Antoine: I guess I've been having them ever since I got back, which is like six months ago now.
Austin: About six months, okay. I bet the couch doesn't help with your back pain, either.
Antoine: Oh hell no!
Austin: Dr. Singh is gonna come in and examine your back, and then we'll talk about what to do to help you feel better.
Coach: Provider’s exam results: Antoine's pain is in his lower back, down into his legs, described as sharp and burning. No numbness or tingling. Standing, walking up the stairs makes it worse. Back flexion and decreased side flexion with bending to the right worse than the left. Point tenderness along the thoracic and lumbar spine and left and right lateral to it across the whole area. No tenderness in hips or buttocks, negative leg lifts, normal lower extremity reflexes. Normal motor strength and sensation but pain with the hip flexion and rotation.
Austin: I've worked with a lot of clients who are veterans, and it usually takes them a while to readjust when they come back because things are just so different here.
Antoine: You got it. Especially when I'm kicked out of my own bed! Nobody gets it. My wife, my daughter, my boss, they do not know what it's like.
Antoine’s thought: Everyone wants something from me. I don't know how much longer I can take this.
Austin: So, with your back pain and your sleeping issues, what makes you feel better besides the Percocet?
Antoine: Oh. Well, the, the Percocet really helps, takes the pain away and helps me sleep. Um, oh yeah! Wait, what was I saying?
Austin: Does anything else help with the pain?
Antoine: Um, just parking myself on the couch and being alone, having some beer, watching TV, trying to get back some of the time that I lost when I was deployed.
Coach: Antoine seems a bit distracted. If this continues, it could be a warning sign of some more serious issue.
Austin: How often do you drink?
Antoine: I don’t know. Like, most nights, maybe five nights a week? Helps me relax.
Austin: And, on those nights, how much do you drink?
Antoine: One or two six packs. Probably closer to one, maybe two. I don't see what this has to do with my back.
Austin: Well, knowing about your drinking patterns will help Dr. Singh determine what kind of prescription to write for you. So tell me, how long has this been your pattern, drinking one or two six packs five nights a week?
Antoine: Since I've been back at home, I guess. But I deserve it! Those last few years were not easy.
Austin: Besides the beer and Percocet, do you use any other substances to help with the pain and nightmares?
Antoine: (laughs) I'll be honest, um, I do smoke a little weed, you know, here and there when I can afford it. Takes the pain away.
Austin: Okay.
Antoine’s thought: I guess I can tell you that, right? Confidentiality and all that?
Austin: And do you ever wake up and feel like you need a drink to get yourself going for the day?
Antoine: No.
Austin: So your wife thinks you're drinking too much.
Antoine: She would prefer that I drink less, that's how she puts it. She's on my back about it, about everything! How come I don't wanna play with our daughter, she wants me to go out more, and she would like me go to the little parties with her friends, and I keep telling her my back hurts too much! And that is mostly it, but I prefer to stay at home. I put my ass on the line over there. I deserve a break. And her friends, they drive me crazy anyway.
Antoine’s thought: We can't go on like this much longer. I wonder who'll give up first, me or her. Maybe it would be nice to live alone again.
Austin: Why don't you want to go places with your wife?
Antoine: Because there's a lot of jerks out there. You don't, you have no idea what they're gonna do. Somebody's always starting something, and I don't want to be bothered with that.
Antoine’s thought: Like that guy at the bar, talking about the war like he knows something about it. I really can't take people anymore.
Austin: It sounds like potential conflicts with other people make it uncomfortable for you to leave the house.