Stories from the Stethoscope: July 2021

Not all stories go as planned. I was covering the emergency department one day for individuals that needed to be admitted to the hospital but did not have a doctor. Josh was in his early 20’s. He was struggling with opioids and was skin popping. Skin popping is injecting drugs directly under the skin. Unfortunately, he did this under the skin on the back of his hand. This caused a significant infection. Skin infections around the hand have the potential to be dangerous. The surrounding tissues and tendons are susceptible, and progression can be quick if not watched closely. I admitted him to the hospital and started him on IV antibiotics. Unfortunately, I had significant difficulty getting an orthopedist to see him. Every time I called someone, they would say they do not specialize in the hand and refused to see him. I was able to track down a new hand surgeon in the community who was willing to come in on his day off for a consult. He also knew that he was most likely not getting paid for his time. I made the nursing staff and patient aware of his arrival time.  I told Josh that this doctor’s opinion was the most important part of providing us with a plan to ensure he did not need his hand cut open to alleviate the infection. 

I drove in that morning and arrived a few minutes before the specialist was scheduled to provide the consult. As I walked into the room Josh was not there. I asked the nurse if she knew where he was. No one knew. I walked around the hospital for 20 minutes until I finally found him outside with his girlfriend smoking.

It was at this point I lost my cool. I yelled at him. I said, “What are you doing? Do you know the doctor is here to see you? Do you know how many hours I spent trying to get a specialist to see you? Do you know that this doctor is coming in on his day off just to see you? Why do I care more about your health than you do? You have all day to smoke cigarettes. I told you to make sure you were in the room. Get your (obscene words) upstairs. I am not going to let you jeopardize your health.”

He spent a few more days in the hospital. We talked, but our relationship was damaged.  He was discharged home. We tried to set him up with addiction services. He refused. I never saw him again. 

I have often reflected on that moment and thought about how I could have handled it better. I regret cursing. There is never a reason profanity should be used. I do not regret yelling at him. I just wish I spend the next day explaining why. I felt that we were connecting.  Up to that point we talked about him coming to see me in the office and working together to restore his health. Tough love can have long-lasting negative consequences if not handled correctly. I could have used that moment to explain that we all make mistakes. I was wrong. I handled that situation poorly, but I will not walk away from my mistake. Before his discharge, I should have apologized and expressed that I want to learn from this experience as I hope he will reflect and learn from the decisions he has made in the past. That moment could have been about growing a relationship and not destroying one.  

Statistically, the story does not end well for Josh. I am hopeful he turned his life around. Despite the inability for us to form a long-lasting relationship, it fueled me to create deeper relationships with others dealing with substance use disorders. I believe addiction should be treated as a chronic disease. No one chooses hypertension and no one chooses addiction. Society does not blame someone who needs help with their blood pressure and receives a pill, why do we do this with a substance use disorder? In addition, society does not realize how often someone with hypertension has a relapse. They need extra medication and additional support frequently. The same happens with substance use disorders. Our job is to minimize the relapses and decrease their frequency. We spend time motivating our patients with hypertension to not give up and work on ways to minimize their risks. Do we do the same for those with addiction?

I now spend my time getting upset at the system and the way care is delivered.  Individuals with substance use disorders need the same access to care and support from our health centers as everyone else. Let’s spend more time assessing an individual’s needs and not judging them based on which chronic condition they have.  Josh taught me it is OK to get upset and yell. Just not at the people who need us more than we realize.