June 30th, 2008

Nescafe rabbit

A funny thing happened on the way to the forum...

Residency patients, to broadly generalize, tend to be poor folks. Many of them are good honest people who are trying to make a living with what they have, and I love them for it. They're the reason I'm at the clinic with the social worker until 7 PM some nights. They're not the ones this rant is directed at.

I'm talking about the Jill's of the world. You see, O Best Beloved, Jill is a mid-fifties former cocaine addict who moved onto prescription narcotics. I think she's selling them. She gets them because she also has end-stage COPD, and she was in Hospice for a while before she got booted out for abusing the system. At one point this woman was receiving daily Oxycontin with a street value of around $350 and couldn't seem to keep track of them all - and it's been my task to wean her off her meds. I know she's taking some of them...I've seen what happens when I took them all away. I just don't know how many.
Jill is on Medicaid. She pays $3 for her prescriptions, and my tax money covers the rest. And Jill likes it that way. She likes it so much that she hasn't bothered to quit smoking or lift a finger to help herself in the last fifteen years, as far as I can tell.

And now in the middle of my free afternoon, catching up on paperwork, I get a call from the ER. Jill, on home oxygen, was smoking in bed. I assume most of you at some point have had it explained to you that fire + oxygen = BIG FIRE, and that's precisely what happened. Her nasal cannula came out of her nose. Her cigarette butt came in contact with the oxygen. A large fireball ensued. Jill burned her eyebrows and her face and the inside of her nose and wound up being admitted under observation for her flash burns.

The point of all of this is that when I came to the ER to admit her, and talk her into having the lab work done, and talk her out of leaving against medical advice (she could die from this!) because I wouldn't give her a turkey sandwich...I found myself with very little compassion for my patient.

Actually, O Best Beloved, to be honest, I wanted to strangle her. This was a preventable event. More than preventable, this never should have happened at all. This is a woman who is intelligent enough to understand the fire + oxygen equation, and whom I have repeatedly warned that such things do happen. She has refused time and again to even contemplate quitting smoking, despite her condition, and now my life is disrupted (and I know I signed up for this when I became a family physician), and she'll sit in the hospital and drive the nurses crazy with ridiculous and unreasonable demands as she has on every other admission. She'll want to smoke. She'll want to be fed. She'll demand ever-increasing amounts of pain medications. She'll refuse to do anything unless it's precisely the way she wants it done.

And I'm bloody well funding it. I just want to scream.
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