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Charm.

The rain was falling heavily on Broadway. Large drops formed a carpet of splashes on the sidewalks. Water was pouring off of the curbs and forming dirty streams in the gutters. Crowds, cowering under umbrellas that failed to keep clothing dry, lurched towards the subway entrance.

She was wrapped in a smart khaki trench coat that stopped at her knees. Her umbrella was leaking; she wiped her wet brunette hair out of her eyes. She followed the parade of bobbing umbrellas towards the subway.

The young man was wearing a red shirt. He had blonde hair and broad shoulders. She noticed him because he was the only person on the sidewalk without an umbrella. He was smiling broadly at the person underneath a blue umbrella who was now leaving him. Around his neck was a lanyard with an ID badge attached to it. She guessed that he was soliciting people for signatures for a noble cause, maybe to save the forests. These young types always looked out of place on Wall Street.

He turned his head and saw her. Their faces simultaneously revealed that they knew that they were looking at each other. A bright smile blossomed on his face, as if he knew her. He opened his arms, preparing to give her a hug.

She was perplexed—who is this guy?—but that did not prevent her from smiling. His affection looked genuine. It was the end of the day, however, and she didn’t want to have a conversation with a stranger.

He casually approached her as she hastened towards the subway entrance. Though he didn’t completely obstruct her path, she had to veer sharply to the right to avoid colliding with him. He was still smiling and his mouth opened to start a conversation.

She reached out a hand and, smiling, patted him gently on the shoulder. His shirt was thoroughly soaked; it was sticking to his skin.

Without stopping, she said, “You should get yourself an umbrella.”

“Oh,” he said, blinking the water out of his eyes. Her back was already to him when he called out, “But I was waiting for you!”

He didn’t see or hear her laugh. After he watched her disappear into the subway tunnel, he used his wet hand to wipe his wet face, turned his head, and started looking for another person.

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Lucky.

Elizabeth hears voices, believes she alone can reunite North and South Korea, and goes through three packs of cigarettes per day. She wants to stop smoking.

“Buddha never smoked and that’s how he got enlightened,” she says.

Tobacco stains adorn her arthritic fingers. She has worn her hair in a bun every day for the past twenty years.

“If I don’t tie it back, people pluck hairs out for their instruments,” she says.

The band of gold is still on her finger, though it is now loose. It wobbles when she moves her left hand.

“Hi, Dr. Sold,” she says. Dr. Seld, accustomed to these variations, waves at her and smiles.

She’s so cute despite her psychotic symptoms, she thinks. Or is it her psychotic symptoms that make her cute?

“Do you have a husband?” Elizabth blurts.

Dr. Seld quickly weighs a few options: I can tell her the truth and consider this a boundary crossing. I can ask her why she is asking me this. I can tell her I’d prefer not to say.

Elizabeth once taught children how to play the viola. She lost her teaching skills when the voices constantly told her that the children were playing music of the devil. She lost her musical talent when she developed tremors and stiffness from the medications that were never that helpful. She lost her husband when the voices insisted that she never knew him, that he was never her husband.

If Dr. Seld asks why Elizabeth wants to know if she is married, she thinks it would likely lead to an unproductive conversation. After taking a breath, Dr. Seld says, “Yes.”

Elizabeth smiles, her eyes sad, and clasps her hands. “You’re lucky,” she says.

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A Lot of Prescriptions (III).

While driving to the clinic, Ms. Blue thought about what she would tell her doctor. She didn’t want to come across as needlessly anxious, but she wanted him to understand how unwell she felt. Was there something wrong with her?

Shortly after she was escorted into the examination room, Dr. Distress entered the room.

“Hi, Ms. Blue,” he said. “What’s wrong?”

“Well, I think I might—well, you see, I’ve been really tired lately.” Ms. Blue paused. “My dad died about a month ago. I haven’t been able to sleep.”

“That’s terrible. I’m so sorry to hear that,” Dr. Distress said.

“Yeah, it was unexpected. I guess no one ever expects someone to die, but he was actually training for his first half-marathon. He was running regularly! Eating healthy! The stress of caring for Mom was high, of course, but he was taking care of himself.”

“Uh huh, uh huh.”

Ms. Blue’s face began to distort. Her voice sounded tremulous. “It was so sad to see Mom look at him and have no idea who he was. She’d get up in the middle of the night, insisting that she had to go to work. She hadn’t worked in almost ten years! She’d get so upset when he tried to get her back in bed. ‘It’s okay,’ he’d say, ‘the work will be there for you in the morning.’ He was so gentle with her and she would scream at him, calling him all sorts of names for getting in her way. He spent the last four years of his life devoted to this woman and she had no memory of his efforts!”

The tears collected in the corners of her eyes before spilling onto her cheeks. She tried unsuccessfully to stifle her sobs.

“Oh, it’s okay, it’s okay,” Dr. Distress blurted, his eyes frantically darting around the room for a tissue box. Unable to find one, he abruptly got up and pulled several paper towels from the dispenser.

“Here, take these,” Dr. Distress said, trying to put them into Ms. Blue’s hands. Using the back of her hand to wipe her face, she looked up, wincing.

“I’m sorry,” Ms. Blue said. Another wave of tears came bursting forth.

Dr. Distress began to tap his foot quietly on the tiles. His fingers rotated the earbuds on his stethoscope. He looked at her, looked away, looked at her again, opened his mouth, then said nothing.

“I miss him a lot. And now Mom lives with me and… it’s hard,” Ms. Blue said.

“Yeah, yeah. Yeah, I can see that.” Dr. Distress suddenly stood up and said, “Let me listen to your heart and lungs, just to make sure they sound okay.” His gaze settled into the middle distance as he moved his stethoscope first across her back, then over her chest. After pushing on her belly, he declared, “Everything’s fine.”

