Sunday, May 30, 2010
Pull the Plug
Sometimes (ok all the time)....I really wish we could choose who we are going to spend thousands and thousands of dollars working up or saving. I'm not talking about the elderly demented or terminally ill. We will save that argument for another day.
Most county or community ERs have "frequent fliers." They are patients that come over and over for no good reason. Most are homeless, drunks, or drug addicts. The ER staff usually refers to them as trolls. Here's a link about 9 patient's that accounted for 2,700 ER visits in Austin, TX.
In my residency, I have at least 20 patients like this. All the staff knows them by name. We know what they want. We hate them. They suck the life out of us. No respect for the system. No respect for the taxpayer. They are extremely demanding, can ruin your day, and we have to see them each time.
One such patient, we will call him Troll-A, came in obtunded from drinking himself into a stupor. He was found down outside of the hospital under his normal bench. He was so drunk he could barely breath. So what do we do???? We have to save him. Why??? I still don't know the answer. I guess b/c we don't get to pick our patient's and who we choose to help in the ER. Even though EVERYONE in that hospital knew it was going to cost someone a ton of money to put Troll-A on a respirator and in the ICU.
So we did what we had to do and intubated him so he could keep breathing off his alcohol. About 16 hours later, his alcohol wore off to the point that he extubated himself....literally pulling the breathing tube out himself....and left AMA (against medical advice). Of course he pissed on the floor and cussed out the nursing staff before leaving. 2 days later he comes back for his chronic low back pain trying to get narcotics!
What the fuck ever. Just don't say "it's job security" like so many people do about these trolls. B/C its not. They are too dumb to go get on medicaid, so know one pays. When no one pays, it wastes money and therefore isn't job security.
Enough of my rant....bc If I don't stop now this post will get much, much longer.
Posted by SerenityNow at 2:14 PM