46 year old male who's uncontrolled hypertension lead to kidney failure at the age of 42. Medicaid is paying for his thrice-weekly dialysis. Unfortunately he doesn't go very often as the three hour treatments interfere with his crack smoking. After two or three missed dialysis treatments he will come to the ER with chest pain. His blood pressure is usually around 280/190. He receives a full ER work up for chest pain and an admit to the ICU on a Nipride drip about twice a month. Each of those visits run around twenty or thirty thousand dollars. After a couple days he will elope from the hospital and go back to the 'hood to score some crack.
This one patient costs the system untold thousands of dollars every year. Where should we draw the line?
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- ERnursey
- A hardworking ER nurse trying to survive until retirement and if I can have little fun or have a positive impact on someone's life, all the better!
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13 comments:
As someone who was born with kidney disease but does everything possible to cling to good health (eating right, exercising, making out whenever possible) people like this frustrate me.
"Hi, I'm not going to work, pay taxes or benefit in any way, shape or form to society BUT when my body can't take any more crack, you BETTER take care of me."
Ugh.
People who throw God-given health out the window (obese, drug abuser) have no sympathy from me.
Sounds like a patient who spent 3 months on the floor I was working on. He was waiting for his insurance (Medicaid) to get worked out. In the meantime he got free housing, food, medicine, dialysis, maid service, laundry service...... Most of the time when he'd go to dialysis he'd get bored after a couple of hours and insist the dialysis be stopped. Then he'd go downstairs and smoke a little crack..... The day he was finally discharged, he came into the ED wanting to be readmitted. He did this everyday until he finally OD'd and died about 2 weeks later.
We just had our crack smoking dialysis patient die a few months ago. Had the same story as yours. Great patients to practice femoral sticks and EJ's on though. There is no solution only acceptance.
Make sure he scores that one bit hit?
We have one, too. guess hospital does.
Our crack-smoking dialysis patient died a few months ago. Same story, same pattern. He was a local drug dealer, they found him dead having fallen out of his wheelchair trying to get to the goods nearby.
I won't miss his screaming in the ER for "cookies and juice" once the chest pain and SOB had resolved.
Unfortunately we don't get to draw the line. I think if more people were aware of how much the healthcare system is abused by people like this we could get people motivated to change the system. Right now people only want to see the system change because of the affect it has on them...not because the elderly lady waiting in my lobby died because some POS like this was taking up valuable bed space.
We have this patient at my hospital too. Same exact story and same exact pattern. :(
Try going to the ethics committee and telling them to stop dialysis on this patient.
You get a speech on how we are here to help people (even if they won't help themselves??!!) and that we just don't decide things like that.
Personal responsibility no longer exists.
This is a tough one. I work for a mental health drug team and there are many people who don't want to help themselves who are physically unwell and taking the gevernement's money. On the other hand there are many people who have had rubbish lives, and if I have suffered their abusive upbringings I would no doubt be a crack smoking, heroin injecting 'loser'. I guess the real question is, does he want to change? Does he have a reason to change? I don't think there is a right or wrong.
Here's a plan from someone who takes care of people like this everyday...If you are a known drug user you get two choices, rehab or stop dialysis...if you successfully complete rehab you get to go back to normal dialysis schedule...if you don't, I'm sorry but there are people who need more help then you.
90% of my patients are prime examples of this, they have a total disregard for anyone but themselves and their drugs...and when they do come to dialysis they demand we hop them up on a cocktail of Lorazapam and Benedryl...even after all this the demands don't stop. So the other 10% of patients who are hard working, trying to make it day by day get less care.
It is so incredibly frustrating. The Death Committees of the 60s and 70s were a bit harsh but don't you think we should have some standards put forth? Like, um, no major drug abuse?
Just like some patients are too hemodynamically unstable to toelrate dialysis, some are not cooperative enough either.
I have no problem with treating anyone short term - even if you have endocarditis from IV drug abuse, you get your antibiotics, cardiac workup and maybe a valve. The valve decision should be based only on medical criteria.
But long term is more complicated. If a patient simply refused to take care of himself, prefering to use drugs instead, at what point can we a a society say "no more?"
Personal opinion (with no authority behind it) - acute care must always be offered, even if it involves comples procedures like surgery or dialysis.
Chronic care needs to be an alliance between patient and health care team.
We have no problem denying dialysis for "ilegals" who came from somewhere besides the USA. Maybe we would have more slots if we didn't reserve spaces for non-complaint "legals" who are abusing drugs?
I guess the real question is, does he want to change? Does he have a reason to change? I don't think there is a right or wrong.
Well, there is a right and wrong. And it is their attitude. Do they want to change or do they just say they do? If they truly show (by their actions) that they want to change then perhaps they should get help. Otherwise, let them OD.
In our E.D. about 10% are emergencies, 30% are urgent, and the rest are bs. I wish I could stop the bs at the door. All our complaints and negative feedback come from this group that deserves "nothing but the best." Smokes a ppd, drinks occasional, and won't buy a bottle of tylenol to help there sick child. We
had a woman leave the waiting room the other day, went home called EMS,
and had the squad bring them around the others who were waiting. As I escorted her back to triage, I wanted to yell "cheater" and point her out to the
others.
I get so pissed with the ignorant
and selfish people of whom we share our world.
Have you ever heard, don't worry about the bill, "I have the Medical Card".
I worry.
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