Tuesday, September 30, 2008

Track Marks

Do drug abusers ever get sick?

There is a particular posture that can be attributed to healthcare providers of any level when confronted with these types of patients. Maybe it is anger, or disgust. Perhaps it is mistrust or simply exhaustion from all of the shit that smells the same way coming through our doors. Signs and symptoms aside, if you, your chart, or your mannerism stipulates that you are a drug abuser: you will be mistreated.

This week, I watched an ER physician withhold ventilations from an opiate overdose with a respiratory rate of six. "He shouldn't have shot up" was the justification. The kid was cyanotic and looked like shit. When the narcan went in, they slapped him in the face in order to help revive their still unresponsive patient, and when he woke up denying drugs, the doctors told him that the narcan would kill him if he wasn't honest about his drug usage.

Same day, same hospital, I brought in a patient with profound right sided weakness, obvious right side facial droop, and a blood pressure of 180/100- all an acute onset 30 minutes before our arrival at the hospital. The patient was obviously frightened, and perhaps by some lapse of judgment she let loose through her slurred speech that she had used cocaine the night before. Hearing this, the triage nurse rolled her eyes. She got a bed in the hallway and I had to make a scene at the hospital in order to get some attention for my patient.

Impose whatever judgment you will upon these ED providers, but I have personally seen these same people provide absolutely top notch care. I've witnessed them go above and beyond to provide emotional support, and I've watched as their expertise illuminated acute pathologies that only great experience and skill could have possibly recognized. I've seen these people as shining stars within their departments, and even thought to myself that if I were ever injured on the job, these are the people I would like in charge of my care.

But then again, I don't do drugs.

10 comments:

Donna said...

Hell, if anything, drug abusers get sick MORE often. And they're not terribly good at

And yeah, they tend to get treated like shit, which in my opinion is pretty sad.

Yes, drug abusers "do it to themselves". But so do adrenaline junkies, smokers, and so on and so forth, and they seem to get treated fairly well. Why do some people seem to think it's okay to give lesser treatment to someone because they make different choices than they would?

one of my closest friend's sister is an "on the street" heroin user, and watching how heartsick she gets every time her sister is in the hospital breaks my heart.

Drug abusers aren't just faceless drains on society, they're daughters, sons, sisters, brothers, mothers, fathers, friends and family. Somebody, somewhere loves them, and it makes me sick when treated less than human.

One of the first "I want to be a paramedic" moments I had was volunteering at a drop in centre for survival sex workers. Sure enough, one of our patrons was having an overdose in our lounge. Paramedics were called, and they were so bloody fantastic with her (even though she was aggressive and angry after they'd woken her up) I couldn't help but think "I want to do that."

Well, I'm working on it. :)

Erin said...

Good for you for being a patient advocate. It's an essential skill that distinguishes a good medic from a great medic. You can have top notch skills out in the field, but if you don't have the ability to be a good patient advocate then what do you expect your skills to accomplish? I'm glad that you stuck up for your patient and your intuition/clinical impression.
Lastly, did your patient have ALL five seatbelts on? ;-) Again, nice work.

Erin said...

Good for you for being a patient advocate. It's an essential skill that distinguishes a good medic from a great medic. You can have top notch skills out in the field, but if you don't have the ability to be a good patient advocate then what do you expect your skills to accomplish? I'm glad that you stuck up for your patient and your intuition/clinical impression.
Lastly, did your patient have ALL five seatbelts on? ;-) Again, nice work.

Anonymous said...

I have to admit I've had one or two moments of 'oh for ***'s sake' with drug users getting sick... It's not good and I'm not proud of them, it's just hard watching people fighting for the right to live one moment and then the next Pt comes in with an OD as if they're throwing their life away.

Just two cents.

Anonymous said...

They do it to themselves that they're beyond help that they become a burden to society. I hate to say it but sometimes you have to devote resources to the people who really need help. No need for medics to go to a drug OD when they could have been at another serious call with a a better person.

DH(A HA)PD said...

i wax and wane about how i feel about drug abusers. i'd rather have a cyanotic heroin od, though, than someone on meth who won't admit it any day of the week.

i think it raises a bigger question than just drug abusers, though. what do you do when you have to treat people that you absolutely despise - people that make your skin crawl. i've had the opportunity on two separate occasions to wake up neo-nazi scum bags when they overdosed on opiates. that takes it to a new level for me...not the average drug abuser, but someone covered in tattoos who clearly believes hitler did the right thing. what do you do then? show your nice, warm compassionate side?

Mystery Medic said...

Let face it...most patients we see are the way they are because of choices...

The OD from drugs is usually from something better then they normally take...
The CHF/COPD patient from years of smoking and stopped the LASIX/breathing treatments for whatever reason...
The IDDM that either doesn't take the insulin or takes it without eating or the NIDDM that doesn't ever check a sugar...
The SEIZURE patient that hasn't taken their meds for whatever reason...
The TRAUMA patient that is hurt from not wearing a seatbelt, walking in front of traffic texting on cellphone, or didn't use the safety devices of the tools they are using...
The MI/HTN Stroke patient that is overweight and hasn't exercised since it was required in High School...
The PE patient with a permanent ass print in the recliner causing DVT's...

So why do we pick on the homeless, the drug addicts, the psych? Most patients we see are the results from choices, either immediate or long term, they did wrong and most patients know it, knew in, or are in denial of it.

Treat them all the same and you will never be unsure that you didn't do the best for all your patients EVER!

Anonymous said...

I don't care how sick of drug abusers doctors or nurses are; that is just inexcusable patient care; and both patients have a right to sue. I know I would if it was my child with incompetent judgemental doctors, they should not be in medicine if their "air of importance" inhibits their ability to DO THEIR JOB!

Anonymous said...

Good for you! Empathy for human kind is all to often lost in our peers. Paramedicine is mot the place to act out our social bias. I am a new medic in a large city and often have similar encounters.

People are entitled to their opinions, but pts have a right to appropriate medical attention to the full extent of our scope of practice.

Eric said...

It is called brain damage. Every provider has brain damage regarding some group of patients. Every provider has a group of patients that get underneath their skin and that the provider can't stand.

I have brain damage for drunks, stupid college kids, and especially for drunk drivers. Each time I know I'm about to face this patient, I try to take a deep breath and measure every word.

Treating patients differently because they are a junkie or "they did it to themselves" is a great way to get fired, at least where I work.