Last July I wrote this post http://thedazeofwhineandroses.blogspot.com/2011/07/what-if.html about the ER's responsibility to say 'No' when it comes to prescribing narcotic pain medication. Addiction is never a patient's intent when they come back again and again and again for symptoms that don't match up with test results but it is a known fact that that is the likely result. While the patient may not be ready to acknowledge this end result healthcare workers DO know the slippery slope on which they are headed. I hate the healthcare dollars that are wasted by this 'frequent fliers'. I hate the drama that each of those visits bring in a effort to convice us that the pain is real. Most of all I hate that this is someone's brother or sister, someone's child and that I am playing a part in their undoing in the name of Customer Service and Patient Satisfaction.
Last year I even wrote Obama about my concerns. I almost got fired over it when I posted the letter on Facebook. I wrote about a patient [didn't name him or disclose any details about him] who had been to the ER 50some times in 6 months. Mine wasn't the only ER he came to. He 'hospital-hopped' and didn't fill his prescriptions because coming to the ER cost him nothing. He mis-used the system, frequently called 911 to bring him in and has been a pain in my butt the entire time I have worked there.
He pissed me off a few times. Really pissed off. Tried leaving with his IV in more than once and I called Security each time. There's only one reason a drug addict leaves with an IV in. After that little stunt I refused to start an IV on him ever again. Met with the Director of the ER and refused to take care of him ever again too, Nobody wanted to take care of him so I backed down from that.
As it happens all too frequently with addicts he got really sick several times. Suddenly I was the only one who could get his IV - his veins were shot. I went from not wanting to do an IV on him to hoping I could get one in before he crashed.
He and I talked about why I was so mad at him for abusing the system. About why I was so frustrated he was only 31 and abusing his body in a way that would eventually kill him. A couple of times I thought I got thru to him. Pretty sure I did. Really thought I did at the time. Talked to his mom. Thought I might have gotten to her too.
I haven't seen this man [or his twin brother who has the same addiction] for several months. I've thought about him from time to time and hoped that they both beat it this time.
His brother came in today. He has gained a much needed 50ish pounds and has been 'clean' since Christmas - he really looked good - but fell off the wagon 2 weeks ago and was looking for some help. He fell off the wagon because his brother had died.
I feel sick about it. Intellectually I know, as one of my favorite, trusted docs pointed out, 'he was living on a spent dime' There is a limit to the abuse a body will take and Larry had surpassed his. I'm sure the mg of Dilaudid administered in 2011 was in the hundreds. Really.
I'm left with this question that will always be there - What if? What if we had said no? What if I had been pushier and refused more? What could I have done to tip those scales?
Just sick about it