Cotton Fever...wtf??

[VentdependenT]

32 previously healthy immunocompetent WM started injecting heroin 2 weeks ago (harder to get prescription narcs because of laws so H is back again). saved up a bunch of his used cotton balls that he previously used to filter his cooked heroin hits, soaked em in tap water, drew up the solution, injected into L antecube, and got violently ill within 10 min. Diaphoretic, rigors, nauseated, flushed, joint pain, palpitations, just friggen ill.

temp 102.6 with HR 120 otherwise normal vitals. labs, ck, cxr, ekg, CE's, lactate all pretty normal. WBC like 14 without bands.

Anyways neg cultures. Hit em with vanc cefipime combo. He got better within 12h. kept him another day because wbc shot to 35 but came down. dispo home w/in 2.5 days.

Cotton fever dudes. Never heard of it. It was the EM attending who suggested it. Weird stuff man. I told the patient to get some new friends.

Endotoxin vs anaphylactoid from enterobacter or cotton fibers respectively as suspected etiology by the scant literature out there on this syndrome.

No murmur btw. negs hiv/hep

Cheers

---

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[xaelia]

Sounds like morgellons.

 

[jdh71]

I can't stand junkies

 

[Anonymous M4]

I can't stand junkies

Isn't that kind of like saying, "I hate diabetics?" :/

 

[RustedFox]

Isn't that kind of like saying, "I hate diabetics?" :/

No. Not at all.

"Junkies, as any junkie will tell you, are not to be trusted."

100 points to whoever names that film.

Its evident that you haven't been directly responsible for enough of them.

 

[Anonymous M4]

No. Not at all.

"Junkies, as any junkie will tell you, are not to be trusted."

100 points to whoever names that film.

Its evident that you haven't been directly responsible for enough of them.

Clearly I've never been responsible for any patient but I would think that someone who is genetically susceptible to a disease, whose environment and behavior triggers manifestation of the disease, is a template that can be applied to an active drug addict or an obese diabetic. Why judge one as worse than the other? Because using drugs is illegal but stuffing your face until you die is subsidized by the government? Or because drugs are morally worse than food?

Maybe I just really buy into the "brain disease" explanation of drug addiction more than the "moral lack" explanation. Maybe next year I will hate junkies as much as the next fine physician

 

[deleted109597]

Maybe I just really buy into the "brain disease" explanation of drug addiction more than the "moral lack" explanation. Maybe next year I will hate junkies as much as the next fine physician

Burnett's Law. Love it.

For the record, your bleeding heart is showing as well.

 

[Anonymous M4]

Burnett's Law. Love it.

For the record, your bleeding heart is showing as well.

LOL looked up Burnett's Law. Have to say I'm often guilty of applying it. Funnily enough my political views are pretty radical on both ends of the political spectrum, so I can't win with anyone. Liberals, Tea Partiers, Neocons, Socialists -- I can find something to hate about all of them LOL.

 

[Anonymous M4]

but before I derail this track any further... Cotton fever. Fascinating. Never heard of it before. Will keep it on my differential.

 

[RustedFox]

Clearly I've never been responsible for any patient but I would think that someone who is genetically susceptible to a disease, whose environment and behavior triggers manifestation of the disease, is a template that can be applied to an active drug addict or an obese diabetic. Why judge one as worse than the other? Because using drugs is illegal but stuffing your face until you die is subsidized by the government? Or because drugs are morally worse than food?

Maybe I just really buy into the "brain disease" explanation of drug addiction more than the "moral lack" explanation. Maybe next year I will hate junkies as much as the next fine physician

1. I never compared junkies to diabetics, or anyone else, and arrived at the conclusion that one was "better" or "worse". That was you. Although I do find obese diabetics aggravating, they at least (for the most part) exercise some sort of understanding of, control over, and interest in their own rational decision making process and best interests.

2. Oh yes, using drugs is illegal just beause 'the government' says so. That's the only reason why they're illegal. I mean, malpractice is only 'illegal' only because... waitaminute.

