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A Piece of My Mind
March 3, 2010

HIV Clinic

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.

JAMA. 2010;303(9):819. doi:10.1001/jama.2010.209

     We met in February, and like many patients in this clinic
she had chronic pain.
     I will try to help but, as for so many in this clinic, the pain
is not just physical.
     The medications you gave me are helping my pain and it is
time for me to pick up a refill.
     My knee is hurting bad today but to get my medicine I will
have to walk to the pharmacy since I have no one to give me a
ride and my voucher for the bus is expired.
     She is here to pick up her prescription, and we meet in
the lobby.
     I hope it is okay to eat crackers in here. I saw the gas
station on my walk here and remembered that I had not eaten
anything since yesterday.
     My stomach pain is worse and I am still bleeding a lot, but
they say I can't get surgery because I don't have an address to
be discharged to from the hospital.
     I wonder to myself if living in a condemned building with
no utilities is the same as being homeless.
     Weeks pass and she calls the clinic.
     My pain is worse. Can we increase my pain medications? I
can't afford to buy my medicine, so will you help me? My phone
does not have any minutes, so I will have to call you back and
trust that you will be working to help me and that when I call
you will have an answer.
     She is back in clinic today after several missed appointments.
     The new pain medicine is working better. It is not time for a
refill, but my husband stole my pain medicine. Here is the police
report. Can I get a refill to relieve my pain or will I have to wait?
     Who can I trust when the one person in the world who says
he loves me is stealing from me?
It is December now and time for another refill.
     I am feeling pretty sick today but need a refill on my pain
medicine. I will have to walk to pick up the prescription if you
can call it in.
     This was the last day that I or anyone talked to her.
     The requested prescription was never filled.
     The last day of her life and one final request to relieve
her suffering or, possibly, a last effort to experience one small
     Is there a difference?

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