Seeker

Angela was having contractions this morning. We are near her due date, so I took her over to her obstetrician’s hospital to get evaluated. At first, Angela wanted me to examine her at the apartment, and since I had only 4 hours of sleep today, I was hoping I could get away with avoiding a hospital visit. So I had Angela sprawled on her bed, completely naked. Why completely naked? Hey….I’m a professional…don’t ask, but other than her protuberant abdomen, she still looks hot! She questioned me why I had to take off MY clothes to do the examination, so I joked with her that it was how I examined all my female patients (except the hideous ones). After I gave Angela a soft, whole-body massage, we both laughed as I stuck my fingers in her vagina to feel her cervix. Yep…. it was closed for business. No baby coming yet. Reassured, Angela let me put in the other instrument that I carried with me at all times – you know – the OTHER instrument, meaning the one that made this baby in the first place. It is awkward having sex with Angela on her back, so she got on all fours for me to finish up. I told her that my special injection would fix everything. It didn’t. Immediately , there was a small gush of blood after I finished and pulled out, and Angela screamed about cramping even more.

So I am sitting next to Angela in Labor and Delivery at her hospital, watching the “baby monitor ” show small contractions and a regular heart rate for the rug rat. I was bored out of my mind, but we both laughed when her OB doctor did a bimanual examination of her cervix when she came in. Little did he know what I just put in there!

I went home to get ready for work. Angela was staying in the L and D unit for the night. She was having premature contractions. I was exhausted and feeling mean. My patients were in for a bad night with me. Sure enough, the usual ER regulars came in as they always do. If a patient has thirty visits a year, or three a month, and 20% of the patients visits are of similar people, then at least one-third of all patients in the department at any one time will be frequent-fliers. They also tend to take up the most time and services, whether it is for pain or psychiatric reasons. They also tend to come in the late evening hours just after midnight, when they have awakened from a hard day’s sleep.

A patient that stands out tonight had left against medical advice 8 hours earlier. He was 25 and diabetic and said he had taken his insulin earlier in the day and immediately showered but felt dizzy. Without checking his blood sugar, he assumed he had hypoglycemia and drank several cups of orange juice. He had a blood sugar of 700 (normal is less than 124), but after a bit of insulin in the ER, it started decreasing, He had three admissions in the past week for uncontrolled blood sugar. I know he didn’t take his insulin because he responded quickly to the same insulin  given in the Emergency Department. Earlier in the day, he actually randomly decided to leave rather than being admitted to the hospital, only to return 8 hors later with even higher blood sugars after he had eaten at a restaurant and had alcohol. What a waste of resources. He is non-compliant with his medicines and diet and can’t even make good medical decisions. I had to admit him to the hospital, and I know the only reason he stayed was because of the persistent vomiting and his constant request for IV Dilaudid. He was developing gastroparesis and chronic pain because of his pain medicine addiction and uncontrolled blood sugar. Sad that at the ripe old age of 27 he was a victim of his own bad behavior. Of course this all was paid for by the tax payer. Is this ‘health’ care? Or is it just damage control?

My other problemed patient stated that she had chronic headaches from Arnold-Chiari malformations. She stated only IV Dilaudid would work because she couldn’t metabolize oral medications well due to a CYP2D6 deficiency. I thought that was an awesome excuse, one that I couldn’t find much information on. Of course she had allergies to our usual headache medications such as Toreador , Ultram, NSAIDS, Raglan, codeine, and compazine. These are our favorite medications – all non-narcotics. Her allergies were severe, so she said, including anaphylaxis and angioedema as the result of using these medicines. She couldn’t have an MRI because she said she had a metallic brain coil from an AVM repair and that she had an iodine allergy which prevented us from using IV dye. I was tired and just gave her what she wanted. It turns out that none of this was true, for it was all made up and there was no way for us to know that. She even said she had a heart attack and stroke in the past! We can’t prove that someone had or didn’t have a medical illness in most cases! Free Percocet for her!

After my shift, I went back to Angela and brought her home from the hospital. We both were tired, and after a shower together, we both slept, cuddled with each other.

-T.C.

I ran across Ashley tonight on my shift. Things had slowed down enough for me to escape to the back room with her to ‘catch up.’ Of course I locked the door behind me as I undressed her and had her sit on me in the doctor’s swivel chair. Her warm, smooth legs were absolutely heavenly as I ran my hands down them and grabbed onto the soles of her warm, silky feet as she swayed on top me. After I came, I had this incredible uneasiness inside me about all the poor choices I was making. Sarah, Angela, Melanie, Cherise, Ashley, and a few others. I can’t help myself, but I haven’t really committed to anyone, have I?

