Disease Burden

Today, there was too much disease. Some days are like that. It's not that I don't understand the purpose of disease or our need for it. It's just that there are days when there's too much to look at.
C came. He has been a patient for a long time. He has a severe pain syndrome associated with a stroke ("Dejerine-Roussy syndrome). Since I last saw him, his wife developed cancer - adenocarcinoma. She is not doing well. Therefore, he is not doing well. He is one of the people that will die shortly after she does. I know this. He loves her and they are no longer two. "The two shall be as one." So they are one.
J came. Her husband has end-stage Alzheimer's and he can't walk. He has severe constant back pain and he has severe heart disease. She does nothing but take care of him and hasn't been out for four months. I told her that she isn't helping him at all. That is shocking, but I said it with loving-kindness. If she were him and he were her, she wouldn't be happy at all that he was doing what she's doing. She would want him to take care of himself. She never thought of it like that. I've never explained it like that before. It works, though. It's the truth. If I'm like that, I want my wife to take care of herself. I don't want to know that I'm dragging her down with me. Anyway, I want her to think about letting him go. We don't use enough Hospice for Alzheimer's disease. We use it more for cancer, but this is wrong thinking.
R is a new patient I saw. She is 30 and describes herself as a "bitch". She has uncontrollable attacks of inappropriate rage. She has a fourteen month old child. Her marriage is struggling. She came to see me because she wants these episodes to be something other than psychological. She wants them to go away with a pill. She wants them to be explained by something that is not her fault. She has had plenty of head trauma, so it's possible that there is some "brain damage" (a useful English word that means very little to me). But I fear that this is far more likely just plain old "can't handle life well syndrome". She has had more suffering than she has suffering-healing skills.
Today is day two of new staff. They seem like they are going to be great and increase the patient's care.
The new "favored" Neurologist is now in town. All of the doctors who work for the hospital stopped sending their patients here. I'm still busy. I'm very lucky that it didn't really hurt. I know that the hospital CEO was really hoping to shake up my practice so that I would be influenced to try to get into the "good graces". She plays hard-ball business. She is good at it, too. I play take really good care of the patients. I'm good at it, too. We aren't playing the same game. I think I understand the rules of her game. But I'm not really sure that she understands the rules of my game very well.