3. Once you've had enough junkies steal enough time/effort/patience of yours that would otherwise be spent on people with actual emergencies rather than "dealer is out of town, need percocets, lets hit up the local ER", then you'll learn. It will sting especially hard when you get to read one of their PG surveys that they returned and know that this is viewed negatively by 'management'.

4. I recently posted an anecdote about the same junkie that I've had to intubate... again. See, he has no interest in his own health, but I'm now mandated to attempt to save his life, and am held liable for any mistakes that might be made. For the record, it was a tough airway - outcome could have been different, and I'm on the losing end of a suit as to why I had to 'trach' this individual.

I could go on.

 

[la gringa]

foxy,

have you actually had a survey returned by an actual or suspected seeker?

i have not.

your other concerns are, obviously, completely legitimate. i just don't think the pt satisfaction/PG one holds water. the # of fake names/addresses used, repeated visits, etc is one factor as well as the fact that they aren't exactly the sort of folks who statistically fill out any kind of survey, let alone one about a physician.

 

[smq123]

Clearly I've never been responsible for any patient but I would think that someone who is genetically susceptible to a disease, whose environment and behavior triggers manifestation of the disease, is a template that can be applied to an active drug addict or an obese diabetic. Why judge one as worse than the other? Because using drugs is illegal but stuffing your face until you die is subsidized by the government? Or because drugs are morally worse than food?

Maybe I just really buy into the "brain disease" explanation of drug addiction more than the "moral lack" explanation. Maybe next year I will hate junkies as much as the next fine physician

Uh, no.

Diabetics do not threaten your staff when they are not seen or when you offer to change their prescription.

Diabetics do not say phrases like, "I will be waiting for you in the parking lot with a gun" (real life example of something a drug-seeker said to one of our office's NPs).

They do not wait in the parking lot and then follow your car home (another real life example of what happened to one of the other physicians in my group).

They do not call your answering service at 2AM and wake you up because "all of the ERs in the area won't even let me in the door, and I'm in so much pain." Even if you tell them that this is a violation of federal law and can't possibly true, they will solemnly swear that EVERY SINGLE EMERGENCY ROOM in the entire county (and the neighboring county, too) is in violation of EMTALA.

And then when you tell the above caller that even if you wanted to call something in for him, you can't, because all controlled substances have to come in to the pharmacy on a paper prescription, diabetics don't chew your ear off with a 5 minute profanity laden stream.

Diabetics, even terribly non-compliant diabetics, don't leave you feeling like you might get shanked if you dare disagree with the treatment plan that they have already decided.

You can argue that the violent, aggressive behavior is just a manifestation of an organic disease, but it doesn't make them easier to like or easier to deal with. And while I can even understand and tolerate a certain level of anger as another sign of the disease of addiction, once they've crossed that line of threatening the well being of me or my medical assistants, that's it.

 

[RustedFox]

foxy,

have you actually had a survey returned by an actual or suspected seeker?

i have not.

your other concerns are, obviously, completely legitimate. i just don't think the pt satisfaction/PG one holds water. the # of fake names/addresses used, repeated visits, etc is one factor as well as the fact that they aren't exactly the sort of folks who statistically fill out any kind of survey, let alone one about a physician.

While I can't say "for sure" (as they're 'anonymous'), the language of such was so familiar and so suspect that the person practically gave themselves away.

 

[WilcoWorld]

Clearly I've never been responsible for any patient but I would think that someone who is genetically susceptible to a disease, whose environment and behavior triggers manifestation of the disease, is a template that can be applied to an active drug addict or an obese diabetic. Why judge one as worse than the other? Because using drugs is illegal but stuffing your face until you die is subsidized by the government? Or because drugs are morally worse than food?

Maybe I just really buy into the "brain disease" explanation of drug addiction more than the "moral lack" explanation. Maybe next year I will hate junkies as much as the next fine physician

Don't worry, you'll hate the obese diabetics too.

/sarcasm font

 

[jdh71]

Isn't that kind of like saying, "I hate diabetics?" :/

No. Not the way you mean it anyway.

Though, I can't stand bad, non-compliant diabetics either.