Ashley and I kissed as she headed back to her work station upstairs. I couldn’t but promise her that we’d do something good together soon, whatever that might be. I needed to work in this hellhole because of mounting bills, especially with Angela getting ready to deliver soon! Likewise, Cherise was sucking money from me as well. She had lost her job because she said she had made enemies among the wrong people at her hospital, but some friends of mine said she didn’t show up to work on several occasions, and there were questions of drug use.

Now it’s 4 A.M and the late night crowd is showing up. The bus routes to the hospital had begun to shut down, so more people were calling ambulances for their various problems. Of the 14 patients on the board, 3/4 were there because of ‘non-urgent’ issues such as pain medication needs, or anxiety, or alcohol-related issues. I have found a lot of the late night patients to be jobless or homeless or just poor decision-makers. They are up all night and sleep all day, having no structure in their lives and no purpose. If I offered them a job, I know most wouldn’t want one, because it was easy for them to bilk money and resources from panhandling and reaching out to community churches and funds. When you make yourself look poor and disheveled, it’s easy to gain sympathy on yourself. I frequently sit down with some of my regulars when I have time to talk about their lifestyle. One alcoholic, who comes in at least three times a week by ambulance for back pain or various aches told me he could make $300 a day panhandling. It probably is true. He has a better phone than I have! Other patients must lower their IQ by 20 points when they come in to see us, pretending to not understand anything we say or offer. They can get more by being helpless. Their apparent ignorance and low intellect, however, is not to be underestimated, because if they feel slighted, they suddenly become very articulate and know exactly how to complain and who to complain to. They will get on social media, twitter, Facebook, and other social media sites to lodge direct complaints against nurses and physicians, who can easily be slandered without recourse. Some patients will call up administrators and supervisors, even going as far as calling the board of medicine! Undertreated pain, poor treatment, slow service, or just about anything will bring out viscous and lively complaints referring to racism or incompetence. Considering most of these patients aren’t paying a penny towards their care, they certainly are demanding and thankless! I can’t discuss their obesity or cigarette use as possible causes of their pain or illness, because it’s ‘insulting’ and ‘ruins the therapeutic process.’ Incredible. Why am I complaining about this? Because I asked one patient if she smoked and immediately she started shouting and complaining that I was being rude. Since when can’t I ask questions? I think smoking has health consequences too, but why should I risk my job to go beyond what is necessary medically for a patient? I need my paycheck.

Then there is the wave of overdoses that fly in at 3 A.M. I often wonder why families are up at this time of night, but some lifestyles are different. These people come in wide awake, with their small children all as awake as the parents who tell me how their kids don’t have a regular sleep time. At the age of five, I would think a kid should be in bed by 8 P.M at latest? I was when I was a child. Anyway, chronically depressed patients, whose alcohol and Percocet are wearing off and haven’t slept for two days finally start to break down at 3 A.M. and come in ‘having overdosed.’ Young teenagers, seeking attention from their parents or recent ex-significant -others drink alcohol and state that they overdosed to kill themselves. The list goes on. Most of the time, there was no overdose, only alcohol ingestion and the claim that some medicine was taken, because most patients don’t seem interested in hearing about potential complications of the medicine they said the overdosed on. Most of the time, the overdose would have been lethal if they truly took the overdose. Honestly, the ones who commit suicide aren’t generally the ones that we see. The true suicidal patients just kill themselves at home. No letter left behind and no ‘cry for help’ and self-saving safety measures being arranged so they can be ‘saved in the nick of time.’  People who openly throw some pills down their throat in front of their loved ones in a show of depression should have done that in a quiet room in the back of the house if they really wanted the intended effect of death. Sorry to be mean but the gamesmanship of these overdoses can be overwhelming to my sympathy and empathy.

When I look on the medical history of my early morning patients – they all have the same diagnosis. Most are in their 30’s to 50’s, many with no true medical diagnosis, but rather a list of problems, like back pain, knee pain, reflux, headaches, and the like. Many are obese, most smoke, and the majority have some mental illness diagnosis such as depression, anxiety, schizophrenia, or my favorite ones, PTSD and Bipolar. They wear these diagnosis like a badge of honor, happy to flaunt them about, because it’s ok to be mental. It’s ok to be a recovering alcoholic or narco who has fallen off the wagon for the fiftieth time, because they are stronger for being that way…And so they come to us, ambulance ride after ambulance ride, describing undiagnosable symptoms and dysfunctional states. Sad about their lives and lack of a job and car and career, as if everyone else with those just somehow had them luckily bestowed upon them. I got my M.D degree by lottery, for their was no work and sacrifice involved with it. I think the majority of the problem is the lack of structure in their lives and the lack of motivation to just work. It’s easier to cope with life by just taking Percocet and alcohol and attributing shortcomings to some painful condition, being Bipolar, or some systemic failure. Why should someone be courteous and reasonable when they can use the cover of bipolar to explain away their poor attitude?

