Tuesday, August 18, 2009

The convention's in town!

Must be a convention in town! Tonight after a long time off, I decided to write my experiences in the emergency room. So, there I was, seeing patients and suddenly the nurses I work with (who are the best in the world) started coming in commenting on each of their individual patients. As I have spoken of in previous posts, in many cases of "drug seeking patients" there will come a certain personality/aura/karma that just exudes a feeling of move away from that person or you will also feel bad. In medicine it is called "counter transferance", a certain personality of a patient induces a counter feeling from the practitioner of hatred or anger. Real world terms of pissed off, irritated, fed up....are all the feeling from the nursing staff when a person like this comes into the doors. Everyone will feel it from the greeter, to the triage nurse to the patient care tech to the nurse to the doc. Simply since this person has the intention of displaying to all; a convincing story where they get empathy and hopefully get the extreme medicines for pain their brain is seeking. Yes, it is not the back or tooth or skull that is calling to them to get the narcotic drug, it is the brain that hasn't had the taste of morphine derivative for a while and will make an average human seek out more medicine by deceiving even the most intelligent being to think the smallest insignificant discomfort is a heart attack or broken bone.
This reminds me of an incident at the Def Leppard concert I went to. As I went to claim my seat after missing Cheap Trick and catching Poison, got to the row, someone was in my seat and I graciously said, this is my seat. Showed her my ticket but before I could get my ticket to eye view, she claimed with an elaborate story; "my husbands wallet got stolen and his ticket was in it". She proceded to show me her receipt and asked if I had a receipt. Of course I didn't carry the receipt to the concert but I said lets talk to the usher, she immediately said "I've done that already". She was so rehearsed and convincing to her 3 family members that the young guy said "give me that ticket!" My 9 years of Aikido had another answer for him but I didn't want to start throwing people so I continued to get the usher and of course, she was told to leave. Getting back to drug seeking patients, I don't doubt there is pain, I just doubt the interpretation of the patient to what is going on with their bodies. I brain is so good at altering the hunting instinct to get what seems to be the best thing available and narcotic meds can really make you feel good.
So tonight, I got the feeling we had alot of seekers since everyone had the worst pain ever, 10 out of 10 on the pain scale and facial grimace was labor like. (Yet physical exam was normal for nerve function, mobility and skeletal range of motion) And none of the doctors could fit them in for the next week. It seemed to be that I had an abnormally high census of the "frequent flyers". As I was trudging along seeing the patients, I guess one of the nurses got fed up with one and called the police. She was so right, the guy was calling out wondering when the doc was coming, I remember him from before. He had a long depression history with not one visit to a psychologist, last time he was here, slurred his speech and blammed it on not being able to sleep. Today he was wobbling and slurred his words and his eyes kept closing while asking for pain meds for his back. (And he drove to the hospital!-this guy is going to run over someones family!) So a police officer came to escort his after discharge to make sure he didn't drive home. Just so happens, the other 3 frequent flyers saw the police officer and low and behold, every suddenly stopped complaining about waiting for the doc. Something about the idea of jail that makes wrong doers become so well behaved.
The reason I bring this night up, I mentioned to one of the nurses who seemed kinda beat/tired after the night was about done, always being on the defense and trying to stay neutral when confronting someone who has so much evil energy, ultimately takes alot of concnetration and energy. I believe it takes alot of mind body relaxation to not get drawn into the malstrom of emotion involving these people-whether in the ER or at a rock concert. No wonder there is such a high burn out rate in this specialty.
For my regular patients, stress should be anticipated and "countered" with practicing the relaxation response. Listening to the "ego" and yelling back, becoming emotionally charged, feeling he is trying to insult me by tricking my intelligence only make you succumb to exactly what the drug seeker is trying to get-an all or none response. "Give meds and get him outta here" Thinking calmly, not worrying about insult, and not getting pulled into the malstrom of human suffering will get you thinking properly so as not to make snap judgement.
Another patient was in for a headache but confronted me by saying, are you angry at something? She commenting on my non tolerant attitude and I appologized and explained the pressure that was happening and duely. calmed down and treated her like a human should be. Amazing how relaxing for a bit in the face of anger, can make stress go away and make intellect return.