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.

-ER Doc


Mel said...

Perhaps you continue to treat them because you swore an oath to do so.

I particularly like this line from the Oath of Maimonides:

"May I never see in the patient anything but a fellow creature in pain."

Anonymous said...

Like oath's mean anything. And who the hell is Maimonides.

Anonymous said...

I'm sure Maimonides was thinking in terms of socialized medicine

Anonymous said...

Let the troll die. I agree with ER doc. Why save people who aren't worth saving? Burdens on society. Through their pain, the inflict pain on everyone around them.

EinAesthetist said...

Mel, if you mean the oath of hippocrates among others, that one isn't up to date anymore. Read up on the hippocratic oath's view on abortion and caring for your teachers (you'd actually promise to care for your teachers' family and kids and further offspring as if they were your own. Yeah, sure.)

This post doesn't seem about to deny those trolls the treatment, but it's a lament over the fucking annoyance they are. Frankly, doctors don't have to be empathic towards all patients. They do get their treatment, but they can't expect to be loved when they're abusive.

EinAesthetist said...

"doesn't seem to be about" (damn typos).

Even when it's hard and seems unfair, everyone should be treated the same. I'm not one to pass a person in need of help without stopping, because you never know why Uncle Bill is lying there with pissed pants. Could have been a diabetic or stroke, too. However, with some people, when you see them the umpteenth time, you wish the next time they wouldn't be found fast enough to even get to the ER.
Of course the best would be if those trolls had an experience (whatever that could be) that made them realize what crap they're doing, and behave better from then on, but those cases are rare. When choosing to work in medicine and especially the ER, one pays the price by having to accept all patients. That's how it is. Unfortunately too many abusive suckers make you cynical and frustrated, which can lower the quality of your own life. I guess there have been good doctors who resignated and left the medical field because of having a job that, as wonderful as it can be, often doesn't make you happy but suicidal.

Mark p.s.2 said...

Yes the work and cost to save him seems wasted, but he is alive and mobile to pursue his freedom to be stupid. Maybe that's what God wants.

It is up to the fates or the Angels/devils if he dies next time. I choose to think God is giving him another chance to change his life.

I think the question is why did the person who saw/found him not mind their own business?
They didn't know him and assumed he was a human being that contributed to society.

The flip side.
"Hugo Alfredo Tale-Yax was stabbed several times in the chest while saving a woman from a knife-wielding attacker. Then he bled to death while dozens of people walked by -- one stopping to snap a picture of the dying man with his cameraphone before leaving the scene.

Tale-Yax, 31, a homeless Guatemalan immigrant, collapsed at 144th Street and 88th Road in Jamaica, Queens, while in pursuit of the woman's attacker around 5:40 a.m. on April 18. He was pronounced dead by medical workers who responded to a 911 call around 7:20 a.m. But surveillance video obtained the New York Post, which the New York Times got the NYPD to confirm is genuine, shows that plenty of people saw Tale-Yax lying there in his death throes and did nothing."

tracy said...

Thank you, Mel.

You don't know who Maimonides is? i'm not even Jewish and i know. Do you include OD's and severe cutters as trolls?

A Troll.

i guess that's why, after 27 (60mg)Cymbalta,and etoh, the ED doc decided to do nothing...i guess he was hoping i would die and there would be one less troll in the i wish i had.

Anonymous said...

Of course, a post about Trolls brings out the cyber version of the same.

It is unfortunate that the "caring hearts" folks don't see these patients day in and day out, to have a profound sense of how different they are from functioning human being.

Frequent Flyers do not acknowledge the humanity, rights, feelings or needs or any other person. We are all "things" in their world, where they and they alone matter. Period. It gets really tough to feel sorry for someone who sees YOU as scum, an object to be manipulated for their own gain. And some of you think the medical staff that puts up with this abuse are mean for not being able to stay in Mother Theresa mode??

The Bible and the Puritans from the Mayflower had it right...if a man does not work, neither shall he eat. [..and of course children, the elderly and the really SICK are excused). Revive this gem and watch how many social problems go long as "sickness" excludes being a drunk or addict, morbidly obese, or too "anxious" to work. JMHO.

Pattie, RN

SerentiyNowHosptial said...

Nicely said Patty.

ER Doc

tracy said...

Yeah, thanks Patty, RN, full of compassion. Apparently just like the rest of the Medical world that i u s e d to truly admire. i really wonder why i did that Stupid me.

tracy said...

