A Draining Kind of Day

Some days are absolutely draining, mentally I mean. Yesterday was one of those and I still feel absolutely exhausted even though it wasn't that busy.

My first patient was an incredibly ancient one who was cared for by family at home. She was brought in for 'weakness.' First of all, let me say how much I hate that chief complaint in the elderly. Weakness can be caused by a million different things - cardiac, stroke, UTI, pneumonia - so of course we have to do a long, complicated workup which, in this case, turned up nothing. There was nothing to admit her for so I called the family and told them to come get her. That is when the trouble began - they didn't want to get her, she was too much for them to handle anymore so they thought they would just dump her on us and let us handle it. This is a lot more common than you would think - apparently America thinks that the ER can fix any problem, medical or not.

So we had to get social services and discharge planning involved. The patient did not qualify for admission and if she needed to be placed the appropriate way to deal with this is to get her PMD to arrange that. Adult protective services got involved and ultimately the family was told to come NOW or face prosecution for abandonment. Arrangements were made with the PMD to get him to follow up with getting the patient into a SNF. This whole deal took HOURS to settle, not to mention two doctors, a nurse, a charge nurse, a social worker, an APS worker and two discharge planners. Ridiculous.

Then I had a psych patient who was on a hold that no one would take. He'd been in all the hospitals in most of California and been such a problem that none of them would accept him so we were stuck with him. How about a mandate from the government that forces psych facilities to take all the psych patients like EMTALA forces us to see everyone? How come they can pick and choose?

Anyway this guy was a complete dick. He was using the system to get a few hot meals and a bed for a couple of days - by saying he felt like killing himself. He didn't have a plan, he was well known for this and he was also positive for methamphetamine on his tox screen, what he really needed was a jail cell. He would not stay in his room so a security guard had to sit outside. He pissed on the floor, threw his meal tray at the wall and basically made life miserable for all. He also liked to scream obscenities- always pleasant for our other patients.

Then to make the day complete I had another patient, also incredibly ancient, with metastatic lung cancer who had no advance directive. Yep, you guessed it - the family wanted everything done. Instead of a pain-free, dignified death we got to torture him with needles and tubes and intubation etc so that he could live another couple of days in pain. Fabulous.

Thank God I have a few days off now, I'm going to need a little recovery.