Kids and Cowardice

Gerald O’Malley, DO, is settling into his new position and has asked Bluto Sose, an old colleague, to pinch-hit this week. Bluto has been practicing emergency medicine for more than 14 years and works in an unnamed suburban community somewhere in the United States.

Kids and Cowardice

Last night I saw a 20 year-old heroin addict brought in for allegedly passing out in a bathroom, sustaining a head laceration. He had been in the ER the week before but had signed out against medical advice when we refused to give him narcotics in conjunction with antibiotics for his - you guessed it - IV drug-related early forearm abscess.

His parents, both working people who've already lost another child to smack, were heartbroken when I told them I can't hold this MENSA member against his will; they'll have to take him home and petition the court in the morning. As I listened to him sob and curse me while I sutured his bloody scalp wound, I could hear in my mind the following words: "Say, where are the people you shoot up with? Where's the buddy of yours who supplies your heroin? Why aren't they here instead of your parents? They mean more to you than your parents, don't they?"

That conversation took place in my mind, because if it left my mouth there would be the inevitable complaint/bad Press-Ganey survey and all the headaches that go with it. So after enduring further language that would make a sailor blush I discharged this prime example of enabled sociopath to the care of his overwhelmed and frustrated parents.

What a contrast to the next patient, a tattooed male in his late 40s complaining of shortness of breath. He also told me that (a) he's a recovering addict not here for drugs and (b) he's in a halfway house now transitioning out of the prison system. He said, "I gotta be honest with you, Doc, because I can't get better without being straight with you." Of course I diagnose this poor bastard with metastatic lung cancer, guaranteeing a death before 50.

I ended my shift angry at the unfairness of it all - the young narcissistic addict who doesn't want to get better and the death sentence for the one who wants to reclaim his life. Was it really an attempt to avoid a patient complaint that led me not to confront the young drug addict, or was it something else? Who is to blame for this young man’s dash toward self-destruction? The junkie? Not really - you can't fix stupid. The hospital administration? No, they want to run a hotel with "customer is always right" philosophy while humiliating their employees - I could leave if I want. Me? Certainly not - I didn’t put the needle in his arm.

I blame the do-gooders. You know who they are: The super-smart overachievers who deal with the guilt of their success by "advocating" for those "marginalized by society" yet have no concept of the greater damage they cause with their "help." Usually they are several layers removed from the actual implementation of their inane theories and certainly don't listen to those people with experience in dealing with the problems they are trying to "solve." Their solutions - often relieving the "victim" of any responsibility for their plight - only further enable the pathology they attempt to correct.

In this case it's drug addiction. The do-gooders have tried to make recovery as painless and effortless as possible. Give addicts clonidine and other medications to make jonesing bearable. Keep them on methadone or suboxone. Take away the pain and stigma of addiction. Put them in detox for a few days. We've taken away the fear of relapsing. In 14 years of practice I've seen addicts jump from roofs, step in front of slow-moving cars, break their legs and dislocate their shoulders. I've only had two that have refused narcotics for pain because they would rather be uncomfortable than risk relapse. There is no fear of relapse because there is no fear of withdrawal.

The addicts I see for "medical clearance for detox" average about one to two weeks between detox or rehab sessions. That’s over 26 ED visits in a year - for one addict - not counting the ED visits when they relapse and OD.

Any rational person, especially those paying for this (the taxpayer - that's you), would consider this an abject failure no matter how much the experts try to pee on your leg and tell you it's raining. How about going back to the old school: Feel the jones! My children remember what is was like to get sand in their eye, touch a hot stove, etc. and strive to avoid getting themselves in the same situation. What about going though a good bout of dope-sick? Unlike alcohol withdrawal, heroin withdrawal won't kill you. You'll feel like you were dying but you won’t die.

I'm sure the do-gooders in their insulated existence view me as a sadistic, heartless, uncaring Neanderthal. Do they have kids? I do, and this is the one thing that strikes fear into my heart.