Coping Skills Don’t Come in Pill Form

July 9, 2009
Just swallow

Just swallow

OK, I promise to write more often (thank you all for the kick). June and July are always mega-busy as everyone tries to go on vacation, and then you get a Dumass doctor fired and it just makes things that much harder on everyone.

One of the saddest commentaries on the modern world that I see on an all too regular basis is the absolute lack of coping skills in the growing generation. We had generation X and then Y, and I guess they’ll need to call this generation W for whiners. Too pampered while growing up that they have no idea how to manage their own problems after they very effectively create them.

Case in point. This past weekend, I had the unfortunate experience of seeing LT on three separate occasions for what he described as “anxiety or a panic attack”. LT was a promising college football recruit out of his competitive high school district. I have no doubt that he was getting his bum kissed all the way through high school and well into college until he blew out his knee.

He went to surgery for his ACL, but being that LT had always had others to take care of him, he ended up with an infected knee and a PIC line. The nurses in the ED came to know him well as he would often roll into the ER for his scheduled IV antibiotics after midnight while drunk and with a different girl on his arm. And things would only get worse …

Soon after, one of his girlfriends got pregnant and decided she didn’t want him in her, or the newborn boy’s, life. On one of his drunk escapades, he got into a fight with some guys on a street corner. For some reason though, he was the one arrested (they were all the same ethnicity by the way). Since his knee was no good now, he also lost his scholarship and with it, the stream of girls who had followed him around.

So now he had only one girl left and a growing list of problems. So poor LT thought he was going crazy and came to the ER. There he received an rx for Paxil and some Ativan to help him calm down. Little did I know that he would be back a short 10 hours later. He told the nurse that the doc he had seen earlier “hadn’t taken the time to talk to him”. He was surprised to see that it was still me though and quickly backtracked by saying that what he meant was that he hadn’t had enough time to fully explain his problems.

So, I listened patiently to him as he told his sob story. Afterward, I explained to him once again that he was not crazy but that he had several issues that he would need to address one at a time (just like the rest of us mere mortals). He didn’t seem to like my suggestion as that entailed actual effort on his part. I resisted the urge to ask him if his girlfriend wipes his butt for him as well.

The next day he showed up yet again, this time saying that he felt chest pain. I was obligated to do more of a work-up this time – which was completely negative 80 minutes and $5000 later. I had no desire to see him again in what remained of my ridiculously long shift and hit him with the B-52. When his mother, I mean girlfriend, came to pick him up he was already half-way to his “happy place”.

Thinking I was done, I actually rested. But less than 2 hours later the police showed up with an inmate who had swallowed shampoo and some toothpaste in a suicide attempt. I asked him why he had done that, and he said that he couldn’t handle being in jail anymore. He was put in jail 3 days earlier for DUI. I thought to myself, “you really don’t know what being uncomfortable is all about – yet.” Then I got out the gastric lavage.

I don’t think he had bargained on getting a garden hose put into his stomach without sedation. But he just couldn’t get it through his mind that he needed to find a way, other than medicine to “knock him out”, to cope with prison life. The whole “do the crime, do the time” thing just didn’t compute in his mind.

The future scares me.

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I’m Feeling a Little Anxious

May 31, 2009

A rare thing happened in my ER last week when two major traumas were brought in after what appears to have been a drug deal gone bad. I was not working when they came in, but got involved two days later when the prime attacker came into the ER for “anxiety and trouble sleeping“.

J tells me when I walk into the room, “You probably heard about what happened earlier this week right?” I had certainly heard bits and pieces from some of the nurses but never got the whole story so I told him I wasn’t sure what he meant. So he gave me his version.

Well, I was gettin together with some of my friends who were buyin some cocaine and other stuff from me when they started arguin with me and for no reason at all grabbed me and started poundin my head against the pavement. [perps always seem to be violent for no apparent reason at all don’t they?] And then they pulled a shotgun and a knife on me. I tried to calm ’em down but they were real angry [coke heads angry? nah, I don’t believe you!] so I pulled out my knife and we scuffled and they ended up comin here to the ER and were flown out …”

What I knew had happened was that two people had come code three by two EMS units with “their intestines hanging out” from knife stab and cut wounds. They were stabilized rapidly and moved on via helicopter to the nearest trauma centers. The attacker, the one who was my patient presently, was unhurt and arrested. He had gone directly to jail but apparently was released on bail somehow so he could come and visit me. Police had searched his house and taken all of his drugs – an assortment of meth, cocaine, benzodiazepines, narcs and other drugs as well as weapons.  That left him in the precarious position of being unable to get high.

So I told him, “Sounds like you’re pretty skilled with a knife from what you’re saying.” He replied, Not really, it was all in self defense” [its always self defense isn’t it?]. So he continues, “I just need something to help me sleep and to calm me down.”

I could understand. The guy was facing some serious jail time for attempted murder x 2, drug dealing, weapons charges and probably some other bad stuff – he couldn’t get high off of his supply and neither could his wife, who was apparently outside raising hell in the waiting room because she too was “anxious”.

And then his mom, who looked like she belonged in WWF, shows up. I guess you could say that he had some reasons to be anxious.

I didn’t buy into writing him any more drugs though and gave him a shot of Geodon to get him the hell away from our hospital. He may be anxious, but as they say, “you make the bed, you sleep in it.” I doubt he’ll be getting anything in jail to calm his nerves so might as well start getting use to it now right?

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