How To Shock Your Doc — New Uses For A Medicine Bottle

We did not really know where this patient was at. I figured out he was some kind of bipolar, because he talked about mood swings.

When I first saw him, he seemed to have a delusional system that had something to do with idealizing a woman pharmacist and feeling he had offended her and thinking obsessionally about her.

He was starting to idealize me, and commenting on my hair and clothes, and I will admit that I wanted to fix this guy as quickly as possible, so I would not get incorporated into one of what sounded like a series of delusional systems. He had come into the clinic several times, usually with sequentially weakening delusions — always an idealized woman. He gave the impression of being gay — always wearing at least one piece of jewelry that I would have expected to see on a woman.

In his 20’s, probably gender confused. It was really difficult to make sense of him, and he did not particularly want to talk to any of the therapists. He was on the streets so he was given some free medication by a caring county. He showed up a couple of days later saying he had no medication, weak, and with a dangerously low blood pressure, so I immediately sent him to the hospital. He did not want to tell us what happened, but I told him he was not going to get any more medication until he did. He claimed his pills had been stolen by someone else in the residence where he lives. Someone who had told him that the meds we had given him were really good stuff, and whom he believed would steal them.

He was taking trazodone instead. He would not tell me where he got it, so I assume he got it on the street. But he told me he had been using it and it felt good, he felt better. Medicine was medicine.

Not quite. He was a bipolar, it was an antidepressant. It had some hypotensive effects — he must have taken a lot to have the low blood pressure he had (80/50) he showed up with.

He must have been abusing the trazodone.

Why would somebody abuse trazodone? Before Viagra, this was used in certain clinics, trepidaceously, to increase male potency. Trepidaceously, because, every once in a while it caused priapism — a sustained and painful erection that does not go down until the interested party receives an injection to help it. Then, getting it back up again becomes the problem. I have had grown men cry in my arms over that one.

I understand that this situation is used as a gag in the current hit movie “Little Fockers” with esteemed actor Robert DeNiro being so afflicted.

Believe me, it ain’t funny and I pity the man who has to go through this.

Trazodone has been used as a sleeper in the Veterans Affairs medical system; the reason cited back then when I was part of that venerable system had something to do with an alleged lack of abuse potential. I had never met a trazodone abuser. He did not want to discuss why he had made this unusual choice, except to say that we had not provided more meds, so he felt obliged to get whatever medication he could, and this was what he was able to do. Oy! I tried to get his “free meds” distributed in smaller amounts. That would have been too expensive for an already broke county. He was going to get the same plastic bottles again, no matter what I did. Whether they were going to be “stolen” again or would be abused or sold, the system could provide only large plastic bottles with lots of pills. I suspected everything he said was lies, and he had abused the plastic bottles of paroxetine (Paxil) and risperidone (Risperdal), which he had told me worked magically well for him. I was not sure how to proceed. “Just give me the plastic bottles, he said. “I will hide them in my pants and nobody will steal them.” I did not understand.

“Hide them in my pants. No, not the pockets. I will put them in my underwear. Nobody will touch them there, I promise. Because nobody wants to go into my underwear.” Then he started laughing, softly but a bit maniacally. “I am not rich enough to go on an airplane, so nobody will ever look inside my underwear to know what is there. The pills will be safe.” This is good for somebody not rich enough to fly on an airplane. It dawned on me that I had become a part of his delusional system — a set up — having never considered the prescription of pills to be an erotic connection with a patient.

He had found a way to get his sexual kicks within the system.

It takes a lot to shock me, but I couldn’t think of a way to get around this one. All I could think of at the time was to tell him to close the little bottles tightly, maybe put them in a plastic bag, before he put them in his underwear. He told me he would take good care of the situation. I hope so, because nobody could think of a way to get around this one.

Our jobs as clinicians are to diagnose and treat the problems presented to us by the patients. We really are not charged with making sure they don’t stimulate themselves if they feel like it.

One of the hardest parts of this kind of job is trying not to look shocked.