About a year ago I first saw Santiago’s mother, a 28 year old guy, half white, half gypsy. She came into the clinic without an appointment to talk to me about her child and ask me to update the prescriptions that the previous doctor had been doing for years. Santiago was going to go to prison for robbery and was desperate for some time because he knew out of experience he wouldn't get his "wonderful" Tranxilium 50 mg. After spending eight months in jail he was released in November and he has since committed a few misdeeds and of course consumed a types of drugs combined with alprazolam and Tranxilium that he can get from a general practitioner or the black market. He finally showed up at the clinic 1 month ago, accompanied by his parents, his appearance was rather peculiar, his long, freshly washed black hair and the dressiness of his outfit drew attention, it proved that his mother had prepared him to go to the doctor, but this neat appearance could not hide his lack of care was evident from the numerous nicks in his teeth, yellow fingers due to the nicotine and other details that now are not worth mentioning. Not long after he entered the office he made it clear why he was coming, to get his Tranxilium 50. I answered that I rather preferred to know his current situation and his medical-psychiatric history, to know about his personal biography, family, etc. With a fairly impoverished speech and struck at times he provided me with the required information and I could make a proper mental image of everything. Suddenly he asked me urgently again about his prescription.
For a moment I look at his parents who had remained silent until then, almost absent. His mother, Dolores, smiled nervously while transmitting despair, helplessness and, above all, pain. Without me asking her she explained to me that Santiago was the fifth of eight children, one of whom, Peter, was also hooked on drugs until being arrested by the Guarda Civil four years ago who died in prison "I do not know if he committed suicide or if he was forced to commit suicide instead" the woman said. Moments later, the father who introduced himself as José and said, "Listen, please do not waste time with my son because he's a fucking bastard that has no solution, ignores everything we advice him and someday he will go through the same thing that happen to his brother." At this point I interrupted him and turned to Santiago who, despite his psycho ways, had a lot of respect, or rather fear, of his father, grimaced in disbelief at what he had just heard, and said: "You see, doc, these are my parents, my father only knows how to mess with me but that’s not including how he gets drunk almost every day..."
Here I was interrupted again and turning to the three of them I commented I could imagine the style of communication they were using in my office was surely the same at home if not worse. I think they got it because from that moment on I did not hear any hurting word. At this point I considered several options to continue the interview and opted for the more daring: taking out of my briefcase a story my daughter had written a few days ago and titled "Life of a drug addict," with Victor, a twenty years old addict, as a main character. I will not reveal the details of the story, apart from its tragic ending and in its many similarities with Santiago’s biography. The idea was for Santiago to read the text, but due to his possible lack of reading skills, I asked him if he would prefer that I read it aloud, to what he nodded relieved.
As I was reading, I occasionally raised my eyes up from the text to evaluate Santiago's and his parents’ reactions. When I finished reading, Dolores’ expression was grave, she began to sob with a mixture of pain, excitement and relief at the same time, José was excited and let out a "That's what I tell my Santiago." Finally I looked at Santiago, who, after all, is the main character of this story and one of my professional challenges right now. He looked like he'd plastered his back against the chair back and his face conveyed perplexity, he was "knocked out" like a boxer after receiving a final punch.
I gave them time to put themselves together again and turning to the three I said: "Together we will not allow what happened to the main character of the story to happen to Santiago, but this is a long war in which it is okay to lose a battle." I think they understood me very well and Santiago stood and extending his hand said to me, "Doc, I promise I'm not going to go take either heroin or snow: what happened to that Victor is not going to happen to me, and, by the way, kiss your daughter for me.”
I am aware that Santiago’s problem will not have an easy solution and it will most likely have many relapses into drug use but I am convinced that our conversation will mark a turning point for his family. I spent an hour and fifteen minutes with them, and the patients who came after had to be very patient, but not one of them claimed.