Medicine from the heart . . . Hugh Silk

On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit:


Thursday Morning Memos founder Hugh Silk, MD, writes about a patient who moved him to tears recently. 

Bagels and Donuts

I have been providing suboxone now for a few years. My success rate with my patients waxes and wanes. I have certainly been duped a couple of times, wanting so badly for the patient to be better that I bought the stories.

"I have a twin and my twin got the oxycodone from the urgent care center and got it from the pharmacy in my name. I swear."

"I have no idea how I am short on pills this month. You know me, I am not lying. My daughter has been home recently—she may have taken some."

This is difficult work. We want folks to be better. I am the son of an alcoholic and I bring that to this work—the risk of transference, counter-transference, and so on.

I have a few patients now who have made it. I mean years. Maybe one slip up or two but for the most part now have a job and a life, and in some cases have reunited with family members, and I feel good to be a part of that.

A few weeks ago, one of my patients who has been on suboxone for a shorter period (after decades of heroin use) said the most powerful statements to me when I asked how things were going.

"I took my daughter out for her 18th birthday to the Ninety-Nine. Have you been there? It is very nice. I had never been there before. I have never been able to take my daughter out to dinner before. I could see that she really liked it too. I am so grateful to be able to do this now; I could never do this before."

Two weeks later.

"Last Sunday I went to Dunkin Donuts and got bagels and donuts for my daughter and me. We just drank coffee and ate those bagels and donuts together. She likes the donuts more. Those bagels and donuts are so good there. Can you believe that I had never taken my daughter for bagels or donuts before?"

"Why not?" I asked.

"I never had no money for it. Put it all into the dope. And no time. And no real energy to do such a thing. It is a miracle, we had so much fun just talking and eating and being able to do that."

I could not shake her hand hard enough or say enough encouraging things to keep up her efforts. A new life not only for her, but for her daughter and for them together, because a medicine, a new-found motivation and impressive will power came together. Simply put: grace.

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