Yep, some of "us" just aren't worth saving...we are not human beings like "the rest of you" wonderful people are. Your hurtful words do nothing to help me or anyone else make a change. Thanks for NOTHING!

Anonymous said...

tracy why are you taking this so personal.

SerenityNowHospital said...


I don't know you. This post was meant as a generalization and an exaggeration. Please don't consider yourself a "troll." I am sure you are not. Plus you have internet access so that already sets you apart!

It does really concern me that you are taking this so personal. I encourage you to seek help if you are having down thoughts. Dont think medical professionals dont care. I/we still do. Just like in any profession, we get frustrated about things. This is simply a way to vent. I am more than sure that you or just about anyone is worth saving. This is just a venting process and somtimes things do cross our mind in a negative way when we are frustrated and abuses. Again, please dont take personally. And please, please seek help if you are having negative thoughts. The last thing I want from this blog is to hurt someone the way you seem to be hurting. I don't mind pissing people off, but don't want people to be hurt. Thats not what this thing is about

-ER Doc

ERP said...

It's called the "one finger code"....

tracy said...

i'm sorry. i'm so, so sorry for writing such mean things. It's just that i've been there. And i hate so much the trouble i caused to a profession i admire so greatly. Thank you for you kind words, they mean so much. Again, i am so very sorry. "If i could turn back time..."

Trust us....we're doctors said...


You have nothing to apologize over. I doubt you caused the medical profession ANY harm, so don't feel guilty. And this site is for fun, so don't apologize to us. Again, don't feel guilty. If you needed help in the past and you received it, you have nothing to be sorry about. Thats what we are here for.

-Er Doc

Geno said...

Even the detox center here in San Diego refuses some drunks, why can't the emergency room? If there is a law that says you have to give a drunk a bed it should be changed. Hospitals are only enabling these chronic drunks to continue drinking. Have you ever heard of co-dependence?

Geno said...

I should have added that I know about drunks from a lot of experience including my own family. I almost got to that point myself before I found Alcoholics Anonymous. I have now been sober for 20 years and have never woke up in the ER since I quit drinking. The worst thing you can do is give them a place to stay, they HAVE to hit bottom to get help.

EinAesthetist said...

OT, but I felt the need to comment on it.
ER Doc, you got my full respect for the sincere answers to Tracy. I know many people don't realize the nature of this (or any, really) medical blog and take a lot literally that should be taken with a grain of salt. Especially because venting often brings out strong feelings and strong language (totally understandable), thank you for not being too much over your own head to step back and show us your caring side - especially when it is so easy to be harsh and flippant in the anonymity of the wwweb. Kudos.

(but please, keep the venting coming. :) )

tracy said...

Thank you, yes, a l l of you, for putting up with me.

And...sincere congratulations to Geno!

Jules said...

Wow, I hope I never encounter you in the ER. I think you chose the wrong profession.

tracy said...

Oh, dear, the post that just won't die.

SerenityNowHospital said...

Honestly....another reason for such extreme words on certain posts is to get responses from readers. Look how many comments we get for posts like these compared to the post about a guy tattooing his penis! That was a much better post

ER Doc

Anonymous said...

I used to feel the same way as "Pattie, RN" about those "too anxious to work" -- until I brought home a few souveniers from my military service (PTSD, TBI, etc). I've overheard one Doc and a few nurses complaining about the costs to society of my treatment and even had one doctor sneer that disability retirement from the military was only for "real" injuries when HE was in the Army. Sigh. So, while I understand your frustrations and how burnt-out your compassion meter can get, it has been an eye-opening experience to be considered worthless and not deserving of help by some. Luckily, I know my worth in the eyes of my family, friends, and God. It's those without that support system I ache for.

tracy said...

It hurts me that you had such awful experiences. i am so sorry you overheard such cruel words. And, i am happy you have such supportive family and friends.

Bless you,

Kolly Flahua said...

Isn't forcing doctors and nurses (saying they HAVE to treat these ppl) to do a job that they sure as hell aren't gonna be paid for (these patients never pay their bill, or they get it excused & the hospital eats the cost, thus eventually laying off staff)... isn't that akin to slavery? And what do we have to do to change this? Cause this happens at my hospital too, I think at every hospital. I mean, we have serious student loan debt. Unlike socialized countries like Germany, we have to pay tons in tuition. This frustrates me. This makes me feel like healthcare is a luxury and not a right. If it's a right then eventually there won't be ANY doctors & nurses, I mean who the hell would wanna put up with that kind of slavery while still incurring massive debt?