Flame-Grilled Karma

I spent a bit of time with a patient at the end of my shift. I was hungry but I didn't need to be anywhere, not really. She wanted cocaine and she wanted some Valium so I wrote a prescription for her Valium while I was having a chat with her.
She was six weeks into her seventh antidepressant, her doctors blindly failing to see the nonsense in their prescriptive decision-making.
And she said this to me...."I have never had a doctor speak to me like this before". (And I hadn't told her to take a hike. She didn't look like much of  a walker).
For somebody who required two recreational drugs, this was an impressive attention span.  (But I'll be honest, I was really delivering!). It's a compelling thing to have somebody's attention when you think you're doing good. But the good I was doing was largely critical of many of the people who thought they were doing her good (and being paid for doing so), starting with the prescriber of her seventh antidepressant, and working up or down to every counsellor who raped her memory to make her repeatedly relive her historical pains.
For her own good of course.

I found myself resorting to examples of shellshocked First World War veterans. She needed permission that it was okay to block these thoughts. IT'S OKAY!!!! It's a great coping strategy. But she'd been told by her counsellors, it wasn't okay. Doing harm. Inexcusable.

By the end of the 45 minutes, I tore up the prescription. I told her she didn't need it. She didn't argue. By this point she was possibly in a slight trance - just the sort of state where change can occur most easily. (Ask any hypnotist). I reminded her that benzodiazepines cause amnesia, and suggested that if I did prescribe then she might forget to mull over the chat we just had, might fail to rehearse a new more constructive pattern. If that happened, I told her, I might feel bad (implying she wouldn't want that -  it's the sort of dirty trick I employ on occasions). Short of surgery, I don't really care how they receive change, as long as they receive it. Loud and painfully clear. People remember pain. Teaching through physical violence is largely under-explored in modern medicine (the domestic arrangements of surgeons aside, that is).
I often imply to patients that if they've enjoyed the conversation, they should try and recall it. Rehearse an aspect of it that may benefit them.
She'll remember that conversation.

I was a bit late for my planned tea but I ended up making a very tasty burger.... a very tasty burger indeed.
From Scotland via Lidl.
Normally, it's very hard to find a good burger.
But that's karma.

And if you don't think so, I've got five knuckles with your face on 'em.