Remain Present

Empathy, addiction, and the quiet power of observation

I stepped out into the waiting room, clipboard in my uninjured hand, and called her name. She rose from her seat, her eyes alert and intuitive. Her short, dark hair framed her face, and inked designs ran down her forearms. She greeted me and noticed the black cast around my right hand, she tilted her head.

“What happened?” she asked.

“Just a grown man acting like a little kid.”

When she heard that she gave a small laugh, “Oh. I think I get that.” In that instant, I was thankful for her understanding. She saw me as a person.

That day’s visit was part of her medication-assisted treatment. Our clinic helped people transition off opioids by offering injections of buprenorphine-based medications. She’d tried Sublocade in the past, which involved rotating injections in the four quadrants of the abdomen. Most patients, including her, disliked the upper quadrant shots—they tended to be painful and left more bruising. Sometimes I would hear a muffled groan or even screams coming from behind closed exam room doors.

She preferred Brixadi, a newer formulation. “It doesn’t hurt nearly as much,” she told me. “It’s so much better.” I nodded, happy she’d found something that worked.

During this particular appointment, she had her fiancée with her. She had proposed a few months ago and her fiancée said yes without hesitation. They were visibly content, speaking to each other with gentle smiles that gave hope for their shared future. She often appeared so collected, that it was easy to forget what she’d already survived.

I learned more about that turmoil.

She suffered intense anxiety attacks, especially after a close friend passed away. She went days without rest, her nights full of vivid nightmares that left her drenched in sweat. She tried medication to alleviate those nightmares, but the side effects were intolerable. She told the doctor that her skin felt on fire each time she felt stressed. She was given coping skills, focusing on recognizing her triggers, journaling to process overwhelming emotions, and even practicing guided breathing exercises. She was encouraged to try therapy.

She presented to the emergency department twice for an angry-looking rash caused by compulsive hot showers. A friend was with her, she said that she was taking six showers a day. The water helped her manage stress and calm down, but her skin paid the price. She also started drinking more heavily, about seven drinks a day, rationalizing that the alcohol at least dulled her tension. After further conversation with the ED provider, she admitted to hearing demonic voices and seeing fleeting shadows moving at the edges of her vision. Hallucinations made their way into her life, which made even the simplest tasks terrifying.

A few days after noticing my cast, she called the clinic in a panic.

“I’ve been here before,” she said. “And I don’t want to feel that fear anymore.”

With remarkable self-awareness, she admitted herself to psychiatric urgent care.

She was admitted for major depressive disorder and to undergo detoxification. The immediate goal was to manage her hallucinations and wean her from alcohol use. While she was in the emergency department, she suffered auditory hallucinations that manifested in the voices of staff whispering about her, calling her a demon. She saw faces morphing in the corners of her vision. Physically, her body was in distress as well: she was tachycardic and hypertensive, her system vibrating with anxiety and withdrawal.

Five days later, she was discharged with a temporary Subutex prescription. The hospital didn’t stock her usual injection. Her Ativan was discontinued. She laughed more that day, reconnecting with her fiancée, preparing to celebrate her son’s birthday. She was tired but present. Things, for the moment, were moving in the right direction.

She wanted to return to life’s daily rhythms. When I think of the relief she must have felt that morning—leaving the hospital, facing sunlight again—I’m reminded of how small my fracture was in comparison. My hand would heal. Her healing would unfold one moment at a time.

I was a witness to her struggle, progress, and small triumphs. A part of me lit up each time I stepped into the waiting room and saw her smile. I believe we both appreciated the connection more than we would admit. We existed in that delicate space between professional care and shared humanity. A part of me looked forward to seeing her on the schedule again, anticipating the gentle conversation that might follow, the short but affirming moments.

Part of my job is to hold that story without judgment, to reflect understanding, and use empathy. We’re just grown adults wandering the corridors of life, shoulders sagging under the weight of our private pains. All we can do is hold each other’s gaze and remain present. God only knows how much hurt the person next to us feels.

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