Don't misunderstand my intolerance for the junkie to mean I don't have a certain sympathy for their plight, but once they've crossed over and are in full addiction mode, they aren't really in control, not really, the addiction is driving the bus, and often over the cliff, and in the mean time the rest of us are burdened by their waste of medical resources and precious time. Thankfully I don't deal with the junkie in the out patient setting, but they wake up on my vents, and they are one of the lowest forms of life on the planet. The one's that don't wake up die, usually because their nasty junkie selves ended up with an infectious disease incompatible with life. You'll see. The notion that "you can't trust a junkie" should be on a top 10 list of truism. Your heart may bleed these zombies for awhile, but you'll learn your lesson after being burned, hopefully not to the point when it's cost you something valuable and or personal.

Sometimes, in life, it's probably best to hold your silence and perhaps, at worst, be thought perhaps to be a fool then to open your mouth and be known as one. Sounds like you're headed to the wards, and that's a little nugget of wisdom from your uncle jdh, but your capacity for pain may be much higher than I am assuming so it could be an interesting 3rd year for you.

 

[jdh71]

Clearly I've never been responsible for any patient but I would think that someone who is genetically susceptible to a disease, whose environment and behavior triggers manifestation of the disease, is a template that can be applied to an active drug addict or an obese diabetic. Why judge one as worse than the other? Because using drugs is illegal but stuffing your face until you die is subsidized by the government? Or because drugs are morally worse than food?

Maybe I just really buy into the "brain disease" explanation of drug addiction more than the "moral lack" explanation. Maybe next year I will hate junkies as much as the next fine physician

Disdain for the junkie has nothing to do with the moral or immoral nature of drugs, nor with any disease model for addiction in the brain. All of that is irrelevant bull**** nonsense for our dislike of the junkie. It's a dislike based on pragmatic world experience.

Take the hippopotamus - an ornery and cranky critter at baseline, completely outside of any moral implications, and its clearly the way it is based on it's hard wiring, but am I jerk for saying that I think they are a dangerous animal, I don't care for them, and highly discourage having them as house pets?

 

[smq123]

Sounds like you're headed to the wards, and that's a little nugget of wisdom from your uncle jdh, but your capacity for pain may be much higher than I am assuming so it could be an interesting 3rd year for you.

Based on his previous posts, he's already matched into EM. In which case, intern year ought to be...an experience.

 

[jdh71]

Based on his previous posts, he's already matched into EM. In which case, intern year ought to be...an experience.

Oh. Good luck with that.

 

[Rendar5]

Had one come into my ED the other day in fullblown endocarditis with at least 50 track marks on his right arm, first fully denied IVDA, then said he stopped shooting up IV dilaudid 3 weeks ago. These were fresh marks, friend said he'd been binging on meth before his fevers started a couple days ago, and injecting. Pt after being told that he's not in trouble and there won't be cops involved and that he's got a serious life-threatening illness still would not come clean. Luckily his case was clear-cut, but do you know how many times I have junkies lying to my face about something that could seriously kill them or impact their health? I can be sued me for my life savings just by being fooled by them. So yes, I have sympathy for them, but I also have disdain because they are dangerous to themselves and dangerous to me and my family if I miss their lies ever.

Now if you have a junkie who actually is honest (and it does happen every now and then), you know what? I feel bad for them and am more than happy to take care of their health needs.

 

[Bostonredsox]

