partly_warmer-watch ER sometime! Sheesh!
Q. the Magician said: “As for my other comments, you were the one to state that Dr J. was not treating her for the right problem in your first post, and when confronted on that, responded that the only thing you didn’t know what to do about in her situation was her disruptive behavior. What is a reasonable person to think? A BP of 280/150 takes immediate priority over most any other diagnosis. It is acutely life-threatening.”
No question, as far as I can see in my very, very, very limited medical experience that the most severe condition must be treated first… But he was talking about several visits, all alike.
Take an analogy to a friend who’s a dentist, who never stops complaining how patients don’t listen to her about brushing and flossing. “Why even try?” she wails. Gee. Does it occur to her that maybe her explanations are ineffective? That she should be more persuasive? Nope. It’s the patient’s fault. Leave aside that she’s the expert, and knows thousands of things the patient might want to know.
So in the OP we have a doctor being (justifiably) upset at some woman strung out on drugs screaming at him. But rather than explicitly give the problem to someone else, or resign himself that he’s tending a sinking ship, he gets angry and starts imagining screaming back at her. Not what she needs. Not what he needs. Ok, so maybe I should have just let him rave unanswered here on the board. It’s theraputic. On the other hand, maybe there’s actually a better approach.
CrazyCatLady said “Frankly, partly_warmer, turning on a computer is roughly equivalent to putting a band-aid on a skinned knee, and you know it.”
Well, it’s not a life and death matter, true. But it is my profession, and I have as much pride in mine as you have in yours. I’ve spent decades having people tell me they understand their computer, and don’t need suggestions: just before all their data’s lost, or they’re infected with a virus they can’t get rid of, or a hacker breaks in. Or they buy $500 upgrade to fix the wrong problem.
They rarely listen. Yet they still use their computers most of the time correctly. Patients rarely listen, yet their bodies work most of the time. Same difference. Professionals are never listened to as much as they think they should be.
Geez, I spend a day admitting, and come back to find my colleage and mentor QtheM and my beloved fiance CCL defending my honor.
What you must understand is that Customer #1 flatly, completely, and 100% denies that she uses cocaine or crack, despite the fact that her urine has been positive for it every single time she’s been admitted. Even mentioning the word “cocaine” will set off another shouting fit. It was a gentle suggestion that perhaps her blood pressure would improve if she laid off the coke that prompted her to throw that phone book at the attending.
Yes, she has been referred for counseling. She has been given the number for alcohol and drug services every time she leaves here. (They like the patients to make their own appointments–when we make them for them, they almost universally don’t show up.) Half of our residents have tried to talk to her about it, to no avail. Our army of cracker-jack social workers and behavioral health folks has been all over the case, only to be rejected one after the other.
My idealistic side would like to call this behavior a cry for help, but my realistic side tells me otherwise. If she wants to get clean, the next move really is hers.
Believe me, I am compassionate. I could have discharged her last night–everyone wanted me to–but I knew she’d be better off with another night of IV fluids, so I kept her. But it’s possible to be compassionate, mind-boggled, and thoroughly pissed off all at the same time. Truth be told, that’s one thing I like about this gig–every day I discover a new combination of emotions I didn’t think was possible before.
Dr. J
Well, maybe the problem is you’re just too nice a guy. I don’t suppose you’re allowed to scream at her, but I could wait outside for her with a cosh and AA literature…
I’ve often wondered what would happen to such people if they were just dropped off on a desert island someplace.
Interesting about you finding new emotions all the time on your job. Sounds worthwhile in itself.
This is exactly it. And, unless you work on the front lines, I doubt you’ll ever truly understand or forgive us for this type of “triple think”.
Umm, he said new combinations of emotions, not new emotions. Please try to pay attention.
Also, if this lady were dropped on a desert island someplace, she’d die. She has kidney failure, and that doesn’t just magically reverse itself most of the time. In the interim, though, I’d say she’d spend most of her time looking for ways to get high.
I think “new emotions” is fair. The wholes are never quite the sums of their parts.
I work at a VA hospital and we see an endless stream of patients like the lady described in the OP. Alcoholics who come in with blood ethanol levels of 0.525 trying to avoid a night in a jail cell. ER physicians always try to talk them into detox but most aren’t interested. Some agree and only last a couple of hours on the floor before walking out. Some go through the whole thing and as soon as they are discharged take a taxi to the nearest liquor store. Some go through the rehab program five or six time and still show up in the ER drunk about once a week. Same for the drug addicts. I’ve run labs on patients who had legally drunk levels of etoh and were positive for opiates, benzos, amphetamines and cocaine. All at the same time. These people are told bluntly their behavior will kill them but still they do it. They are talked to so many times it begins to sound like a broken record. The only person who can stop their cycle of destruction is them. They have to want it. It sure isn’t for lack of the doctors and nurses trying to beat it into their heads that they’ll die if they don’t stop.
Jeez, I used to think I was bad. All through the past decade I was going up to DUMC* for IVs^ treating my ITP" anywhere from once a week (on the not working stuff) to four times a year (on the working stuff). Problem? I am severely needlephobic. I almost passed out when I got a TB test last month. There was a time when the hematologists used me to break in the new interns. But I was never ever as bad as these people. (Mostly because they doped me up real good on Benadryl as part of my pre-meds so I was nigh unconcious by the time I left).
