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Doctor Nagel opened the door with a little pad and a pen in his hand, walked in the small exam room, sat down on the black swivel stool and looked at me with a stern smile. I could see he was a serious man but I didn't expect him to look me in the eye when I spoke. He put the pen and pad down on the counter beside him and shook my hand as he introduced himself to me (I noticed as we were shaking hands that the pad he had brought in was not a prescription pad and later saw he used it to take notes). Our conversation looked something like this after the introductions: "I'm here to establish with a primary care physician to manage my anti-depressant prescriptions. I moved to here about a month ago and only have one refill left of each medication I'm taking.  I feel miserable, like I don’t exist.  I feel like I live in a glass coffin that someone has put into the ground but no one has buried. I can see the world passing me by as I lay looking out, banging on the glass begging a passerby to let me out, but that's only on one of my two good days a month. The rest of the month, I'm screaming at passersby to bury me altogether.  I don't feel like an active participant in my life, I'm barely existing. I feel like I’m standing on the sidelines of life watching everyone else live it." Dr. Nagel responded with, "I'm not really interested in managing your depression.  I'm more interested in finding out what is causing your depression. You weren't born depressed, and you certainly don't have a Prozac deficiency.  Let me gather some information and take some lab work and I'll tell you what's causing your depression". I said, "Does this mean you're not going to write me any prescriptions for my medications today?"  That was my biggest worry. The thought of being without my anti-depressants frightened the hell out of me. I didn't want to feel just yet.

During our lengthy appointment he asked me questions I'd never heard a provider, let alone a physician, ask before in my hundreds of medical visits, including emergency room and specialty providers. In additional to the typical history and physical, he asked me things about what I ate, what my lifestyle was like, how often I pooped, what was my poop like when it came out, how many hours of sleep I got and was it day or night hours, what kind of recreational drugs I used, and other questions that gave him a good picture of the choices I made and make in my life. He checked my teeth, pinched the skin on the back of my hand, made a comment about my eyebrows, and asked if my parents had their entire eyebrows still, he took my pulse and listened to my heart (he commented on my irregular heartbeat). I think because of his lack of response to my answers gave me the freedom to answer candidly. It felt like he was more interested in my health than I was. I never felt judged by him and I gave him some answers to cringe at. He actually did cringe at a couple come to think of it but it was very cringe appropriate, even for a stone-face like Dr. Nagel.  For a stone-faced kind of a doctor, he was the only doctor I felt listened to what I was saying.  He validated how I felt and had an underlying compassion that came through somehow.  

As the unusual questions kept coming, one question Dr. Nagel asked stopped me cold in my tracks.  I did not expect this question of this magnitude and worse, I certainly didn't know how to answer it.  He asked, "Tell me about your childhood".  As I sat on the end of the worn exam table, I contemplated the question and how I should answer that.  "What a Pandora's box", I thought, and "Should I be completely honest and how much should I reveal, if anything at all"?  I still wasn't sure about the relevancy of the question so I responded to him, "If you read the book  A Child Called It  by Dave Pelzer, you'll get a pretty good idea".  He nodded and handed me a lab requisition to get my blood drawn.   He instructed me to make a returning visit for two weeks out to go over my labs and a plan for treatment.  It wasn’t until later that evening when I realized I left Dr. Nagel’s office without any prescriptions.  In fact, I hadn’t seen a prescription pad at all and no talk was mentioned about what medications we were going to “try and see if they work“.   I wasn’t sure if I scared or hopeful. I did go t bed that night feeling like a doctor had listened to me for the first time.  

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