have a problem," he said, coming straight to the point. He thrust his right hand into his trousers pocket and pulled out a square tinfoil wrapper.
"I'm hooked on this and I need help to get off it," he said, with obvious agitation. "I feel so nervous all the time and I can't sleep. I lie awake most of the night sweating and twitching and I can't get up in the morning. I've been missing a lot of school."
I looked down at the discarded packet. Duragesic Transdermal Patch, This was not good news. This was Fentanyl,
"Where have you been sticking this?" I asked. A transdermal patch is applied to the skin, through which the active ingredient is absorbed. It is fifty to a hundred times more potent than morphine,
"The kids at school cut them into four and we suck them."
"This is heavy duty stuff," I said. I wanted to know where Glen had got hold of this stuff; this stuff came right out of a hospital. It sure as hell didn't come wrapped like that on the street, I'd have to find out how this was getting on to the street, but I didn't want to frighten him off by going down that street right now because I thought I was getting through to him.
"Yeah, I know. I have to do something about it,"
"I'm going to tell you what you have to do. I have to see you on a regular basis and you've got to join Narcotics Anonymous or Alcoholics Anonymous, you can't do this on your own."
Glen looked doubtful. " I think I can do this on my own, if you can just give me something to help me sleep at night."
"That's not the way it works,"I said. "Right now, you're at a crossroads in you life. If you do things the right way now, you have a chance. If you don't you're on the slippery slope to a life of addiction, detox centres, rehabilitation centres and worse. If you don't want to waste your life, you have a chance to act now."
"Okay," Glen agreed, perhaps a little too readily, I thought, "I'll do it"
I printed a list of of treatment centres near his address.
I said, "I'm going to make time to see you next week and when I do, I want to hear that you're been to an AA or a NA meeting and that you have plans to get set up with a sponsor. I'm going to give you a few pills to help you to sleep, just enough to last you until I see you next week. This is where you'll get help if you want it" I added, handing him the list.
" OK, " he said, "I'll see you next week."
I never saw him again.
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