From the folks that brought you…
chronic drug seekieurs/chronic painieurs
comes a whole new group of fun-time pains in the asses:
*drum roll please…*
Yes, you too can have nebulous complaints that never seem to be fixed without the aid of “dilauntin”.
Why pay rent when you can convince the docs that your symptoms are still sooooo bad that you can’t go home? And in spite of having a jejunostomy tube, you too can be a bulimic by sucking out the stuff you just swallowed through said tube.
Ran out of IV fluids and phenergan at home? Come on down, we’ll hook you up! Mix some dilaudid in the IV piggyback bag they now make us use for phenergan and throw it all down at once…it’ll be great! Just don’t complain that, “I get bigger doses of phenergan at home!” because we just might tell you to go back there!
But in all seriousness…
I know that gastroparesis ican be a debilitating medical problem, whether from diabetes, destruction of the vagus nerve, what have you, it can make one’s life miserable. I feel bad for those that truly have it. These aren’t the ones I speak of.
Lately we have had a string of patients with “gastroparesis”, where the etiology is more psych related that physical. And these are the patients that wear you out physically and emotionally. Manipulative? Yep. Borderline personalities? Probably. Entitled? You better believe it. It’s almost like they have a local club where they get together, talk “shop” and trade secrets and regale each other with new stories of how they pulled it over on Doc So-and-So. Several of them have implanted ports and administer IV fluids, pain medications and anti-emetics at home, but “decompensate” and get admitted to our observation unit for treatment of “nausea and vomiting.”
They seem to be the ones where nothing you throw at them works. Zofran, compazine, phenergan never seem to take their nausea away. (Maybe next time I should suggest droperidol or thorazine…) Their favorite for pain relief? The Big D, baby. Dilaudid, or as one so eloquently put it, “diluantin”. And not small, infrequent doses either. 1-2mg q2 hours. Srsly. One even sets their cell phone alarm to when they can have it next. And boy do some of them have tolerance. One had an endo and received 10mg of Versed IV and 300mcg of Fentanyl IV. If you have given me that last week I would still be gorked today. But it did “nothing.”
Luckily though, the docs are wising up. The one I had the other night had written in the orders section, “NO NARCS!” in bug, bold strokes. Two of them have been black-listed from our observation unit as they tend to stay for days-weeks at a time instead of the obs stay of 24-48 hours. I’m sure that as of now, they are passing the info and will soon to migrating to another local hospital for the cycle to begin anew. I hope.
One last thing that bugs the shit out of me: when you ask for nausea medication, don’t ask for 2 yogurts, some graham crackers and a turkey sandwich to wash it down with. The nausea you’re feeling is probably just hunger pangs…