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!!
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….