Yes Virginia, Drug Seekers Get Sick, Too
Shadowfax finds a kidney stone in a “known drug seeker” and treats her with toradol. Success. I had a somewhat similar case with a “known homeless drunk” who had pretty severe electrolyte derangements after I bothered to check, despite nurse balking. Only re-iterates the point: trust no one.
I assume that everyone I see came to the ER with the express intent of finding a way to die and make me look bad.
And I hate looking bad.
My question: What homeless drunk DOESN’T have severe electrolyte derangements? Many of them are chronically low on potassium, magnesium, etc (and presumably thiamine) because they drink, don’t eat, don’t absorb, and/or puke it all up or whatever.
Voila…the banana bag, folic acid, and thiamine.
As far as homeless drunks go, I always assume they’re sick with something. Depending on what that something-wrong is, many times you’re not going to have any measurable effect on the long-term cure or treatment of that something. Follow-up care? Long-term medication compliance? Dream on, brutha.
I have to second this. We have a notorious frequent abuser of Emergency Services who spends so much time wasting our time that we pretty much just give her all the dilaudid she wants almost no questions asked who came in with an honest-to-god perforated bowel. And the resident who caught it just said that something just wansn’t right…the drugs didn’t alleviate he pain.
The nurses always want to kick these patients out but I always tell them that I can only do what the patients tell me. In other words, if they complain of chest pain even if I suspect it’s a ruse to delay going to jail, I am as handcuffed as they are, both legally and ethically to assume they are legitimate.
Well, sooner or later, all of the drunks, med seekers and in general, psych patients who present to the ER WILL have something very, very wrong. The seriously/chronically mentally ill, many of whom are “street people” have more and more severe medical conditions than people who do not have serious mental illness. I’m a nurse whose 23 year worklife has been split between critical care/ER and public health/mental health. I’ve spent alot of time annoying co-workers because I insist on treating “THOSE patients” as I would any other. And numberous times, like Shadowfax and many, many others have found serious illness lurking. In addition, I’ve seen many a hope-to-die-dope-fiend clean up, soooner or later…as well as many a hope-to-die drunk. I figure I can’t see the whole picture…there are surprsies along the way…many…so, I’ll just do the bit I signed on for and work @ keeping open eyes, open mind. And yeah, it’s very, very hard sometimes. Kudos to Docs who keep on, keepin’ doing the “right stuff.”