Crackheads!

Scalpel is talking about the paranoid, emotionally labile crackhead-types. As a reminder to those who have not experienced crackhead or other drug-seeker/emotionally-labile types, here is the play-by-play of 99.9999% of interactions:

1) Patient puts forth a statement in the affirmative for the argument "I'm not a drug seeker, I have a real problem that needs sedating and/or narcotic medications."

2) Nurse sighs, charts BS complaint and moves on, keeping it in the back of her mind that sometimes crackheads really are sick, but this one likely is not.

3) Toradol and/or nubain is ordered IV.

4) Patient has no veins due to years of IV drug abuse and nurse tries x 2 to place #24 IV in thumb. Asks MD for IM order.

5) Patient says that they don't want no toradol (insert "because I'm allergic" or "I need dilaudid---that's the only thing that works"). Nurse explains that toradol is what was ordered and that the doctor is aware of his request and declined to order dilaudid. Patient starts to become agitated.

IF allergy="toradol" THEN GOTO doctor for nubain order. IF allergy="nubain" THEN GOTO doctor for toradol order. IF allergy="nubain" AND allergy="toradol" GOTO doctor for other recommendation. If psychosis="present" OR mental health history="present", GOTO doctor for risperdal rapid-dissolving tab ELSE hold recommendation. If doctor="ballsy enough" GOTO doctor for droperidol order.

IF patient="not satisfied" OR IF patient="want dilaudid" OR IF patient="want demerol" GOTO doctor for less-than-usual dose of dilaudid. GOTO chart document request and MD response.

5) Now is about the time where the doctor has to go in and play "Let's Make a Deal." Maybe they'll give in to a small dose of IM dilaudid, but with the caveat of "after that, no more drugs due to your history of chemical dependency issues." Otherwise, they may hold any additional drugs until the tests come back. Whatever. You get the pictures. Basically, the patient is not getting what he wants, which is to get high.

6) Now the patient starts screaming, wanting a new doctor and a new nurse. The nurse is left to deal with this situation.

"Please sir, there are many sick little old ladies here. I'd ask you to keep your voice down."

IF patient status="discharge imminent" AND patient status="labile" OR patient status="disruptive" THEN GOTO charge nurse and ask her to be patient's nurse for a few minutes.

IF patient status="doctor ordered tedious exams and patient not leaving anytime soon, dammit" THEN call security for back-up AND consider restraints AND consider new nurse. IF another nurse volunteers to be patient's nurse THEN accept offer ELSE consider asking another nurse to be patient's nurse. If patient status="agitated", consider 4-points AND administer IM injection.

7) Patient more calm or leaves AMA. All tests are negative. Patient discharged/admitted to detox/psych ward/jail or other appropriate location. Note that, of course, there are quiet, really sick people not being attending to during this entire interaction in all likelihood. Assuming lack of emergency condition, the goal is to spend the least amount of time on this as possible, avoid getting hurt, get the patient out of there, avoid encouraging repeat visits for controlled substances if possible and move on.

PS Thanks Dad for teaching me BASIC when I was 10. It comes in handy sometimes.