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I just want to go,” the man said.

To the left of him were two medics. One of them had driven the ambulance to the emergency room. The other medic had sat in the back with the man. The medics looked at each other and smirked.

The man got up and started to walk towards the exit. The handful of patients in the waiting area watched him. The tattered hems of his oversized jeans stuck to the heels of his shoes. Stains of different colors and sizes were splattered over the front of his sweater. His shoulders were hunched forward and his dragging pants added scraping sounds to his shuffling steps. He hadn’t washed his hands in days; he looked like he was wearing dark gloves.

The security guard quickly walked in front of him and blocked his path.

“Hey. You can’t go. Just wait for the doctors to see you, okay?”

“I just want to go. I don’t want to be here,” the man said. He looked blankly at the security guard and took a few steps back.

Nurses walked by, scribbling notes onto sheets of paper. A patient was reclining in a stretcher, holding his leg tightly. When he gingerly let go, the pads of gauze in his hands were soaked with blood. He grimaced.

“There’s a gun shot wound coming in,” the medic commented to his partner. The other medic nodded. The man started walking towards the exit again.

“Okay, Gandhi. Just wait, Gandhi,” the security guard barked. The man stopped and his shoulders rolled forward.

“Oh, are you Gandhi today?” one of the passing nurses said. “I thought your name was Moses.”

“It’s Gandhi today,” snorted one of the medics. The nurse chuckled. The man looked down.

“Oh, you’ve been Moses, too?” the security guard laughed.

Still gripping his leg, the man on the stretcher craned his neck to see who they were talking about.

“We see you all the time, Moses. Why are you Gandhi today?” the nurse asked.

“I don’t know, I don’t care,” the man said to the floor. “I just want to go.”

“Hang on, Moses. We know you’ve parted the Red Sea in the past, but you can’t lead an exodus today, okay?” the nurse said, pointing to the row of chairs in the waiting room.

“Come on, Gandhi,” the security guard said.

The medics, nurses, clerks, and security guards snickered at him. The handful of patients in the waiting area watched him return to his seat.

“The gun shot wound will be here in two minutes,” another nurse called out.

“… and the patient is blind,” the medical assistant said as she passed the chart to the physician. He nodded his thanks and walked into the room.

“HELLO, MRS. CALAHAN!” he said. She turned her head towards him and smiled. She seemed to be looking at his left ear.

“Hello, Doctor,” she said. He pulled the stool from under the table, rolled it as close as possible to her, and sat down.

“HOW ARE YOU?” he asked, trying to speak directly into her ear.

“I’m okay,” she said, leaning away from him. “I’m here for an annual checkup.”

“GOOD! GOOD!” he exclaimed, leaning further towards her. “WHEN WAS THE LAST TIME—”

“Doctor!” Ms. Calahan interrupted. She raised her hand and turned her palm towards him. “I may be blind, but I am not deaf!”

He decided to approach her while she was drinking her afternoon tea.

“Hello. My name is George,” he said, extending his hand.

After placing the teacup back onto the table, she did the same. He took her hand and held her thin fingers.

“Jane,” she said.

“Jane,” he said, “you’re the most beautiful woman here.”

She smiled at him. Her dentures were whiter than the porcelain that held her tea. She withdrew her hand and picked up the teacup again.

“I moved here about a month ago. I’ve been wondering who you are,” George said, gently settling into a chair nearby. He leaned his cane against the table.

“I noticed when you arrived,” Jane said, wiping a small smudge of lipstick from the teacup. He was one of the better dressed men there. Today, he was wearing navy blue slacks, black loafers, a cream colored dress shirt, and a tan-colored sweater vest. His thinning gray hair was brushed away from his face. His left eye was cloudy and grey. His right eye was a faded shade of blue.

“That’s wonderful,” he said, grinning. “How long have you lived here?”

“About five years,” Jane said.

“If you don’t mind me asking, what happened?”

“I fell and I broke my hip,” she said, slowly swiveling the wheelchair around to face him.

“That’s unfortunate, though that clearly has not affected how you move yourself… or other people.”

“You’re charming,” she said, smiling coyly at him. “And you? What has brought you to the Hillcrest Nursing Home?”

“About six months ago, I had a stroke,” he murmured. After a pause, he said, “I can’t move around quite like I used to.”

“Oh,” she said. “That’s too bad.”

She resumed drinking her tea. He watched her.

“How have you been spending your time since you’ve been here?” she eventually asked. “Does anyone come to visit you?

“I have a son, but he lives far away.” George looked steadily at her. “I’d like to spend more of my time getting to know you.”

Jane smiled and adjusted the red bow that was tied to the armrest of her wheelchair. “George, this is a nice place. How do you pay for the rent here?”

George looked at her quizzically before replying, “Medicaid. Why do you ask?”

Jane frowned. “Just wondering,” she murmured. She turned her wheelchair back to the table and took another sip of her tea. She didn’t lift her eyes from the cup afterwards.

