Monday 9 October 2017

Fool me once again

I've written before about not learning from mistakes. In case you missed that episode, please go back and read it. I just did, and that story is fucking hilarious (if I do say so myself).

Anyway, it seems that in my trauma bay I see more than my fair share of people who are either unwilling or unable to learn from what they've done wrong so that they don't do it again.  Everyone makes misteaks (myself included, naturally), but unlike many of my patients I try to refrain from making the same misteak twice.  This is a lesson that I beat into my children (NOT LITERALLY) on a daily basis.  After all, I tell them, if you don't learn from your mistakes, then what the hell is the point of making mistakes.  Right?  Of course right.

I have to assume that Lacey (not her real name™) didn't have such caring and knowledgeable parents.

Lacey was brought to me in a bit of a heap one fine late evening, the police trailing just behind.  That is, as you have probably guessed, never a good sign.  When she was wheeled into the trauma bay, she was completely unresponsive, unable even to open her eyes.  When I see such a patient, I think of the three Most Likely Possibilities:
  1. She has a severe brain injury,
  2. She is drunk (or otherwise intoxicated) as hell,
  3. She is faking to avoid talking to the police.
It's my job to differentiate among the three.

"Evening, Doc.  Here we have Lacey.  She's 29, history of anxiety and depression, allergy to penicillin, takes one medication for anxiety though she doesn't know which one.  History of heroin abuse.  We found her like this, unresponsive, outside her car on the side of the road.  Basically no damage to the car, but, you know, we can't tell if she hit her head or oh-deed or what.  She's been unresponsive like this since we found her, though her vitals have been rock stable."

A quick glance at Lacey revealed no outward sign of trauma, not even an abrasion.  She literally had not a single scratch on her.  I strongly suspected Most Likely Possibility #2.  She had a grossly abnormal neurological exam: her pupils were pinpoint and she did not respond to painful stimuli, so I could rule out Most Likely Possibility #3 (though #1 was very much still in play).  Her physical exam was otherwise completely normal.  X-rays of her chest and pelvis were normal.  An ultrasound of her chest and abdomen showed no sign of bleeding around her heart, lungs, liver, spleen, kidneys, or bladder.  A full-body CT scan was negative.

This did not seem to be Most Likely Possibility #1 either.  Shocking.

A few minutes after seeing her normal scans, her lab work finally came back.  Her chemistry and complete blood count were (are you sitting down?) totally normal.  Finally I saw what I was looking for: something.  Something.  Anything that could explain why she was out cold.

Her urine tox screen was positive for heroin.  I hate the term "Duh", but really.  DUH.

Now clearly no one in the trauma bay was surprised, but as we started to discuss the sheer stupidity of driving after injecting way-too-much heroin (though to be fair, any amount of heroin is way too much if you plan on driving), something occurred to me about the medics' presentation that hopefully occurred to you too.  I cocked my head as I thought about it, wondering.  

Fortunately the ambulance crew was still milling around the hallway, so I decided to ask them the question that was noodling around my brain: If she was unresponsive when you found her, how the hell did you know her medical history other than heroin use and that she was allergic to penicillin??

The medics turned to each other, laughed, turned back to me, laughed in my face, and then started high-fiving each other.  Not really, but that's what it felt like as he chuckled politely and said,

"Oh, because we picked Lacey up for a heroin overdose earlier this morning too."

Wait, you . . . what?  Of course you did.  Somehow, that made total and complete sense.

Unfortunately for the general public, the police left without arresting her.  I have no idea why and no reasonable suspicion other than that the officer got bored of waiting for Lacey to wake up.  So instead of going to jail for endangering every single person around her, Lacey got away with it.  Again.  She woke up, got dressed, asked me for a prescription for narcotics (HA!), and went home.

I can guarantee that she learned absolutely nothing from this episode, and I can further guarantee with near 100% precision that I will see her again.  Probably soon.


  1. Some people never learn from their misteaks.

    1. Yes there are two of them in in the first paragraph.

      I also hope Lacey is arrested later on in the week for DUI in the interest of public safety.

    2. I suspect that was done intentionally, right, Doc?

  2. Any amount of heroin is to much. Not just for driving.
    One of my oldest friends last year died of a dangerous mix of narcotics and alcohol after hed gone clean from heroin. Hed been clean for a while too.

    Despite that, I have little to no sympathy for those who continue to use heavy drugs like this and endanger others

  3. I once saw “If you like learning you’ll love mistakes” on a throw pillow in needle point. I wish I’d purchased.

  4. there are a few patients our local paramedics are on a first name basis with.

  5. on the second read, I get the idea the medics were waiting for you to ask that...

  6. She probably wasn't arrested because she was found outside her car unresponsive. If arrested for DUI (or whatever its called in your neck of the woods), shell maintain that she was not the driver and the driver in fact took off after dumping her out of the car. When asked who the driver was, she'll plead intoxication.

    and, if the car was not running, she doesn't even have to allege somebody else was driving.

  7. There will be a time when nobody will be around to save her.
    By the way, I live in Santa Rosa, California. We have been on fire, many homes lost. I am one of the lucky ones, my house is ok. It is horrific here, air quality very bad.

    1. that sounds like a total disaster down there. hopefully things will pull together for you and everybody else.

    2. Hope the rest of you in Santa Rosa survive. My neighbor grew up there and has family there. Her little sister has been answering the county emergency services phone line. She says so much is just gone!May some rain please come your way soon.

  8. Sheesh.. I wouldn't drive on 30mg of Codeine..

    Mind you, you'd think that in a civilized society, cases like this could be sent to an appropriate institution where they could get cleaned up and off drugs. Two ODs in a day suggests a need for help.

    1. that would involve admitting the problem isn't just bad people.

    2. Ken it was obviously societyparentsbadchildhoodillness! Who would DARE think it was up to the individual? Scoff!

    3. as my mother said over 30 years ago: "maybe we should try to find out why reality is so painful for them."

    4. Ken, your mother is definitely on to something; far, far too many people can't handle reality. Unfortunately, the only 'solution' for these is some form of addiction to replace reality: drugs, booze, sex, video games, et. al.

      Some of us learn to use our escapes to make the rest of it more tolerable. OTOH, far too many see the escape as a replacement. This appears to be the case for Lacey (NHRN). Where the satisfaction in life should be is a vacuum. She chooses to fill it with Opiates (oids? so unsure about that anymore). One hopes she can find something to anchor her back into reality.

    5. honestly, whether it is ates or oids only matters from a medical or legal perspective. from a sociological perspective, they are close enough to the same. the next step for the sociologist is to find out whether the problem is in reality or in the person's interaction with it. or more practically, do we need to fix reality or do we need to better prepare people for dealing with it?

    6. Opiates are medicines derived from the opium poppy, which opioids are synthetic opiates.

    7. do we need to fix reality or do we need to better prepare people for dealing with it?

      Both, I think they are interconnected and am thinking the legal side (or actor) of society help fix reality while counselling help people to deal with reality.


    8. Thanks for the clarification Doc!

  9. Connor -

    Even if you take all emotion out of the situation, having active heroin addicts around is expensive for everyone. There's the property crime, police time, effect of criminal networks, uninsured hospital time, home insurance, and the drain on relatives/dependents. Never mind jail time - about $100 a day.

    So unless you endorse the Khmer Rouge option of just shooting undesirables, you have to realize that helping these people back to normality is the cheap option. Do you *like* paying taxes?

    1. I don't think "I have no sympathy for them" equated to "I don't think we should get people off drugs"

      have little sympathy for people who can use seat belts but choose not to - that doesn't mean I don't tell people to use seatbelts.


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