Turnaround

My patient, T, was really unpleasant for the first two weeks I was at clinical. She was constantly requesting pain medication but refused everything available, she only wanted narcotics. Unfortunately she has a history (and a present) of lots of drug use and the doctors weren’t willing to prescribe more narcotics. The pain clinic refused to see her until the active drug use stopped. We tried to explain this to her, but she complained bitterly about being treated differently from everyone else. She was also incredibly lethargic, even stuperous at times and kept reporting falls (not surprising given her condition). The falls were concerning, but her reports didn’t make much sense (for instance, reporting a fall on steps outside…where there are no steps) and her pain was always a 10 out of 10 and moved from the left side of her back to the right and then back to the left. It all spelled drug seeking to the health care providers. There wasn’t anything we could do except keep offering tylenol, heat packs and ice, none of which she wanted. I would have felt worse about this – and that I couldn’t do more to help her – except that she was so obviously using lots of drugs already.
A staff person found a rock of crack in her room one day and the police were called. Unfortunately the patient was so far gone when the cops got there that she didn't even remember seeing them and it had no affect on her. Not so with the other patients - one of the more active users had seen the cops walking down the hall and cleared out his room and was gone within the hour. It was for the best that he left; he'd just received some disability backpay to the tune of $10,000 and all the staff were concerned about what that would do to the amount of illicit drugs on the floor.

Back to T. A few days later a crack pipe was found in her room and the cops made visit number two. They were actually really cool about it and gave her some tough love. Really though, what could they do? Her medical condition was too complex for jail, so if they arrested her, T would have gone to a hospital and have round-the-clock guards. A pretty expensive option, particularly considering that she's barely conscious enough to do harm to herself and not likely to cause problems with other people.

I'm not sure if the visit with the cops did the trick, T ran out of drugs, got some really good drugs, or some combination of all three, but she was really pleasant today. She joked with the staff and danced in the hall to make us laugh. She's got a really funny sense of humor and is just so goofy sometimes. I'm so incredibly glad to get to see her like this and get to know her a bit more as a person, not just some drugged-out hopeless case. It's going to make it so much easier to provide good nursing care to her, even when she is stuporous, because I now know who it is I'm caring for.