In case you haven't noticed, recently I've tried getting away from calling my patients "idiots". I've been trying my damndest to keep in mind that everyone makes mistakes and some people even have reasonable reasons for those mistakes. People don't deserve to be crucified for doing stupid things, right? Right, they simply need to be educated. Jumping to calling people names is childish and silly (not to mention very judgmental), and I think of myself as better than that. Call it the New And Improved Insult-Free DocBastard!
Having said that, Erin (not her real name™) is a fucking idiot.
I have never done illegal drugs in my life. I've never felt the urge and I've never given into peer pressure, though I've been around many people who have. I've never really understood why anyone would want to allow himself to be out of control of one's senses and/or body parts. It just doesn't look like a good time. Erin, on the other hand, got herself into heroin at a very young age. At just 23, she had been in rehab twice already and was taking buprenorphine, an oral medication similar to methadone, to try to stay off heroin.
It wasn't working. At all.
One gloriously stupid evening 25-ish year old Erin stupidly decided that, in addition to taking her buprenorphine, she would also stupidly inject herself with heroin. To add to the steaming, stinking stack of stupid, she then got in her car and drove . . . somewhere. She apparently had no idea where she was going, because several minutes later she found herself in the middle of nowhere with her car wrapped around a tree.
Well, I shouldn't really say "she found herself", because she was completely unconscious and in no position to find much of anything except the inside of a morgue. When the medics found her she was slumped over in the passenger seat next to a half-empty liquor bottle (and no, of course she wasn't wearing her seat belt). They recognised the telltale track marks on her arm and rightly gave her a dose of naloxone to counteract the heroin they (correctly) suspected she had taken. Normally patients who have overdosed on narcotics wake up immediately after being administered naloxone and are very angry that someone killed their high. But not Erin. She woke up only minimally because in addition to being high as a fucking kite, she was also drunk as a Tyrion Lannister (I greatly prefer him to skunks).
Fortunately for Erin (and unfortunately for me), she woke up a bit more on the ambulance ride to me, because when the medics oozed her into my trauma bay, she was fully awake. And screaming. Screaming at everyone and everything. I've never been so angry that I've yelled at a complete stranger who was trying to take care of me, but that was exactly what Erin did, in addition to yelling at the floor, oxygen mask, and cervical collar.
"GET ME THE FUCK OUT OF HERE! AAAAAH! GET OFF OF ME! AAAAAAAH!"
Sigh. Just another Tuesday night.
My initial survey revealed a few abrasions here and there and a chronic-appearing ulcer on her leg, which looked suspiciously (read: obviously) like a former (or current) heroin injection site. Of course I never found out because she refused to tell me anything. When I got to her abdomen, she seemed to wince a bit when I pushed on her left side.
In the trauma world, that's an injured spleen until proven otherwise.
Unfortunately she wouldn't allow me to perform an ultrasound to see if she had blood around her spleen. Her refrain of "GET THE HELL AWAY FROM ME!" kept ringing out, loud and clear. After about 30 minutes she finally calmed down (i.e. sobered up) to the point where, instead of screaming at us, she was simply saying "Get away from me" in a calm (though rude) voice.
After much begging and cajoling, we finally convinced her to allow us to perform a CT scan of her abdomen, which continued to hurt rather significantly (though she wouldn't allow anyone to re-examine her). If you've been reading this blog for any period of time, you can probably predict the outcome of the scan:
Actually, no you probably can't, because I enjoy fiddling with people. You see, unlike most of the patients I write about, this one WASN'T uninjured. She had a very nice laceration of her spleen (SURPRISE!) with a significant amount of blood around it. An injury that severe doesn't usually require surgery, since the bleeding typically stops on its own). But it does require close monitoring in hospital, preferably intensive care, with frequent blood draws to make sure that the bleeding actually stops (which it does about 90% of the time).
As I walked back to the trauma bay to give her the wonderful news, I thought about just how lovely and fun the next week or so of rounding would be, knowing that she would be a model patient: polite, cooperative, and pleasant to care for. I probably had a visible scowl on my face when I walked in, but that scowl quickly changed to a gape.
Erin was getting dressed.
The nurses were trying to calm her and get her to sit back down on the bed, but Erin was having none of it. "I'm getting the hell OUT of here!" I calmly and rationally (read: quickly and loudly) explained that she had a very serious injury and she had to stay here. With me. Oh, the joy.
"The hell I do! I need to go home so I can smoke. BYE!"
I again explained about her injury, why she should stay, and would could happen if she left. If her spleen continued to bleed, she could easily bleed to death. She listened, paused, and then demanded to see the papers she had to sign to leave against medical advice. She also insisted that we not tell anything about her injury (or her drug use) to her father, who had apparently just arrived to see her. Obviously she had been in this situation before, because she knew all the things to say that prevented us from caring for her in any way. When her father walked in, she simply told him "I'm fine, dad. Let's go."
And two minutes later, she was gone like Keyser Söze.
I have no doubt that Erin has pulled this shit before, and I have even less doubt that she will do it again, assuming her splenic laceration didn't kill her. With her luck, she probably healed up just fine and went back to doing heroin the next day.
Since as you know I'm a hopeless optimist and always try to see the good side of every story, here is the silver lining of this story: Erin lives well over 2 hours away from me, so the chance of her driving high and drunk again and encountering my wife driving my children around town is very close to zero.
But it is not zero. And that scares the shit out of me.