had a 23 y/o fem who initially came in a resp arrest. ED narcan'd her admitted to me for 24 hour obs as she was still drowsy and breathing a bit slow. Fever 103 not otherwise explained. I notice track marks in right arm. ask the BF whose arm is wrapped up completelly says he needed 17 stiches in ED eralier today, didnt say why, what happened, he admits she crushed up Opana CR and used an insulin needle, used he thinks, to inject herself. rest of EDs labs come back....lactate >7, WBC 32k, shes looking crappy. Pressures start to fall. Treat her as septicemia with possible endocardidits though no sequelae on exam. Stat TEE negative. 36 hours later she is recovering. getting ready to send to stepdown unit. She actually accosts my MICU nurse because she overheard her calling her an addict. Starts screaming going beligerant. I come in to talk with her, and she was crying and labile as all hell the first night saying this is the first time im ever done this and i dont want mom to find out or school im gonna graduate this summer yadayadayada......unbeknownst to her I have read psychs consult where she admitted and was confirmed to have been in delinquent centers since age of 8, has multiple felony arrests for narc possesion, has been admitted inpatient psych in 4 other hospitals, and has admitted to using IV drugs ranging from Opana to crushed Oxy to heroin. My response "well mam, you crushed opana and injected it.....thats called iv drug use, not sure how else you would like me to describe it".

do I hate her? no. I feel sorry that this is what her life has come to. She was once someones little girl (I have 3 little girls).

which brings me to the actual anger. She has a 4 y/o little girl who is being subjected to junkie parents like that. But a quick phonecall to CMS with backup support from my psychiatrist got that little girl a new home with grandparents.

Junkies are an everyday occurence. better get used to them. espec in EM/IM/CC

PS BFs wrapped up arm is because she slashed the **** out of him right before she shot up

 

[dotcb]

You can't work in the ED and hate drug and alcohol abusers. It doesn't make sense and you'll have a miserable career. It's like a surgeon who hates appendixes and gallbladders, a dermatologist who hates acne, or an endocrinologist who hates obesity or diabetes. It's one of our things that is bread & butter. Embrace it with humor. Don't let them phase you. Love what you do.

 

[nlax30]

Have heard of cotton-fever but haven't directly seen it. When I got my full license last year had to sit through some state required CME courses, one was a drug abuse/addiction lecture and the lecturer pointed to a website called opiophile.org that's basically a forum for those either addicted to or abusing narcotics with all sorts of posts about how to scan narcs from your doc or how to inject, etc....

I'm in an area with rampart narcotic/substance abuse and thought I had heard/seen a lot, but reading though through some of those posts was eye-opening and was first I had heard about this "cotton fever".

 

[VentdependenT]

Don't worry, you'll hate the obese diabetics too.

/sarcasm font

After your 20th admission of the same patient for DKA in one year you can dump the sarcasm font...

 

[Arch Guillotti]

Opiophile.org makes for some very entertaining reading. Should be required reading for anyone who prescribes narcotics.

Have heard of cotton-fever but haven't directly seen it. When I got my full license last year had to sit through some state required CME courses, one was a drug abuse/addiction lecture and the lecturer pointed to a website called opiophile.org that's basically a forum for those either addicted to or abusing narcotics with all sorts of posts about how to scan narcs from your doc or how to inject, etc....

I'm in an area with rampart narcotic/substance abuse and thought I had heard/seen a lot, but reading though through some of those posts was eye-opening and was first I had heard about this "cotton fever".

 

[alpinism]

One of my not so favorite memories from working in EMS involved having an addict pull a .45 on my crew after we refused to give him our narc box. Usually the dispatcher would recognize the caller was an addict and send the cops as well. Unfortunately, it didn't always happen and sometimes went in blind and alone.

That and the weekly 3am calls for addicts who dialed 911 bc they were in withdrawal (11/10 pain) and couldn't sleep (usually after being turned away from the ED earlier that day).

After seeing what their family and kids go through, it's more sad than anything else.

 

[FSU2013]

Opiophile.org makes for some very entertaining reading. Should be required reading for anyone who prescribes narcotics.

Holy cow. Never heard of this before. Been reading it now for about the past hour. Whoa.......

 

[VentdependenT]

Opiophile.org makes for some very entertaining reading. Should be required reading for anyone who prescribes narcotics.

Huston we have a MAJOR problem.

95% of all vicodin made is used in the US. Opiates have their place but clearly the supply is made to fill the demand of addicts and not just those who have true indications. Tougher laws = rise in heroin = HIV/HEP/ivdu related infectious sequelae rates skyrocket. Either way its a problem.

Did we really NEED opana? cmon. Keep them hooked big pharma, keep em hooked crooked docs, keep em hooked.

