- 1.deliberately destroy, damage, or obstruct (something), especially for political or military advantage.
"OW, MOTHERFUCKERS! WHAT THE FUCK IS WRONG WITH YOU? CAN'T YOU SEE I HAVE BROKEN BONES IN MY FACE? GOD DAMN, BE MORE CAREFUL!"
We could all see that his face was broken, and none of us wondered why someone would want to do such a thing.
"Hey Doc, this is Robbie," the medic started, clearly trying to prevent himself from punching Robbie on the other side of his face. "He was hit in the face with a bat or a club or something a few hours ago. Positive loss of consciousness. He admitted to using heroin . . ."
"I DIDN'T FUCKING ADMIT TO USING HEROIN! I'M ON FUCKING METHADONE, ASSHOLE! I FUCKING TOLD YOU THAT!"
". . .for a few years," the medic continued with a deep breath, "but he claims he's clean now ("I AM CLEAN, ASSHOLE!") and takes methadone. CT showed a bunch of fractures - here's the disc with the images. He's all yours."
I have rarely seen an ambulance crew scatter as quickly as they did. Roaches scurry slower than these guys. And just like that, Robbie belonged to me.
"CAN I GET SOME PAIN MEDICINE? NOW?! HELLO??"
I tried, and probably failed, to make my sigh inaudible.
After a quick glance at Robbie's broken face, I took the disc over to the computer and waited approximately 3.2 years (I counted) for the images to load onto the screen. Sure enough there were several fractured facial bones on the left side of his face (I assume his attacker was right-handed). However, the fragments were not displaced and there was no evidence that the muscles that control movement of his eye were entrapped. I seriously doubted he would need any reconstructive surgery, so with the blessing of the facial reconstructive surgeon on call, I could most likely send Robbie home.
There was still the issue of treating Robbie's pain and convincing him he didn't need A) a hospital, B) surgery, and C) more narcotics. Obviously Robbie's most recent methadone dose had worn off, and he had every reason to have pain. I'm not saying he deserved it, but . . .
Ahem. The problem with pain control in narcotics abusers is multi-faceted. First, their tolerance tends to be very high, with effective doses being high enough to kill a whole team of very large mules. Second (and more dangerously), it feeds into their addiction. I therefore asked the nurse to give him some ketorolac, which is a rather potent non-narcotic IV anti-inflammatory analgesic. Robbie had obviously been through this before and knew exactly what to say.
"I'M ALLERGIC TO KETOLAC OR WHATEVER!"
Of course he is. I asked him what his allergic reaction was, expecting him to say 1) it doesn't work, 2) it makes me die, or 3) I don't know I just am. Instead, he went off-script and said it makes him feel nauseated. Ha, nice try but GOTCHA. I explained very calmly that nausea is not an allergy, but rather an intolerance, so I would just give him some anti-nausea medicine with it. Right on cue he went back on-script and screamed that the anti-nausea medicine doesn't work for him. Because of course it doesn't. I de-escalated a bit and asked if he could take ibuprofen.
"I'M ALLERGIC TO IBUPROFEN!"
And of course his "allergy" was nausea again. By this time the patience of everyone in the room was wearing thin. Actually that's not exactly true - our patience had completely run out the second he started cursing at the ambulance crew, and we were now all completely tired of his bullshit. A few minutes later as I was putting in an order for acetaminophen (I CAN'T TAKE ACEMATINOFEN OR WHATEVER!!"), his parents showed up. His father hobbled in with a cane, and his mother smelled like an ashtray that hadn't been cleaned in 30 years. They sized up the situation rather quickly, and they obviously were well aware of Robbie's drug history. Mum started trying to sooth him with quiet, calm words mixed with tears, and dad stood back towards the door, obviously seething. It seemed he was rather angry with Robbie, and rightfully so.
After some back-and-forth arguing between Robbie and his mother, dad had seemingly had enough. He set his jaw and marched forward (as quickly as he could considering his cane), and I expected to hear a thorough tongue lashing. I did, but the object of dad's wrath was completely unexpected.
"THAT'S ENOUGH, Robbie. Enough. God damn it. Let's just get the hell out of here. These people don't know what the HELL they're doing. I'll take you home, and I'll take care of you the way I always do."
There was nothing but stunned silence as Robbie's mother nodded solemnly.
The implication was clear, and dad was not trying to hide his intentions one iota: Since these people won't do it, I'll give you some of my narcotics.
I usually have it in me to confront situations like this, but this had me so taken aback I had no alternative but to let them leave. This was obviously not the first time they had been in this situation, and it most assuredly will not be the last, since they both fed right into it. My intentions were nothing but pure: 1) don't feed Robbie's addiction, and 2) treat his pain. Dad's were the exact opposite. He was satisfied not only sabotaging my well-intentioned plans, but his son's health too.
I'm not a babysitter. I can't go home with my patients and make sure they do the right thing, so I damn well can't ensure everyone else does the right thing too. All too often I have to rely on family members and friends to help their loved ones along and keep them on the right path. But sometimes those reliable family members just don't exist.
I strongly suspect I'll see Robbie again in the near future. And I will treat him exactly the same way as I did this day.