So I would like to take this space to apologize to anyone who’s ever drawn blood from me, past, present, or future. And if you’d like to relax after dealing with these clowns, DrJ, you can always scrape me off the ceiling after I see a hypodermic.
*Duke University Medical Center
^Intravenous (I think there’s supposed to be something after that, but dunno what)
"Immune Thrombocytopenia Purpurae (look it up)
Before I start ranting, let me state my qualifications in the addictions area just in case someone joining us doesn’t know them.
I worked for four years in a drug rehabilitation facility. Although the bulk of our business was methadone treatment for opiate addicts, we saw quite a lot of other business, not to mention the mix-n-match-substances crowd. Granted, I was administrative, but I certainly saw a lot of amazing stuff, and if you think administrative folks are totally insulated from the crap flying around you haven’t been paying attention. Everything from diving under my desk during a police raid to ducking while someone sailed over me on their way through a window to getting out of the way of lobby fist-fights to providing comfort friends and family members (and occassionally counselors) who had lost a loved one.
No, DoctorJ is venting in a forum where the privacy of his patients will not be compromised, away from their earshot. It’s a sign of good mental hygiene in someone working in medicine (and certain other fields). You can’t bottle this crap up forever, it will eat you alive (and I’ve had co-workers literally removed from the workplace for doing just that back in my clinic days). Prior to the internet, this venting used to take place in bars (“cop bars” being another area this sort of thing erupts) and restaurants in close proximity to hospitals, firehouses, and so forth. Now, the general public gets to enjoy some of it. I’m really sorry if it gets your panties in a twist, but folks who have to deal with this as part of their job really DO need a safe place to voice their 'forbidden" attitudes.
If you don’t like it, change the channel.
Hate to break it to you, honey, but some broken things can’t be fixed. I’ve seen hundreds like this woman. Yes, sometimes all you can do is treat their physical problems until they die. It is harsh, but true.
This is what separates the saints from the do-gooders. Saints will give whatever aid and comfort to the suffering they can, even if said sufferers are unpleasent, horrible people. Even if they’re irresponsible people. Even if they are criminal. Even if they have poor bodily hygience and parasites crawling over their skin and through their hair. Do-gooders just want to feel good for helping the unfortunate, as if someone else’s recovery should be a feather in the do-gooder’s cap, or points towards heaven, or whatever, but they get hostile and frustrated when having to deal with the reality of some people will die because they don’t want help.
You, Partly_warmer, are a do-gooder. Qadgop is in the saint category, providing medical care to very unpleasent people. That doesn’t mean our favorite Mercotan is always such wonderful company himself, or that he’s flawless, just that he adheres to a very admirable code of professional ethics even when doing so is difficult. I’d say DoctorJ is leaning the same way.
Do you have good medical insurance, Partly_warmer? Addicts do not always react violently, but I had to call 911 a couple time for folks passing out literature outside the clinic I used to work at.
Let me repeat something that has been said before: You can NOT help an addict with the addiction problem until that addict WANTS to be helped. You can stand by and offer all you want, but you can’t force a cure on them.
I can’t count the number of times that we had to content ourselves with damage control, rather than actually rooting out the cause of someone’s problems. I’m really sorry if this doesn’t conform to reality as you know it, but that is the way of things.
Yet another doper checking in to tell partly he/she is behaving like an ass.
partly, in one of your many snide and insulting posts, you mention: “Take an analogy to a friend who’s a dentist, who never stops complaining how patients don’t listen to her about brushing and flossing. “Why even try?” she wails. Gee. Does it occur to her that maybe her explanations are ineffective? That she should be more persuasive? Nope. It’s the patient’s fault. Leave aside that she’s the expert, and knows thousands of things the patient might want to know.”
And then, later, you neatly contradict yourself by saying: "But it is my profession, and I have as much pride in mine as you have in yours. I’ve spent decades having people tell me they understand their computer, and don’t need suggestions: just before all their data’s lost, or they’re infected with a virus they can’t get rid of, or a hacker breaks in. Or they buy $500 upgrade to fix the wrong problem.
They rarely listen. Yet they still use their computers most of the time correctly. Patients rarely listen, yet their bodies work most of the time. Same difference. Professionals are never listened to as much as they think they should be."
Hey, maybe your explanations are ‘ineffective.’ Do your job better, and these people won’t be so bull-headed. You’re the expert.
I think you should apologize to DrJ.
Broomstick made an excellent point about saints versus do-gooders. I think it bears repeating with a slightly different emphasis on the distinction. Saints help people live their lives any way the person wants to. Do-gooders help people live their lives the way the do-gooder thinks is best. Saints don’t force their intervention on people, they calmly and non-judgementally offer their assistance. Do-gooders actively try to convert, coerce, or even force people to do things they believe will benefit the person. The difference is respect. A do-gooder does not respect the right of a person to screw up their own life.
PEOPLE HAVE TO BE ALLOWED TO MAKE THEIR OWN DECISIONS EVEN IF IT APPEARS THEY ARE MAKING A MAJOR MISTAKE.
Saints understand and respect this. They offer advice to help people make better decisions, they offer advice and help to mitigate the consequences of mistakes. That’s as far as a Saint goes. The first rule of being a Saint is, you can NOT force a person to make the decision you think would be best for them.
It’s HARD to be a Saint and it hurts to watch people screw up thier own lives(thus DoctorJ’s need to vent). It’s still the right thing to do. Free will is the greatest gift and greatest birthright of being human. Saints respect that. Do-gooders do not.
Enjoy,
Steven