George cleared his throat, wondering what had just happened. After taking a deep breath, he said, “Jane, perhaps we could meet for dessert after dinner tonight? I could bring a pastry to your room.”

Jane pushed the teacup towards the center of the table. Before wheeling herself away, she said, “George, no money, no honey.”

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?

Soon after she was escorted into the examination room, Dr. Refer entered the room.

“Ms. Blue,” he greeted. “How are you?”

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

Dr. Refer nodded, inviting her to continue.

“He just didn’t wake up one morning. I guess he died peacefully. He was taking care of Mom, though, and since he died, she’s moved in with my family. I have no idea how he did it for the past five years. She’s… not well.”

“Mm hmm,” Dr. Refer encouraged.

“He had mentioned that, sometimes, she had problems sleeping at night, but he never said anything about her walking around and trying to leave. She gets upset and says something about having to go to work. She can’t get herself together to correctly unlock the door. Thank goodness. But then she screams more.”

Ms. Blue sighed.

“And on those nights when she isn’t going on like that, I find myself lying there, thinking, thinking, thinking. It’s like my mind won’t shut up. I wish I had helped my dad out more. Maybe he would have lived longer.”

“Ms. Blue,” Dr. Refer interjected, “have you been feeling a lot of guilt about his death?”

She looked away.

“I don’t know,” Ms. Blue eventually said.

“With the amount of sleep you’re getting, do you have enough energy during the day to take care of things?”

“Not really. I’ve been taking naps during lunch. The kids have made comments about the coffee I’m drinking after dinner. Even if I had more energy…. I just don’t want to do anything. Things aren’t interesting anymore.”

Dr. Refer nodded.

“Has all of this gotten to the point that you’ve thought about….” He paused and nervously coughed. “… hurting yourself?”

Ms. Blue looked at him and said nothing. He waited, internally wincing.

“I can’t, I can’t,” she said as tears welled in her eyes. “We’ve got kids to support, my husband’s job situation is shaky, and someone has to take care of my mom.”

Dr. Refer coughed again 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 murmured, “Everything’s fine.”

He settled back onto a chair and looked at her while she wiped her nose with a tissue.

“I think,” he began, “that you might get some benefit from seeing someone. A specialist. Someone who can provide better care for someone in your situation.”

“What do you mean?” Ms. Blue said.

Dr. Refer coughed again.

“Well, some doctors have more experience in helping people who are feeling as… stressed as you are right now.”

She looked at him quizzically. He quickly added, “Your situation is difficult. I can’t imagine how difficult it must be.”

“What are you saying?” she asked.

“Well… I think you might want to consider seeing a psychiatrist.”

She looked at him blankly. He heard the quiet whir of the office ventilation.

She didn’t move. He coughed.

“You think I’m crazy,” she flatly said.

“No, I don’t,” he hastily said. “I think you’re in a tough situation and—”

“You think I’m nuts. You think I need a shrink. Am I really that crazy?” she continued, looking at the floor.

“No, you’re not crazy,” Dr. Refer said. “You’re in a stressful situation. I’m worried about you and I think you would get better care from a psychiatrist right now, given everything that is happening.”

“But why? Don’t you think my reaction is normal? My dad just died, my mom has Alzheimer’s, my husband might get laid off, I want to make sure my kids are provided for—I mean, isn’t this normal?”

“Well, yes—”

“Then I don’t need to see a psychiatrist,” she said. Her eyes began to glisten with tears again when she asked, “Can’t you help me?”

Dr. Refer looked at her. He opened his mouth, then closed it again.

“Yes,” he finally said. Her shoulders dropped and she exhaled. Taking out a prescription pad from his pocket, he scribbled something onto the top sheet and handed it to her.

“What is it?” she asked.

“It’s an antidepressant, but I think that it will help you sleep more through the night. In a few weeks, you should feel better. You might experience some dry mouth, headache, or stomach upset, but that should all go away within a few days,” he said. After scratching his head, Dr. Refer added, “Call me next week to let me know how you’re doing.”

“Okay,” she said. “Thank you, Doctor.”

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

---

Later, Dr. Refer finished the note for Ms. Blue’s chart.

“Attempted to refer patient to psychiatry for further evaluation and treatment,” he murmured as he moved the pen across the page. “Patient declined referral, but agreed to follow up with me. Provided an antidepressant and asked patient to call me in one week for follow up.”

He dropped the pen on the chart and rubbed his temples.

“I don’t know what I’m doing for her.”

---

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

The physical therapist watched the elderly man guide himself with the walker down the hallway. His steps were small, but he walked with confidence.

“How do you like the walker?”

“Oh, I like it,” the elderly man said. “I like the walker. I can lean on it.”

He purposely leaned into the walker to demonstrate its stability.

“It’s like a friend,” he said. He looked down at the walker, then up at the physical therapist.

“Actually, it’s better than a friend because it doesn’t complain.”