We present to you the challenges of treating a fellow physician in dire straits. A resident who is mid- way through residency training is referred to us by the Committee of physician health for Addiction treatment , which the patient must complete to stay enrolled in the program. How do we deal with this situation when the physician minimizes symptoms, the circumstances of referral, the need for treatment despite having lost multiple support in life and is now about to lose a residency position, possibly the only remaining protective aspect of the patients life.