When I got into nursing I really, truly thought the vast majority of my time and effort would be spent on helping individuals that met with poor luck, poor health, or poor timing. I had expected trauma, elderly, and the infirm. What I get instead are abscesses, lots and lots of them. A few are related to a rough cat or a pet rat or the neighborhood dog taking an inopportune nibble on someone, but most are related to injectable drugs. And if it isnt an abscess related to drugs, it is a side effect from years of self abuse. Wonder why your heart is failing at 50, lets look at your 30 year history of meth. Why is it so hard to find a vein through your scar tissue and prison tats, oh yeah, the 20 years of heroin. We have had people in their 60s and 70s that come in with drug related ailments now.
And far more often than one would think, people going through alcohol (ETOH in med speak) withdrawals. Nothing like tending to someone going through delerium tremors and fighting their restraints. Want to see people the color of the Simpsons, come on down and I will take you on a tour.
And even when you think it couldnt possibly be the case, it is. That soon to be mom you just placed an IV in because they couldnt find anything to stick themselves, inevitably they are on Methadone. If the baby is lucky, that is all they have been on during the pregnancy.
It is harder and harder to care when most of the people you see in a given day (mind you, we get called for any start that is difficult or not easily visible......so by percentage, we generally see only the worst) don't seem to care about themselves in the least. Plus, we set up a consequence free environment for them. If you shoot drugs into your central line, the doctor will pull it....and then shortly thereafter realize that the person still needs 3 more weeks of ABX and then order another line placed. Want to go AMA (leave in spite of the recommendations from the doctor)? Go ahead and feel free to come back whenever and we will do it again. We have patients who go AMA and return later the VERY SAME DAY to the ER and then get readmitted and they order another line placement. Its like you had a buddy who had no job and you let crash on your couch for a bit who then proceeded to eat all your food, drink all your beer, and then takes a shit on your rug before leaving.......only to then knock on your door later that evening looking for a place to crash. And you fucking let them!
The good news is, these people are no longer uninsured. No sir. Now they ALL get signed up to OHP (in ORegon anyway). So, we are monetarily contribute to this horrible little tax scam.
The ultimate fuck you in the whole situation is that we do nothing (ZIPPO) to help these people. IF they came in homeless and drug addicted with a raging infection, they will leave without the infection but nothing else will have changed for them. We have no plan. Why would you repair the heart of someone who has been abusing amphetamines for 3 decades without any plan in place? Are they going to suddenly stop? Or are you just prolonging their ability to live a few more years within which to put more amphetamines in?
I don't claim to have a solution to this, other than cutting the drugs with antibiotics so they can stop the infection before it starts, but I am running out of empathy and growing so tired of feeling like what I do doesnt really matter. I am doubtless far more competent in my skills because the patients are so very difficult because of what they have done to themselves.....now I just wish I could use those skills to treat people who I felt good about helping.
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