My first time seeing a dime bag

“Look what the patient dropped,” the medical assistant says.

I see a teeny tiny ziplock bag filled with a powdery crystallized slightly off-white substance.  Coffee sweetener gone bad, is the first thought that comes to mind. In a teeny tiny zip lock bag.

“What is it?” I ask, not knowing, cocaine heroin ground up methamphetamine.

What comes in powdery crystals, in dime sized bags?

“It’s heroin,” she says. “I worked in a pain clinic. I’ve seen it before. What do we do?”

What do we do? Medical school didn’t prepare me for this.

My gut response, my initial plan: give it back to the patient and provide information on addiction centers.

Except he has left without being seen.

Which means we are left holding a dime bag of heroin.

I do not want to call the police.

In my clinic, I take care of everyone. I take care of illegal immigrants, asking all uninsured patients their immigration status to see if they qualify for health insurance, but not changing the work I do as a doctor to support their health.

I take care of illegal drug users, asking all my patients routinely if they use drugs. The information is for me to understand their health care needs and risks.  AA? smoking cessation counseling? Information on drug treatment centers? HIV and hepatitis screening?  I take care of patients who I know are actively abusing tobacco, alcohol, marijuana, cocaine and heroin.  I do not report their use to the police.

But there is the physical evidence of the dime bag. With the heroin. I don’t want to keep the heroin in the clinic. I also don’t want to give it to the police and be forced to file a report to turn my patient into a criminal.

The MA and I create a plan.  Tell the clinic manager. Empty the bag into the toilet. Place the empty plastic bag into the sharps container. Do not report it to police.

Do not chase down the patient.

Pretend it did not happen, we did not see.

“Look what the patient dropped” says the MA.

There is no patient. There is nothing that dropped.

I see nothing.




cough cough cough

Of course I went to work today,

Said little peggy ann mckay

i’ve got a presentation for colleagues! a brochure to proof!

assignments to post and a final report due

a lecture on bullying, a panel too

cultural competency for all whether green black or blue

planning meetings for projects, a new business to start

and an IRB submission to  conclusively prove that I’m smart!

colleagues to smile at, students to support

and did i eat lunch?

just imagine my retort!

and was i cough coughing?

and cough coughing some more?

but of course I was, dear, on my hands–on your door!

the air that we breathe?

contaminated with junk

the green gobbley goobers of my nasal gunk

what do i say at the end of the day?

No more of this cough!

Tomorrow–home, i will stay!


Scheduling: A Morning of Patient Complaints

We went to a new scheduling system–call in for same day appointments. Trying to cut down on the number of no-shows–patients who just don’t come in after making an appointment.

Patients are not liking it.

These are the comments from a single morning.

K.B. complained about difficult access. “I tried over and over.”

K.C. “I couldn’t get through last week so I went to the ED. Now you’re seeing me for followup.”

JG. “You are hard to reach.”

D.B. “Who is my care team? You are hard to reach.  You call that 555 number and they have you over to every clinic.”

N.T. “I waited two hours to make this appointment.”

All I could say was “I’m so sorry, please complain to administration. I’m so sorry, please complain.”


The Hard Knock Life of a Community Physician