When I look at the chart of most of my patients, I can see the direction of their medication needs and their medical experience based on their allergy lists. Many of the late night patients will tell me exactly how much pain medication they need and what type to use. Some tell me they need Benadryl as well to keep from itching. They know the side effects and state horrible allergies to medicines that I have never seen occur before to anyone. It’s almost disgusting. Every pain management patient has an allergy to aspirin or NSAIDs. They will list ulcers or anaphylaxis as side effects to them. They will tell me that Ultram ( non-narcotic pain medicine)  makes them seize, and codeine makes them vomit. I can’t use Raglan or compazine because they get dystonic and start twisting and writhing. Those allergies always come up in my migraine patines. The list goes on, but I can tell legitimate patients apart from these people because their reactions and allergy lists are non-existent for the most part. You can dictate the medicines given to you by structuring your allergy list in the right way. Very few patients are allergic to Dilaudid!

I’m tired. Why fight all of this? I think part of my anger is due to the fact that many of these patient are no-pay and have no credit, so they don’t care about the cost of their twenty CT scans they have every year. The Medicaid patients can arrive at any time with impunity and demand immediate care for any whimsical complaint and yet they pay NOTHING for a visit. They come in for ‘baby checks’ at 3 A.M to get an ultrasound of their baby, whose father will never be seen, They come in for 4 A.M vaginal itching and chronic headaches at 5 A.M. because it’s not as busy. There is no copay. With Angela, even though she has insurance, my copays have been $2000.00 this year alone for her pregnancy. Insurance sucks. I pay for mine and I pay for the copay. I would have to be dying to come in to the Emergency Department, whereas many with state insurance can drop by for a runny nose and demand Percocet on the way out because they have some headache as well. Remember to always throw in a headache with every complaint so you get some Percocet. I have cough and a headache, I have a fever and a headache. Each case wins you a Percocet in the Emergency Department. I am taking notes on this for my own future!!

Exactly!

I was so glad to get into bed this morning – Angela was very sedating to me as she spooned me in a warm, cozy bed….

-T.C.

What a night shift. I hate work, and I hate dealing with detritus. I want to complain right now because I am frustrated. So, among the things that bother me are when my patients interrupt me while I’m trying to tell them what their situation is and what is wrong with them. Nothing is more annoying than having a patient interrupt me to tell me what they think might be going on. “So, sir, you have unstable angina, which is a condition that is a result of poor blood flow to…” No sooner do I get started on my explanation to find that the patient has stopped me to add their own theory. “I think it’s my indigestion,” the patient inserts. Why come to the doctor to get an opinion if you are going to just throw it out the window? Be your own doctor and have a nice day. Here is your $200.00 bill to give me your opinion!

Then there are the 500 pound patients who wonder why they have back or knee pain. It is a medical mystery that they have pain. Could it be the weight bearing down on all those joints? Absolutely not. I just sugar coat the problem and write a prescription for what gets the job done: Percocet. It seems everyone pops a Percocet for just about everything. Have a bad day at work? Here’s a Percocet. One lawyer told me how she pops two Percocet in the morning and has a cup of coffee every day. How awesome! The other medical mystery is how many times patients come in with out of control blood sugars and wonder why they can’t get it under control with their medicines. First of all, you have to buy the medicine, and then you have to actually take it! Finally, you can’t be eating potato chips and sweet tarts if you plan on having controlled diabetes! Your body is just like your teeth. You have to actually take care of your teeth by brushing and flossing them if you want to keep them.The same thing goes with your body. You can’t just let it rot away like your teeth, otherwise, your body talks back to you through pain.

I could go on for hours, but right now, I gotta take a Valium.

This morning I decided to crash at Melanie’s. I was feeling lonely. We had several mimosa’s before I fell unconscious! I actually did take a Valium.

-T.C,

Cherise was blowing up my phone this morning wondering where I was at. Text after text after text…. She seemed very irritable, which wasn’t her norm. I called her up after stepping away from Angela, who also was clamming up to me. This whole holiday thing was totally stressful. I felt very uncomfortable around Angela’s family, who seemed ready and willing for me to pop the question to Angela. What if I don’t marry her in the end? Then this was time wasted.  That begs the question of what to do with all those photos and memorabilia that I collect with each particular person I am with. Do I pitch them and erase my memory of a whole period of my life? I see so many women who just literally burn their past when they move forward. They destroy old photos and change their entire Facebook story-line as if an entire segment of their life just disappeared and never happened! I think that is wrong, but we can argue that point all day. The past is the past and I say “live for today!”