“I feel terrible, Doctor. I just don’t know what to do. I can’t sleep, I don’t want to eat—I mean, I am eating and I eventually fall asleep, but I’m tired all the time and I just miss him so much and I want to take good care of her and keep her out of a nursing home but I’ve got to work and—”

“Here, here,” Dr. Distress blurted. He had scribbled something onto his prescription pad, tore the top sheet off, and was flapping it at her, insisting that she take it. “This will help you feel better. You might have some side effects—headache, dry mouth, things like that—but it’ll help you feel better. You’ll feel better.”

Ms. Blue wiped her eyes and looked at the prescription. “What is it?” she asked.

“It’s an antidepressant. It’ll help you feel better. Just try it. Come back in a month and we’ll see how you’re doing.”

“Um, okay,” Ms. Blue said. “I’m sorry that I cried. I’m just—”

“It’s okay, it’s okay, you’ll feel better, it’ll get better. I’ll see you soon, okay?” He walked to the door and began to open it. She quickly wiped her face again and took a deep breath.

“Okay, good-bye,” Dr. Distress said, walking out. In the hallway, he heaved a huge sigh of relief.

She walked out of the office, feeling tired and embarrassed. What did he give her again? Oh, she could look at it later. She just wanted some time alone.


“Recurrence of leukemia… new diagnosis of HIV… hospitalized for complications related to diabetes… father passed away….”

Dr. Distress was going through his charts at the end of the day. He sighed again. Ms. Blue looked so sad. What could he possibly do to help her? It was so hard to see her cry like that. He was relieved that she left when she did.


This is part of a series about why some physicians write many prescriptions for psychiatric medications. You can read more stories here.

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For As Long As Possible.

When the psychiatrist told her, “I’ll try to keep you out of the hospital for as long as possible,” she cringed. The psychiatrist presumably meant well, but she caught the meaning in his absentminded comment.

“What did he mean, ‘for as long as possible’? Doesn’t that mean he thinks I will end up in the hospital again? Doesn’t that mean he thinks I will only get worse… and not better?”

She frowned.

“I don’t want to work with him anymore,” she said. “I don’t think he’s a good doctor.”

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A Lot of Prescriptions (II).

While driving to the clinic, Ms. Blue thought about what she would tell her doctor. She didn’t want to come across as needlessly anxious, but she wanted him to understand how unwell she felt. Was there something wrong with her?

Upon entering the office, she was promptly shown into an examination room. Only three minutes behind the scheduled appointment time, Dr. Rush entered the room.

“Ms. Blue,” he greeted, extending his arm. They shook hands and he sat down on the rolling stool. “I understand you’re not feeling well?”

“Well, I think I might—well, you see, I’ve been really tired lately.” Ms. Blue paused. “My dad died about a month ago. I haven’t been able to sleep.”

Ms. Blue and her father had always been close, though they increasingly relied upon each other for support in the past five years. Her mother’s memory was steadily worsening over time. Prior to his death, her mother periodically woke up in the middle of the night and tried to leave the house, believing that she had to go to work. She remembered less and less of her history with her husband with each passing day. He never cried when he talked with Ms. Blue, though his weariness and sadness were obvious. Since his passing, her mother had moved in with Ms. Blue and her family. Neither Ms. Blue nor her mother were adjusting well to the change. Any energy she had was now gone and—

“I’m sorry to interrupt, but we’re running out of time,” Dr. Rush said. “So you’re not sleeping well, you’ve been feeling depressed, you’re tired—all understandable. I’m sorry for your loss.”

“Thank you,” Ms. Blue said, wiping her eyes.

“With all that has happened, have you had any thoughts about wanting to be dead?”

“Oh, no, no. Nothing like that. I just wish I didn’t feel this way.”

Dr. Rush nodded, putting the earbuds of his stethoscope into his ears as he said, “Let me listen to your heart and lungs, just to make sure they sound okay.” His gaze settled into the middle distance as he moved his stethoscope first across her back, then over her chest. After pushing on her belly and murmuring, “Everything’s fine,” he sat back onto the rolling stool.

“Maybe we can talk more about this next time, in about a month? And, in the meantime, you can try an antidepressant. You might start feeling better and have more energy,” Dr. Rush said, checking his watch before taking the prescription pad out of his pocket.

“You think I need an antidepressant?” Ms. Blue quietly asked.

“It probably won’t hurt,” Dr. Rush said. He scribbled something onto his prescription pad, tore the top sheet off, and handed it to her. “Some people experience side effects—sleepiness, dry mouth, stomach discomfort—but those usually go away in a few days. It might help.”

“Thank you,” she said, tucking the script into her purse.

“You’re welcome. I’m sorry that our time was cut short, but they have me on a tight schedule,” Dr. Rush murmured. They said good-bye.

She walked out of the office, feeling both relief and dismay. On the one hand, Dr. Rules apparently didn’t think that she had a major medical condition. On the other hand, she wondered if she really needed an antidepressant. Was her condition that bad?


While going through his charts later that evening, Dr. Rush spread his arms out to loosen his shoulders. He sighed.

“If only I didn’t have to see so many people in a day,” he mumbled. “I might actually be able to help people more. I can’t possibly do a thorough job in fifteen minutes.”

He heard a knock on his door. The clinic manager stuck her head into his office. “Only one no-show today. Your productivity numbers have been great. Our reimbursement will be high this month. Good work!”

A weak smile crossed his lips and she ducked out of the office again. When he looked down, he saw Ms. Blue’s chart in front of him. He wondered what she didn’t tell him today.


This is part of a series about why some physicians write many prescriptions for psychiatric medications. You can read more stories here.