Bring in your dead dog

Dante has a love-hate relationship with Roberta Flack. Tonight, he hates her. The reminders of his wife are painful.

Dante sighs and dips into his shirt pocket. He looks at the 2 yellow football-shaped pills in his hand before he chases them down with beer. He will sleep okay tonight.

Dante has already lost his wife and kids. His job is secure, for now, because he is so good at it. Dante is on a perilous slide, and you and I cannot save him.

Dante is a fiction, but we all know patients like him. All we can do is do our jobs. Compassion for people like him will pay no returns. We would just be enablers.

Dante's not the only one. A few weeks ago, a patient who is very real, a classic type we'll call Steve, stood in front of me. I looked at him and said, "I am not filling your prescription for Vicodin ES. You made a mistake, and no pharmacy in town will fill your prescriptions."

"I have refills. You can't refuse to fill my Vicodins."

"You called in and gave me an Rx number that starts with a 4. That's not our number, but it is a big-box store number. I made some phone calls. You have Vicodin prescriptions at 3 pharmacies. A different doctor on each one."

"You violated my privacy," he charged. "You can't do that." All of a sudden there was white foam in the corners of his mouth. "I'm calling my lawyer."

"I can do that," I said. "The law is on my side."

"I want the name of your boss."

"Cut the crap, man." I carefully judged the counter. He was the quintessential drug-seeker. He had forgotten to eat and was rail thin. I didn't think he would climb over the counter and get violent.

"You're busted," I said. "By tomorrow, all your doctors will know what you've been doing."

"You can't do that." He was panicking.

"Would you rather the police do it?"

"I want my prescription back."

"You're lucky to be alive." Now I had his attention.

"What do you mean?"

"You've been taking 16 g of Tylenol every single day for months." I tried to make eye contact, but he looked over my shoulder at the technician, who was standing behind me with her mouth open. "Your liver is fried, Steve."