 

[la gringa]

Holy cow. Never heard of this before. Been reading it now for about the past hour. Whoa.......

can't believe it's legal... a website that gives out info on how to adulterate legal to rx controlled substances into illegal ones?

i've started looking up state controlled substance database info on anyone i even get a slight spidey sense about... the results have been even worse than i had suspected:
- pt on opana and oxycontin (no clear reason per her hx) - not reported as a med to me or nurse, then pt asked for pain meds at dc! my response: i can't rx anything to you that is stronger than what you are already on... with a knowing grin and head nod
- pt who had gotten over 300 hydrocodone in the last month and rx for HC from over 20 different providers in the last year (including 6 different DDS)
- pt who had gotten over 300 pills of oxycodone in the last 45 days, all 10mg, AND seen in my ED in the last 24 HOURS for etoh o/d, ASKING FOR PAIN MEDS

in the meantime, i have seen a college student almost die from taking opana + binge drinking, pt who took "pieces of a friend's roxy" for tooth pain, and all sorts of other chronic pain maladies rolling through the ED. it is really hard for me to treat a chronic pain pt's legit acute pain... and even harder when a solo practice pain doc has NO CALL COVERAGE!!!!!!!! this was a very legit lady who fortunately i was able to get a plan together for... but ugh, did i hate the idea of having to undertreat her for fear of violating her pain contract.

 

[glorfindel]

can't believe it's legal... a website that gives out info on how to adulterate legal to rx controlled substances into illegal ones?

Speaking, writing, and posting about crime is not illegal b/c of first amendment. And I think this is a good thing.

As for prescription drug abuse: It can be hard to refuse a patient a script for just a few days of narcs, or benzos. It's easy to write; you'll never get hung out to dry for writing an rx for 12 to 20 tabs of anything; it makes the patient leave the ED without arguments or confrontation, you can always justify it on the chart.

But all it takes for me is to see that 24-year-old come in by ambulance from a night of hanging out with the boyfriend, taking a few percocets, drinking a few beers, throwing in a few ambiens for ****s and giggles, and slipping over too far into the apnea realm of things, and now they're brain dead.

That makes me feel much better about denying people narcs and benzos.

In fact, I think we need some more group-wide quality metrics:

-- # of opiates prescribed for pts treated as outpatients w/o dx of fracture or cancer or lacs smaller than 5 cm.

-- # of benzos prescribed for patients with the following CCs: "anxiety" and "insomnia."

If primary-care docs out there want to prescribe patients trazodone for "sleep", that's their prerogative; but as an ER doctor I will never do it.

 

[jdh71]

Speaking, writing, and posting about crime is not illegal b/c of first amendment. And I think this is a good thing.

As for prescription drug abuse: It can be hard to refuse a patient a script for just a few days of narcs, or benzos. It's easy to write; you'll never get hung out to dry for writing an rx for 12 to 20 tabs of anything; it makes the patient leave the ED without arguments or confrontation, you can always justify it on the chart.

But all it takes for me is to see that 24-year-old come in by ambulance from a night of hanging out with the boyfriend, taking a few percocets, drinking a few beers, throwing in a few ambiens for ****s and giggles, and slipping over too far into the apnea realm of things, and now they're brain dead.

That makes me feel much better about denying people narcs and benzos.

In fact, I think we need some more group-wide quality metrics:

-- # of opiates prescribed for pts treated as outpatients w/o dx of fracture or cancer or lacs smaller than 5 cm.

-- # of benzos prescribed for patients with the following CCs: "anxiety" and "insomnia."

If primary-care docs out there want to prescribe patients trazodone for "sleep", that's their prerogative; but as an ER doctor I will never do it.

trazodone isn't a benzo, maybe I'm misunderstanding, but are the sick ****s abusing trazodone now too??

 

[glorfindel]

trazodone isn't a benzo, maybe I'm misunderstanding, but are the sick ****s abusing trazodone now too??

Sure they are! It comes from this belief they have (and many of us reinforce) that there is a little pill for every inconvenience and discomfort of life.

