incentive rehab

What better way to get a former drug abuser to talk status post stroke than to deny controlled substances? One of our patients suffered a stroke a month ago and has been starting to speak for the past 3 weeks. In the past few days, however, her speech has improved and she has now become more adamant about getting vicodin, benzodiazepines, and codeine. She refused to eat or take any other medications unless she got the above substances. She, however, describes no pain.

I feel sorry for her for regarding her stroke, but I'm beginning to see her true colors. The weird thing is that none of her next-of-kin or friends have come to visit her during her stay at the hospital. I'm wondering what type of person she was before this stroke.

rocks

A "rock," is a patient who is practically impossible to discharge from the hospital for various reasons. We have 4 rocks on our service. One has been there for 2 years! It's all about funding. Rocks usually do not have insurance, Medicaid, Medicare, or don't qualify for our county sliding scale health service. We can not discharge these people because they have no where to go. No family, nursing home, or rehab center will take them. This is yet another "frustration" of the "system."

The New Twenties

I hit the big 3-0 last week and had a small surprise party at the house. I've been so tired and busy that it really wasn't monumental. Plus, now that I'm pregnant with the due date so close, I'm way too distracted to even bother with being 30.

Baby showers

I had 3 baby showers in the past 2 weeks. Two were surprise parties done by the nurses at the clinic and another by the residents. Then I had the big bash at my parents. Everyone was so generous--our child will be spoiled.

Being Pregnant

I was really doing well with being pregnant. I gained about a pound a week after the 1st trimester and was just coasting along. Although I have yet to vomit from morning sickness, the lower extremity swelling has finally accosted me. Of course, it doesn't help that I'm on a wards rotation right now and on my feet all day.

I gained 7 pounds in two weeks and have gained a total of 33 lbs. whoa! I'm almost as heavy as my husband. Even scarier!

But being pregnant is still fun. A bearded and gowned woman in the ER stopped me in the hallway to ask if she could pray for my baby. She was so enthusiastic and even prayed that my son would want to be "the President of the United States." TONS and tons of other people shout at or greet me in the hallway predicting that I'm having a boy. I always ask "how do you know?" They say b/c I'm just carrying him in the front with no extra weight anywhere else (they haven't seen my ankles of course).

Pregnancy has other perks. People don't expect me to do much--lift things, pull things--and so they do these things for me. I also have a handy conversational piece to refer to during those silences in the elevator.

Nesting Syndrome

Despite the fact that I leave for work at 6:30am and get home anywhere from 7-9pm, I have stayed up till midnight for the past week organizing our nursery. It's still not done. I've got to wash the new clothes before the baby can wear them, open boxes of gifts, pack the baby bag and my bag for the hospital, etc. So much to do, but it's so much fun. I haven't had this much fun planning for something since my wedding four years ago.

Help me . . .help you

While I said I wanted to "serve the undeserved" in my personal statement to medical school and residency, in my 3rd year, I can't help to be a little jaded. I am getting tired of people asking for Darvocet, Vicodin, Handicap stickers/tags, food stamp forms, and Valium FOR NO VIABLE REASON.

The other day, a woman who I saw for the 2nd time said she wanted to be sent to a specialist for osteoarthritis to her knee. She had already been sent to the physical therapist and said all medications didn't help. I told her the definitive treatment by a specialist would be knee surgery or a steroid shot, but she vehemently was against both. I then asked her if she was performing her exercises daily. She said yes, but when I asked her to describe them, she couldn't. I then told her, besides the physical therapy, she could also try to lose weight since her BMI was ~40. She totally disagreed with me that weight could play a factor in her knee pain. She did not want to try water aerobics or any other form of exercise and DEFINITELY didn't want to even TRY or ENTERTAIN the idea of losing weight. AND FINALLY, she hands me a sheet for me to sign to allow her to get a handicap tag.

I tell her I will send her to physical therapy for a "functional capacity" test to assess what she can and can't do i.e. to show which ways she is disabled. She tells me," Oh, I'm not disabled, I just want the tag." DUHHHHHHH! I tell her,"Well, the top of this sheet says "Disability" on it, because, most people who have these tags are disabled." I was very frank.

And then I had the patient who wanted Valium because when someone taps her on the shoulder unexpectedly, she gets jumpy. Hmmmm. . . I don't think giving a habit forming sedative will help you out with that.

These type of "give me" patients are not few and far between. I see at least one every 3 days asking for controlled substances just because s/he tried their mother's, brother's, friend's pills and "they worked." Then they want this and that, and to give them a excuse from work for not just the day of the clinic visit, but also yesterday and the day before that.

moochers.