It's only Wednesday, and already it's been a spectacularly shitty week in clinic.
Monday afternoon was crazy enough without any extracurricular nonsense. But I nearly had to throw a patient out of the clinic for good. I've visited with this patient for a couple of years now. When he's not high as a kite on cocaine, he's a real sweetie. When he's hopped up on cocaine it's even odds that he's going to be either annoyingly upbeat or a real trash-monster.
He receives disability benefits from the state, which requires regular updated paperwork if one is going to continue to receive one's benefits. Well, Monday afternoon, he barged into the clinic, pushed past everyone wanting a spot on the shower list, or to do laundry, or to go on standby for a clinic visit (the schedule was already maxed out, which is its own stress factor.) and shoves his state papers in my face as I was coming back to my office after finishing with a patient. "I'M GOING TO LOSE MY PLACE! I'M GOING TO LOSE MY FOOD BENEFITS!" he shouted at me (none of this was my fault), and he demanded a letter from me to give to the state to stave off a dismissal.
I told him I was in the middle of clinic and didn't have time right now. He wasn't happy, but he grumbled and hunkered down in the waiting room. A little later, I'm at my desk trying to chart the latest visit before moving on to the next patient. My MA Supervisor came in to the office to tell me he had been accosted by this patient, who told him if I didn't give him a medical approval letter to give to the state, he "would see me outside when the clinic closed."
I stormed out to the waiting room and gestured for him to follow me. I led him back to the lab, the only room not in use at the moment, closed the door behind us, and read him the riot act. I told him not to threaten me, not now, not ever; he's lucky I don't call the cops on him (I didn't bother lowering my voice; my MA Supervisor said he could hear me from his office) I told him this is not how you get anything out of me, and if he ever threatens me or anyone on my staff again, it will not go well for him.
This is not like junior high; when a bully threatened me with a beating "after school", I would tremble in terror for the rest of the school day, then slink home by a different route. Not anymore. Someone threatens me, I let them have it.
Well, I did. He cowered in the phlebotomy chair for a minute, and then burst into tears. (For a second I thought 'Wait. Am I the bully now?' ) I softened a bit and told him that I had always been there for him, and still would be, 100%. But he can't behave like that and expect to get what he wanted. I told him I'd do what I can to keep his state benefits going, but he can't stage a sit-in in my clinic, and issue threats like a mob enforcer. I got him to calm down, and then gave him a hug. Then I went back to my office to try and calm myself down.
Yesterday was no better. Another one of my homeless patients is suffering terribly from depression, and is having a hard time sleeping at the shelter (noise, smell, snoring, bed-bugs, etc.) He started crying during the visit; I held his hand and gave him a tissue to clean up with. I prescribed something to help him sleep, and walked him over to our counselor to see if she could help, and to send him a message that we're not going to leave him hanging.
Last roundhouse to the jaw for the day: clearing out my electronic in-box when I see a message from the local morgue: one of my patients had died that afternoon. Drug overdose. She had been suffering terribly from addiction for about the last three years, and I hadn't seen her in around a year and a half; she constantly no-showed for her appointments, and her in-home caregiver was sending me pessimistic updates on our patient's progress, or lack of it. I put my head down on my desk and cried for a bit. She had been pretty, funny, smart, with a biting sarcastic wit. She also had a developmentally delayed sister who was also one of my patients. And I'm still wondering what's going to become of the sister now that the one person who could look out for her is gone.
Anyway, thank you for reading all of this. i'm trying to get it off my chest. Looking forward to a drink, or two, or three on Friday. Dreading the next couple of days. I love you all...
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That sounds incredibly stressful and in the case of the death and the sister, very sad. 
Hope your week gets better somehow 
Also, you deserve a hug.
It helped. 
days outnumber the rough ones .
goddess' (or whom- or whatever's!) work, Aristus!
What I mean is...I hope you know that you are a HERO! Such compassion! Especially in the face of deep distress - yours, and your patients.
I deeply admire you, and you are a beacon for me in MY human services work!
I know I can always count on my DU friends to give me strength.
But I am very grateful there are people out there like you.
...with every horrible day, every ungrateful human, every sad outcome...there are the lives you've touched, saved, bettered. Some, maybe even most, you have no clue to the extent your kindness has had an impact. They remember you, they pray to their gods for you, they talk about the doc that took a few minutes to make a difference. Millions of little and big differences in so many lives.
None of this eases your pain or anxiety, but the world is a better place because of people like you. So, for your own mind, remember those souls the way they remember you.
~Namaste and happy day off! 
You are one badass doctor and human being. Cry it out -- and then get on with your badass self!
You are what keeps me having faith in humanity. (Believe you me, I'm so close to losing it.)
Thank you for sharing your hard week. That you esteem us enough to do that means we're a blessed group in a blessed place on the nets.
Welcome to DU.
Back at you.
Retired nurse here. Try a Manhattan on rocks with one of those overpriced cherries. Or two. 
I’m not the biggest fan in the world of rye whiskey. So I substituted a sublime local bourbon. Yummy! 
I’m overwhelmed. I said it above, but I’ll say it again: I love you all…
and that's so sad, yet you keep trying. Simply, you care, and that's getting rarer and rarer.
....which I myself could not do. It's HARD. Especially when you care. But reserve a little of that care for YOU. Don't drink too much. That won't help.
Who can give YOU a hug? I mean a REAL one, not virtual.
They won't or can't thank you for all you do for them. But I thank you. And no doubt the Universe and the Great IT (what I call "God" sometimes), certainly thanks you.
…of our careers, you have often expressed that you found pediatrics challenging. I find what you do overwhelming, and I could not have spent 45 years doing what you do. You have my profound admiration.
Most of outpatient private pediatrics is a relatively happy specialty. As an NP, I never had to break bad news to parents as that was always done by the docs, which was fine with me. With very rare exceptions, I seldom worked by myself as all 3 of our offices were designed to have 2 of us seeing patients. That was also fine with me, as on those rare solo days, that would be when someone would have a problem outside my comfort zone, or it would be one of the families that didn’t think an NP was good enough to see their child and be pissed off because the doctor was not available.
I’m so glad to hear that you are not 5 days a week anymore.
Please take as good care of yourself as you do of your patients.
Sending hugs
I found it difficult enough being a caregiver, with usually only one person to worry about. Can't imagine how difficult it must be to try to take care of so many, with limited time and resources, especially if they're not cooperating.
Hope to see you on Friday for a drink.