I personally enjoy asking patients who ask me "can I get something for sleep?" if they exercise.

I then go into this long monologue about VO2max and lactate threshold and periodization and hill repeats and pistol squats and ....

Soon their eyes glaze over, they start to think I'm the freak in this conversation, and they drop the subject.

 

[jdh71]

Sure they are! It comes from this belief they have (and many of us reinforce) that there is a little pill for every inconvenience and discomfort of life.

I personally enjoy asking patients who ask me "can I get something for sleep?" if they exercise.

I then go into this long monologue about VO2max and lactate threshold and periodization and hill repeats and pistol squats and ....

Soon their eyes glaze over, they start to think I'm the freak in this conversation, and they drop the subject.

Heh.

I guess I hadn't seen a tradozone OD admitted to the unit yet. That tends to be on how I get to follow these trends these days.

Saw a nasty seroquel OD last year. Went into ARDS, barely made it. Came out of the ICU with a trach and a bad ICU myopathy after three and half weeks.

This is probably why we should just let people toke some refer. Honestly, I bet we'd see a whole lot less of this is people could just smoke some pot. But I'm probably preaching to the choir. The only people who really seem to want pot illegal are the old foegs, and in 20 years won't really matter to politics.

Yeah, I'm really glad I don't have to deal with the the addicts on the front side any longer. I can't keep up with this garbage any longer. I just looked up opana, because I have seriously not heard of it. I mean WTF? I wonder if the model of dealing with the guys the way BC (and some something countries have) with "clinics" where junkies can just shoot up with clean needles and whatnot would be a good idea.

 

[smq123]

Sure they are! It comes from this belief they have (and many of us reinforce) that there is a little pill for every inconvenience and discomfort of life.

I personally enjoy asking patients who ask me "can I get something for sleep?" if they exercise.

Most of the people I see who "need something for sleep" generally have some measure of anxiety and depression as well. The trazodone helps with both.

For those people who just have poor sleep hygiene, things like exercise and OTC melatonin are a tough sell. Plus, a lot of the urban poor that I see aren't able to/don't want to pay even $4 for Norvasc, so telling them that they need to BUY something OVER THE COUNTER is, like, blasphemy.

 

[Perrotfish]

Opiophile.org makes for some very entertaining reading. Should be required reading for anyone who prescribes narcotics.

That was an entirely new and awful Internet experience. Less shocking than what I've been linked to before, but more horrifying. That site is to tub girl what Hitchcock is to the Saw movies

Beyond the content, which is depressing/miserable, what wierds me out about that site is the coherence of it. People aren't just writing about heroin, they're writing well constructed, correctly punctuated paragraphs about heroin. If this is what heroin addiction looks like, WTF are people smoking when the comment on YouTube?!?

 

[FSU2013]

That was an entirely new and awful Internet experience. Less shocking than what I've been linked to before, but more horrifying. That site is to tub girl what Hitchcock is to the Saw movies

Beyond the content, which is depressing/miserable, what wierds me out about that site is the coherence of it. People aren't just writing about heroin, they're writing well constructed, correctly punctuated paragraphs about heroin. If this is what heroin addiction looks like, WTF are people smoking when the comment on YouTube?!?

HAHAHA. I thought the same thing. I couldn't believe some of the vocabulary and knowledge of science some of the people on that board posses (and subsequently bastardize).

 

[WilcoWorld]

That was an entirely new and awful Internet experience. Less shocking than what I've been linked to before, but more horrifying. That site is to tub girl what Hitchcock is to the Saw movies

Beyond the content, which is depressing/miserable, what wierds me out about that site is the coherence of it. People aren't just writing about heroin, they're writing well constructed, correctly punctuated paragraphs about heroin. If this is what heroin addiction looks like, WTF are people smoking when the comment on YouTube?!?

William S Burroughs

Heroin does a lot of terrible things to people, but it doesn't make them bad writers.

 

[ihearttriangles]

How can you guys be hating on junkies/dirtbags? These are the people that put food on your tables and clothes on your backs. Emergency medicine like most of medicine would become obsolete if people stopped being f@%ktards.

