* * Anonymous Doc

Tuesday, November 3, 2009

We have a homeless patient, a crack addict who's either faking chest pain to get pain meds or has chest pain because of all the crack she's smoking, and she's refusing to talk to med students, residents, or fellows. "Get me a real doctor," she insists. "An attending."

Somehow, at some point on her journey toward crack-addicted homelessness, she became informed about the medical education process in this country and decided she would only deal with attendings. If my parents were in the hospital, they wouldn't know the difference between an intern and an attending, between a med student and the chief of surgery-- but this woman, somewhere along the line, has decided she's going to check out everyone's name tag and ask them who they are and what their title is-- and she's not going to talk to you unless you're "real."

And this is MY problem?

She doesn't want my help, I'm happy to leave her alone. Except I can't, because it's my job not to. I thought we got rid of her yesterday. We decided she wasn't getting any pain meds, and we discharged her. She walked out of the hospital-- or so we thought. No, instead she walked right from her room back to the ER and started complaining of chest pain. They put her at the back of the line, she slept in the ER all night, and this morning, when they finally took a look at her, she was still insisting chest pain, so they sent her right back up to us.

At first I thought, gosh, how unlucky my team is to get this woman again-- but it's not about luck. If you're discharged and then you come back within the same rotation cycle, the team you were on gets you back-- we're "familiar with her case." Uh, yeah, we're familiar with her crazy. I wish you could do a CT scan and it would show the crazy. It would light up, you could point to it and be like, yep, there it is, this scan proves it, this patient is a lunatic, let's move her over to psych. But, no, it's not that easy. Scans don't show the crazy, we just have to find it ourselves.

My Halloween dragon guy from the other day finally got discharged this afternoon. He wanted to leave this morning, started complaining to me. There's paperwork, I said. "I don't have time for paperwork, you're trapping me in here," he said. Hey, we didn't come kidnap you and drag you here-- you came to the hospital for us to help you. You can wait another two hours. "It's boring in here." Yeah, well, I'm stuck here too, and I don't even get to complain.

It gets so frustrating sometimes that none of the patients seem to recognize that we're trying to help them, none of them realize we're working long hours for their benefit, that we're the ones making them better. It's not that I even want them to thank us-- but at least they can be civil and a little polite. But, no, instead they threaten to sue (one patient today-- insisting she's getting a lawyer) or they grumble about everything, confuse the doctor with a chef whose job it is to get them a gourmet lunch, and just generally make things more difficult than they have to be. I don't want to make you have a lumbar puncture (spinal tap). I wish we didn't have to do it, it doesn't benefit me in any way, I am not doing it to punish you. But, alas, it doesn't matter, they think we're out to get them, they think we want them to suffer, they think we want them dead. For most of them, not true. Perhaps I do want some of them to leave-- but even in the worst cases I'd rather they leave through the front door than out the side exit in a body bag.

I guess it's been a frustrating day. It had been good for a few days, or at least okay. But things start to build. Need positive reinforcement sometimes. Just a little. Just to remind me why I'm doing this.

1 comment:

  1. I just came across your blog and this post SO hit home with me. I'm in primary care (FNP) and have been dealing with a patient who suddenly lost feeling in her legs and unable to walk. She ALSO has multiple psyc issues and is "unable to take psyc meds because of a seizure disorder." Her psyc case manager is sick of her hanging up on him. None of the home health agencies will accept her. The hospitals won't admit her because the issue is psychiatric and the psyc hospital won't admit because the issue is physical. Finally got her into a rehab facility and she left after a few days because they weren't "providing her the care she needs." APS got involved and the case worker called my receptionist demanding "proof" that her problem is a psyc issue. My response was to tell him we did an MRI and it showed "crazy."
    Sorry for the long drawn-out story...my point was that I feel your pain! The long hours, the lack of any real social life, and the crazies...