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A funny thing happened on the way to the forum... - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
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.

now feeling:: angry angry

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Comments
coanteen From: coanteen Date: July 1st, 2008 08:21 am (UTC) (etched in stone)
Best thing would be for her to go AMA. Maybe one of the nurses will piss her off enough to do that.
I remember back in clerkship we had a patient like that, IVD abuser, frequent flier and most annoying man on earth, leave AMA when he most likely had IE ("most likely" because he refused any further tests once he became coherent). Came in a few days later already VSA, and staff consensus was good riddance.
winktwice From: winktwice Date: July 1st, 2008 11:40 am (UTC) (etched in stone)
glurgh
jillofthejungle From: jillofthejungle Date: July 1st, 2008 02:45 pm (UTC) (etched in stone)
...gees.
clipdude From: clipdude Date: July 1st, 2008 04:21 pm (UTC) (etched in stone)
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.
Do you ever find yourself wanting to say "Fine. If you want to risk your life over a @$@# turkey sandwich, be my guest?" (Not that you would say such a thing, of course, but you must be tempted!)
ayradyss From: ayradyss Date: July 2nd, 2008 10:11 am (UTC) (etched in stone)
Oh, so tempted sometimes.
smallstar From: smallstar Date: July 1st, 2008 09:08 pm (UTC) (etched in stone)
Ahh, personality disorders. Anybody who makes you want to strangle them that badly must have one. :) Don't forget to set firm limits, and be totally calm. She'll waste less time trying to manipulate you if she knows it won't get her anywhere.
From: broken_onewon1 Date: July 2nd, 2008 02:59 am (UTC) (etched in stone)
Every society has a percentage of people that is just plain worthless for all practical purposes, and their only redeeming attributes know only to God, who in these instances seems to keep his cards pretty close to his vest. You might find comfort in that your not alone in having to deal with people like this sadly people like her exist all around the world, being annoying anchors around the neck of what ever society they exist in. I know It's a misery loves company anology, but it was all I could come up with. your not the only one who has to deal with crap like this. *hug*
ayradyss From: ayradyss Date: July 2nd, 2008 10:11 am (UTC) (etched in stone)
Thanks, hon.
mdrnprometheus From: mdrnprometheus Date: July 2nd, 2008 11:48 pm (UTC) (etched in stone)
What *is* this thing with crazy persons and turkey sandwiches, anyway? That's also the desired food item of the people in our psych ER, and is almost as effective as Haldol in calming them down.

This whole sort of thing is actually one of the reasons I really like working at the VA. The patients often take miserable care of themselves and are generally crotchety, but once admitted, they're very undemanding. I guess once you've survived war, everything else just isn't so bad.

Of course, it's also why I'm seriously leaning towards psych as a specialty -- I get *paid* to deal with the Jills of this world, and moreover, I will be given sufficient behavior-management tools that all their acting out will get them precisely nowhere.
ayradyss From: ayradyss Date: July 3rd, 2008 03:37 am (UTC) (etched in stone)
More power to you :)
I thought about psych, but ultimately I'm too nice :P
jays_princess From: jays_princess Date: July 3rd, 2008 02:56 pm (UTC) (etched in stone)
can i say i empathize? because i do.
11 whispers echo . o O ( ... ) O o . whisper a word