It may be tough to deny these requests, but an addict must face the consequences of his actions for recovery

A patient stormed out of my office yesterday, but I think I did the right thing.

Paul was an alcoholic who had been abstinent for more than six years. He told me life stress “caused” him to pick up a drink again, and that led to disaster. He was charged with DUI, his third offence, and one that, should he be convicted, comes with a one-year jail term.

He was released by police but continued to drink and became suicidal: He ingested more than 100 amitriptyline tablets and had to be resuscitated. This included CPR, intubation and advanced cardiac life support. Paul survived and was transferred to a psych floor, where he stayed for a few weeks. He was then discharged to my care, at which point I met him for the first time.

He seemed depressed, but that wasn’t surprising. He had recently attempted suicide. He had only recently started taking antidepressants. He had only recently stopped drinking. He did seem motivated, though—he had already been to AA meetings since he got out and expressed a genuine desire to get better. I met with him every two weeks to monitor his progress, and he gradually improved.

About four months after his brush with the law, he asked if I would write a letter for the court explaining that he “wasn’t ready” to appear at trial. I explored this a little, asking why he didn’t feel ready. He confessed to having nightmares about the resuscitation, which he insisted he remembered, and to having a severe fear of public places. I asked him what he did in his usual life, and he could still go to the grocery store, etc. I felt a little uneasy about this but was willing to give him the benefit of the doubt. I wrote the letter.

I didn’t see much of Paul after that. I left it up to him to schedule appointments when he felt he needed to, and three months later, a day before his next appointment, I got a call from his lawyer. “We need another letter, otherwise this is going to trial.” The lawyer was pushy and wanted a letter that day. I said I couldn’t write a letter because I hadn’t seen Paul in months. The lawyer pushed for a letter stating that, as of the last time I had seen Paul, I felt him unfit to stand trial.

I wrote the letter. I now know I shouldn’t have.

Stalling tactic
Paul saw me the next day. I inquired about his health, which he said was “good.” I asked a few more questions about his mental state. When I was done, he thanked me for writing the letter. I took that as my cue: I told him I felt uncomfortable writing these letters and there would be no more. I told him part of the process of recovery was facing one’s consequences, and avoidance just made things worse. Paul told me his lawyer’s strategy was to “delay this thing as long as possible,” a real red flag. His lawyer believed they could stall for a year. Eventually he got to the point: “I’m not ready to stand trial. I need you to write letters saying that.”

I firmly said no. And no. And no again. Once he realized I was not going to change my mind, even when he painted himself as sick and weak and in need of my help, he got up and muttered, “What fucking good is this?” and left, slamming the door.

A professor of mine once told me, “What kind of doctor would I be if I just told people what they want to hear?” I heard her voice the rest of that day. I wished I had heard it a little earlier in the game, is all.

Shane Neilson is a GP in Erin, Ontario.