 

[deleted109597]

How can you guys be hating on junkies/dirtbags? These are the people that put food on your tables and clothes on your backs. Emergency medicine like most of medicine would become obsolete if people stopped being f@%ktards.

Uh, no. That's like saying that the dumpster divers keep Burger King in business. These people pay no bills. They make other, paying customers leave the waiting room.

 

[jdh71]

How can you guys be hating on junkies/dirtbags? These are the people that put food on your tables and clothes on your backs. Emergency medicine like most of medicine would become obsolete if people stopped being f@%ktards.

find me a junkie or dirtbag that pays their medical bills and maybe you'd have a point

 

[RustedFox]

How can you guys be hating on junkies/dirtbags? These are the people that put food on your tables and clothes on your backs. Emergency medicine like most of medicine would become obsolete if people stopped being f@%ktards.

ldsk;fj;asldkjf;lasdkjfpodmaekj;laskfj

 

[Anonymous M4]

You can't work in the ED and hate drug and alcohol abusers. It doesn't make sense and you'll have a miserable career. It's like a surgeon who hates appendixes and gallbladders, a dermatologist who hates acne, or an endocrinologist who hates obesity or diabetes. It's one of our things that is bread & butter. Embrace it with humor. Don't let them phase you. Love what you do.

I wasn't going to dig this post up but since it's back... I like this approach. To me a drug addict deserves the same compassionate care as any other mentally/ medically ill person. I can understand how frustrating that might get but I like the idea of using humor to get past the unpleasant nature of their disease.

 

[ihearttriangles]

Uh, no. That's like saying that the dumpster divers keep Burger King in business. These people pay no bills. They make other, paying customers leave the waiting room.

Interesting. My time as an inner city paramedic left me with the impression that 90% of patients we brought to the ED were people who were unable to pay their bills. Either cause they were too poor, too smart (why pay your bill when you don't have to), or both. I never imagined that their was a hierarchy of bill payers. Do you find that alcoholics and/or your run of the mill idiot that does any number of idiotic things to end up in the ED to be more likely to pay their bill than a junky?

 

[RustedFox]

I wasn't going to dig this post up but since it's back... I like this approach. To me a drug addict deserves the same compassionate care as any other mentally/ medically ill person. I can understand how frustrating that might get but I like the idea of using humor to get past the unpleasant nature of their disease.

At the end of the day, its still the responsibility (or fault) of the individual for any and all choices that they make. Not mine. Not yours. Not anyone else's. Theirs. I do not wish to be made responsible for them or their decisions in any part, way, shape, or form.

You'll find that your compassion will fade quickly, as you begin to take more responsibility for other people's mistakes.

 

[Anonymous M4]

At the end of the day, its still the responsibility (or fault) of the individual for any and all choices that they make. Not mine. Not yours. Not anyone else's. Theirs. I do not wish to be made responsible for them or their decisions in any part, way, shape, or form.

You'll find that your compassion will fade quickly, as you begin to take more responsibility for other people's mistakes.

Sure it is, which is why I asked if there was the same disdain for the obese diabetic, the salt hapoy chf guy, the smoker with emphysema...

I truly hope that I can maintain compassion in the face of frustrating patients.

 

[RustedFox]

Sure it is, which is why I asked if there was the same disdain for the obese diabetic, the salt hapoy chf guy, the smoker with emphysema...

I truly hope that I can maintain compassion in the face of frustrating patients.

Yep. and most attendings here have piped up and said - "Yes, they're all aggravating, but none of those border on abusive and criminal so much as the narc addict."

 

[Anonymous M4]

Yep. and most attendings here have piped up and said - "Yes, they're all aggravating, but none of those border on abusive and criminal so much as the narc addict."

fair enough but I would think being careful of your safety and aware of the manifestation of their disease (i.e. Lying, etc) wouldn't preclude also refraining from judging and/or "hating" them. But we all have different ideas of what our best patient care looks like. I'm sure mine will evolve as I move forward in my career.