This OSP Journal of Case Reports section is a vignette almanac whose purpose is to provide a record of the emotional climates of the general practitioner, expressed as metaphors of landscapes, geographical features, atmospheric data, lunar phases, sunrises and sunsets, beginning and end of the seasons of the year, winds, tides, etc., when dealing with different clinical cases, with the aim of achieving a greater understanding of what we are and what we do as doctors, and then achieving greater empathy. Here, a vignette of a case of mental and behavioral disorders due to cocaine use, and dependence syndrome is presented. This situation creates an emotional climate in the doctor that suggests the patient seems to be a river delta, which was formed over years by a process of deposition and erosion under the influence of currents, waves and tides.
Emotions; Cocaine-Related Disorders; Metaphor; General practitioner
[River deltas are formed when the supply of sediments to the coast by a river is faster than they are dispersed by waves, tides and the associated currents]
Vignette
Mike, 43, says he has a cold with a slight fever and “snot” and “cannot work.” He asks for 4 days off work.
Another day, he says that “he couldn't work for fever.”
Another day: “he can't work today either because of a sore throat.”
The same for diarrhea. Etc.
Mike frequently asks for sick leave from work.
Mike makes frequent consultations with general practitioner (GP) for minor and repeated problems: upper respiratory tract infections and gastroenteritis, where the emphasis is on a few days' sick leave.
The doctor, given the indicators of frequent consultation for minor problems and difficulty in making sense of the reason for consultation, suspects the existence of a hidden problem, and alerts him to the need to examine the contextual factors more thoroughly [1].
In another consultation, when he again asks for “two days of sick leave” the GP refuses to give such justifications. The doctor explains his surprise about Mike behabiour, and asks his opinion.
Mike confesses that “he is using drugs again.” He reports having consumed 0.5-1g of cocaine for 6 months after a period of 2.5 years of abstinence [2, 3].
Mike is the eldest of four brothers. One of his brothers was also using cocaine and cannabis. He is married. He has been working as a cleaner for 14 years. He has two children aged 17 and 13. He reports a good family relationship, although he has had difficulties in his relationship due to consumption.
He is sent to a specific consultation for addictive behaviours.
A few weeks later he is seen in the emergency room: 2 weeks ago, he had abruptly stopped consuming due to the appearance of paranoid thoughts. He would wake up thinking that someone was coming to harm him and he was suspicious. He has not slept well for a week and a half and has not been able to go to work for several days, a situation that he has hidden from his family until today. The patient left home in his car these days as if he were going to work, although he remained sitting in it all morning. Today, while he was in the car, he planned to jump into the river without warning. When he was going to do it, his wife called him after receiving a communication from the company that he had not come to work. The suicidal ideation persists at times, associated with apathy and withdrawal.
The GP has, almost unconsciously, negative emotions about Mike [4]. But at the same time, while he is treating Mike, he thinks of a patient with a chronic health problem: with mental and behavioural disorders due to cocaine use, and dependency syndrome [5, 6]. And this makes him remember and feel a river delta.
Mike is at the fan-shaped mouth of a river or a tidal basin, formed by several distribution channels. River deltas are formed when the supply of sediment to the coast by a river is faster than its dispersion by waves, tides and associated currents. Mike's situation was formed over years by a process of deposition and erosion under the influence of currents, waves and tides. Now we see the sediments deposited by ebb currents [7].
- Turabian JL, Perez Franco B (2008) Community-oriented individual health care. Contextualized care: the figure is the background. Revista Clínica Electrónica en Atención Primaria.
- Karila L., Petit A., Lowenstein W., Reynaud M (2012) Diagnosis and consequences of cocaine addiction. Curr Med Chem 19: 5612-5618.
- Araos P., Vergara-Moragues E., Pedraz M (2014) Psychopathological comorbidity in cocaine users in outpatient treatment. Adicciones 26: 15-26.
- Van Boekel LC., Brouwers EP., Van Weeghel J., Garretsen HF (2013) Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend 131: 23-35.
- Bartlett R., Brown L., Shattell M., Wright T., Lewallen L (2013) Harm reduction: compassionate care of persons with addictions. Medsurg Nurs 22: 349-353.
- Cazalis A., Lambert L., Auriacombe M (2023) Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review. Drug Alcohol Depend Rep 9: 100196.
- The Coastal Wiki (2024) Definitions of coastal terms.
