Juxtapose

I don't get a lot of drug-addicted patients on my unit at the hospital. More often, it's alcoholics who are in liver and congestive heart failure, scraping the bottom of the barrel of health to try and survive a few more years. Every once and a while, I get one or two, and each experience with drugs is more sobering to me than any anti-drug campaign. I'm stuck with the task of doling out narcotics that we're forced to prescribe as maintenance doses who they don't go into withdrawl, but even the massive amounts that the prescribers allow are usually not enough to tide people over.

My favorite addict was a chest pain patient on a nitro drip and 90 percent occluded coronary arteries who was awaiting bypass. He was a young guy, a sweet guy who talked to me the whole shift about his love for fly fishing and who, mid-assessment, yanked my stethoscope out of my ears to show me that on the television there was a little otter, belly-up in the water, cracking oysters with a rock so it could eat them. He never once pushed the button for the nurse except for every six hours when he would politely ask me if it was time for his pain pill yet, and every six hours I gave it to him, and every six hours my heart was a little bit sadder.

I've also had horrible experiences - people who are so tiny they barely look like they could stand, so wasted from drugs, alcohol, and smoking that they barely look alive. So, because we can't ever say we can't do something for someone, we give it a go once more. We take half a lung out this time, then another half a few weeks later, then biopsy the liver or try to coax their kidneys to work again after thirty or forty years of mistreatment. One eighty-eight pound patient in particular was a bit of an actress and in between screaming at me for her pills and calling me a bitch and other (more unmentionable) names because I couldn't give her more narcotics than she was prescribed, said, in a tiny, raspy voice, a crooked finger pointing straight down my nose, "You are making a med error. A MED ERROR. You need to get my meds straightened out or you will Lose. Your. License." Two minutes later she had taken her (prescribed) pills and grabbed my arm to pull me into a bony hug and started crying about how she was sorry and that she just couldn't understand why she would get lung cancer (40 years of smoking two packs a day) and why she was so thin (methamphetamines). Just.. so lost.

As if to remind me after reading Heidi's blog post about drug addicts in the hospital, yesterday I had a med-surg overflow admit who was a wearying cocktail of schizoaffective personality disorders, fibromyalgia, and "chronic pain" diagnoses. I ran myself ragged to try and nip his five bajillion absurd requests in the bud - "I'll need three cups of coffee, six sugars, three creams, an orange juice, and a prune juice.. my sugar gets low..." and "Get me a social worker right now! I need to make sure I get a voucher for my cab ride home tomorrow!" And as I brought him one of his three varieties of daily scheduled narcotics, he said the line that they all say, every time, every single time I have a "chronic pain" patient, "Thank you, honey! I didn't mean to yell at you for my pill, I'm not addicted! Been clean and sober for years! I'm just in a lot of pain, you understand..." And with that, he promptly gulped down his thirty milligrams and passed out, like the pain was gone already.