Anyway, I called Cherise up, and she seemed out of it. She was crying and yet half stoned on the phone, saying she was lonely and didn’t go home. I couldn’t talk much to her because of Angela being so needy today, so I told Cerise I was at work. She threatened to come up to see me. What could be bothering her so much? I asked her, but she gave no logical reply, but kept saying how much she wanted me and needed me. Then she actually had the nerve to ask me to prove I was in the hospital by calling her from a land-line. That was unexpected…but I was ready for that. Enter the SpoofCard! This little gem of a creation allows me to enter any number that I want to appear on someone else phone as the caller’s I.D.! Interestingly, Cherise quickly calmed down, saying that she loved me and was sorry she doubted me after I called her back and her caller I.D. showed my hospital’s phone number as the caller’s source! I guess she was skeptical of me! I see problems on the horizon!

As for Angela, the rest of the visit was ho-hum boring. I had to be on my best behavior and uncomfortable, unable to let my guard down for a moment as her family was constantly trolling for information about myself! It’s hard to keep my stories straight.

Nothing felt better than getting back home. I dropped Angela off at her place and drove off to get ready for work. I felt a weight lifted off my shoulders! I was glad to be busy tonight. It kept my brain from thinking too much. As always, the Medicaid bunch comes in the Emergency Department late at night. No one with co-pays would show up unless they were really ill. Every night at 2 A.M., every Medicaid mom brings inter child for a sniffle, cough, or fever, having seen their pediatrician ( so they say) earlier that day, complaining that their child has a fever. Of course, they haven’t given the kid any motrin or tylenol for the past 12 hours, so it’s not surprising that the child has a temperature! Of course, I do my best to diagnose some mystical answer for the illness, which is generally an ear infection – whether they have it or not. It allows me to prescribe an antibiotic, which every mother wants. In the meantime, the mother will sign in as well to be seen in order to get some chronic complaint taken care of on the fly. Of course they have Medicaid as well, so there is no cost to the patient for frivolous “emergency” visits. So now I have to treat the mother for ‘vaginal itching’ that she has had for the past year. At 2. A.M., this is an emergency?! Really?

-T.C.

So Christmas was really hectic. My work schedule was insane. I somehow forgot to schedule myself for sleep! Luckily Amazon has great delivery service, so I was able to order all my presents on-line in between patients. My parents expected me to join them at home this year for our typical family gathering, inviting me to bring along my ‘secret girlfriend’. This year, Angela decided to go home and visit her parents, who were fully accepting of her pregnancy. She begged me to join her for this Christmas celebration at her parent’s place. I was torn, but I felt strongly that the best thing to do was go with her, otherwise she might demand that I bring her to my parent’s place. Of course my parents had no clue about the pregnancy.

Her family lived several hours away, so we were going to stay overnight. I had never met them before, so this was going to be awkward, and of course, my parents gave me hell about not being at the house gathering. The morning before we left, I went over to give Melanie her Christmas gift, a small bracelet I ordered from Tiffany’s. She was absolutely ecstatic about it, and kissed me wildly after she opened the gift. I had arrived in the early morning at her place, and she was still in her soft, fuzzy night pants and bathrobe. She looked irresistible, and of course, since she offered, I took her up on a quick session of intimacy…

So later today, after four hours of sleep, I threw some clothes together and ran over to Angela’s. She was looking a bit tired and her weight gain is beginning to show, especially with all of the swelling in her ankles. For some reason, Angela was very frisky when I arrived at her place, and she practically assaulted me in order to get me to the bedroom. I was afraid to be rough with her during sex, being fearful that I dislodge ‘something’. Her protuberant stomach, filled with a kicking baby, didn’t do much to sexually arouse me. I knew that there was a sexy Angela inside that pregnant, naked blob somewhere, and that she would return again after the delivery, but as I placed her swollen ankles against my shoulders, her formerly perfectly shaped, smooth feet had become noticeably coarse and dry, which reminded me even more of the sacrifices women make with pregnancy. In short, I went through the motions of sex, cumming in her after a good 45 minutes. I ‘faked’ my orgasm, or at least the strength of it just to get it over with. Angela, on the other hand, was oblivious of my lack of motivation.

Angela was insanely irresistible before the pregnancy. I had just came in her butt thirty minutes before I took this photo!

So the rest of my Christmas holiday was spent with me being on-stage, plastering a steady smile on my face to keep everyone else happy. Introduced to Angela’s family as the ‘baby’s daddy,’ I had never foreseen myself being in this situation. I had planned on a traditional engagement and wedding, ultimately having a house with a white-picket fence, 2.6 children, and a dream job. So as I sat at the table with Angela, her parents, several siblings, and extended family, listening to them drone on about family matters and farming, I couldn’t but wish I were with Melanie or Cherise, worry-free and commitment-free on this fine holiday. Please pass the turkey…..

-T.C.