Sometimes Love Means Saying No

For I wrote to you out of much affliction and anguish of heart and with many tears, not to cause you pain but to let you know the abundant love that I have for you. 2 Corinthians 2:4

I’ve practiced medicine – in the Emergency Room and Urgent Care – in the same town for almost 20 years and so it often seems that I’ve met almost everyone in the community. When I first came out of training, I’d been taught to be liberal with pain medications. That was the culture and standard of care back then, so, I wrote a lot of prescriptions for controlled substances in my early career. Years later, myself in recovery now, I’ve changed my prescribing practices radically just as our knowledge of pain medications has drastically evolved.

When I speak on addiction around here now, it’s not uncommon for someone to come up to me afterwards and tell me that my prescription was his or her first exposure to opiate pain medications. You gave me the pills that began my addiction. That hurts more than a little. I meant well, but looking back, it wasn’t just the medical culture at the time. My own proclivity for pain medications made me less likely to say no. I thought I was being kind – I prescribed how I wanted my physician to prescribe – but in doing so, I contributed to the addiction of others. My misguided efforts at compassion were actually destructive and evil.

In today’s passage, Paul admitted that reprimanding other Christians was hard for him. It pained him to cause them pain, but his anguish was necessary to truly display his love. Love doesn’t always mean being tough but discipline is sometimes necessary.

Now, as I spend a fair amount of time in addiction medicine, I’m frequently presented with unhealthy requests. I want my opiate pain medications while in treatment. It’s often my job now to say no, which is rarely met with gratitude. Saying no isn’t natural to me. It would be much easier to simply give people whatever they want. Denial often leads to confrontation and confrontation makes me uncomfortable. If I want to be a good physician though, I must love my patients enough to embrace the discomfort of doing what’s right.

Whether it’s in our parenting or in our work, we all have those moments where it would be easier to just choose the smooth, easy path. If we truly love those around us though, we must, at times, sacrifice our own comfort to do the right thing. Sometimes love means saying no.