my last patient of the day has had 107 ER visits to our ER in the last three years. That is just my ER, a friend that works across town told me he is a frequent flyer there also. His visit history reads; back pain, dental pain, arm pain, pain, pain, pain. If you take the time to go through the charts he has been told 8 times in the last three hears that he will be given no more narcotics and yet on the very next visit he will be give a 'script for Vicodin.
We are contributing to his slow death.
This is not why I went into nursing. I did not intend to be turned into a drug dealer. I don't like it and it sucks the life out of me. We are not doing these people any favors, just the opposite in fact.
Tonight played out like this:
He came in with acute narcotic withdrawal. He ran out of Methadone three days ago and he had a visit to our ER that day for dental pain for which the NP gave him 20 Vicodin. Obviously he has used those all up, he sits in the triage room vomiting into a basin, covered in goosebumps. We offer him IV fluids, anti-nausea medicine and clonidine to block some of the symptoms but he refuses. All he wants is drugs. The doctor is firm, no drugs. He becomes enraged and flings the basin of vomit at the doctor. A security alert is called and the police summoned. He is dragged from the ER in handcuffs, screaming threats on the way out.
While all this is going on there are families with small children, elderly ladies with chest pain and a dying grandfather in the adjacent room. Real patients with real problems who are cheated of the care they deserve by toads like this man. I would hate him but we helped to create him.
Wednesday, January 23, 2008
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12 comments:
I work in gen med, where these parasites eventually get admitted (the ones that do anyway).
I've seen patients on enough narcs to take down much larger animals (640mg of OxyContin daily plus IVP Dilaudid, for example), still complaining pain at a 12, but so stoned they look like they're on heroin.
What drives me nuts is we all know they're seeking, and some docs give in, some don't, but nobody is in a position to say "listen chief, you've got a problem, and we're not feeding into it anymore, here's a social worker to get you hooked up with a rehab" because it's a monster we've created...among other things.
Sigh.
I love your blog, by the way.
Thank you Melissa.
I've actually thought about calling the DEA on our Dr. Bloody Gloves. I can't stand this drug dealing crap anymore. Percocets are for severe pain, not a 1 cm finger lac, repetitive stress injuries nor viral syndrome with body aches.
You should call the CDC too while you're at it. But make sure you wipe the phone off first.
The sad reality, though, is that it would take far more resources to fix a long-term, hardcore, drug-seeking addict.
Where would you start? Housing, employment, psychotherapy, detox? How many times should you let someone bomb out of rehab? Twice? A dozen? Two dozen?
There are some issues that are just too expensive to fix. The best you can do is try to meet these people's basic needs and point them in the right direction in the event they decide it's time to quit their habit.
I am sorry any ER must serve as gatekeeper to any addict's habit. I don't understand opposition to people using pain meds to feel better in any way they wish, even if it makes them sick and leads to their demise...but I certainly understand the drain on the gatekeeper's time and energy and the drain on resources the way narcotics are controlled now.
I think the controls on narcotics don't help addicts or physicians, and harm people who are suffering from conditions the narcotics improve.
Your last line - I would hate him but we helped to create him - contains so much. Very poignant, and well written.
You so well phrased every RN's frustration with this matter.
You know it's a bad day when you are taking dilaudid out of the Pyxis and you already know the count because you have visited the dilaudid drawer so many times. For one person. I hate that!
You are right, we help create them.
Where I work it just seems like the chronic seekers only come in when a few certain doctors (the ones who give them the drugs) are present. It happens so much that I can't help but think it's not coincidence. I have to wonder, Are they being tipped off?
Does this happen to anyone else?
Many people in the rest of the hospital think we are very cold because we know, pain is not always what the patient says it is. A few years ago we had someone come in frequently complaining of pain in her foot. The doctors jsut gave pain meds and got her out. Eventually she rolled her car while high on drugs she got from the various ERs, Doctors, Clinics, etc in the area. She killed herself and her unborn baby. Did we do her a favor by feeding her habit?
Come to my forum and find people who are like minded :)
www.ihatenursing.com
There's not enough money for rehabilitation; at least, not for the average person. Jail is probably the best place for someone like that to get the help they need with their nasty narcotics habit.
Did your facility and your doctor press assault charges? My guess is "no," but I'd be very happy for that patient if you did.
Unfortunately if you stop giving them drugs they'll just move on to the next hospital. *sigh*
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