“Sonny’s Blues” is a 1956 story by the author, James Baldwin, about a “sensible” and pragmatic algebra teacher and his younger musically gifted younger brother (“Sonny”), who struggles with heroin addiction. Both of them, raised in Harlem, are deeply affected by anti-Black racism.  Although the older brother, who narrates the story, feels responsible for Sonny, he struggles to relate to him. With the help of an English professor, Laura Greene at Augustana College, we reflect on some of the lessons of this story for the physician-patient relationship, especially when caring for individuals with substance use disorder. We explore the cost both to patients and to ourselves, as healthcare professionals, of holding patients at arm’s length because we fear engaging, especially in the face of suffering. A PDF of “Sonny’s Blues,” can be accessed from the story’s Wiki page (scroll down to external links).