And now back to seeking sweet, elusive sleep.
Wednesday, August 31, 2005
4:15 am blues
Wanted to blog a bit, but am awfully tired. Awake because the dog needed to go out. Now she is sleeping blissfully at my side, and I am wide awake. Damn dog. Good thing I love her, else I'd give her to one of those ethnic restaurants reputed to cook those of her kind. .
And now back to seeking sweet, elusive sleep.
And now back to seeking sweet, elusive sleep.
aiiii... I was evil last week. That'll teach me to try to stop my antidepressant medication. I really know better. I have done it before and it never works out for me. So, last week before I resumed my medication, I had this patient who was REALLY pissing me off. I honestly don't often get pissed off by patients. I don't. I love my patients, and I try to do my best by them. But this guy... well, first of all, I could smell him from the other end of the building. He likes cheap, loud cologne. I hate it passionately. So I was pissed immediately, just from his swirling miasma. I have even told him how offensive I find his cologne. It makes me sneeze, makes my eyes water and generally makes me unhappy. So the mere fact that he wore it when he had an appointment with me was clearly an affront.
I enter the room and Bubba, as we'll call him here, was in a rare good humor. He has reasons not to be. He has insulin dependent diabetes with all the nasty things that go along with it - poor vision, nerve damage that causes pain in his feet and legs, heart damage, early kidney failure.... the list goes on, but you get the idea. He comes here for pain management mostly. And he does have pain, no doubt about it. But geez.... he has gradually worked Doc until he is on oxycontin 80 mg twice a day along with which he gets 180 hydrocodone tablets (eg, vicodin, lorcet) a month for his breakthrough pain. Eighty milligrams of oxycontin is equivalent to 8 of the highest strength percodans, and he takes two of them a day -- which is like taking SIXTEEN percodan a DAY. Plus 6 lorcet a day in case the oxycontin doesn't do it. Well, he's a big man, and he and Doc settled on his pain medicine regimen. None of my business.
Except Doc wasn't there that day, and I had to see Bubba. Bubba had last gotten his medicines 19 days prior to this particular day. He was there to see me for two reasons. He was out of his lorcet already (ONE HUNDRED AND EIGHTY of them!!) not to mention that he had on one of his brother's fentanyl patches, and he liked it and wanted some of them too! (Fentanyl is a high-power synthetic narcotic delivered through the skin.... or IV in the operating room. It is easily as strong as the oxycontin, if not stronger.) He wanted more lorcet, since he was out.
Hence the good mood, I suppose. I mean, I don't know how he walked. Or stood, or even spoke. If he indeed took all his prescribed meds, (and lord knows, he may have been selling most of them and still had enough left to be high as a kite all the time), it is a wonder the added fentanyl that he decided on his own to use didn't kill him.
I chastised him for doing that. I told him it was against the law, and indeed was a felony, both for him to take it and for his brother to have given it to him. Not to mention it could have killed him, considering all the other narcotics he was taking. He became surly. He let a tear drip down his cheek. He started whining (oh gawd how I hate whining, especially from grown men!) about how severe his pain was, how I didn't understand how often he lay awake at night crying, and about how much he wanted to be dead. Yes, he emphasized to me, he just really wanted to be dead more than anything.
Oh dear. He shouldn't have said that. It was so calculated to make me just go all soft and buttery and sympathetic. I gave him the cold fish-eye and said, Bubba, you are a grown man. If you really wanted to be dead you COULD be. I went from there into a rant: You sure have plenty of drugs to do it with! And I bet you have at least 16 guns in your house! (here he interjected sadly that someone had stolen all but 3 of his guns -- which I ignored and continued) You are willing to risk not only your life and health taking all these drugs, but you are risking MY license! How dare you? I wouldn't risk my license for someone I liked, I SURE wouldn't risk it for YOU! I ranted on in that vein for probably ten minutes.
When I stopped to take a breath, he asked me, Does that mean you aren't going to give me any more lorcet today?
I was spent. I shook my head and left the room. I could still hear him complaining that he was out of lorcet and really needed more.
I am better this week. I haven't ranted at a single patient.
And finally, a warm and personal HI! to a special girl out there. :)
I enter the room and Bubba, as we'll call him here, was in a rare good humor. He has reasons not to be. He has insulin dependent diabetes with all the nasty things that go along with it - poor vision, nerve damage that causes pain in his feet and legs, heart damage, early kidney failure.... the list goes on, but you get the idea. He comes here for pain management mostly. And he does have pain, no doubt about it. But geez.... he has gradually worked Doc until he is on oxycontin 80 mg twice a day along with which he gets 180 hydrocodone tablets (eg, vicodin, lorcet) a month for his breakthrough pain. Eighty milligrams of oxycontin is equivalent to 8 of the highest strength percodans, and he takes two of them a day -- which is like taking SIXTEEN percodan a DAY. Plus 6 lorcet a day in case the oxycontin doesn't do it. Well, he's a big man, and he and Doc settled on his pain medicine regimen. None of my business.
Except Doc wasn't there that day, and I had to see Bubba. Bubba had last gotten his medicines 19 days prior to this particular day. He was there to see me for two reasons. He was out of his lorcet already (ONE HUNDRED AND EIGHTY of them!!) not to mention that he had on one of his brother's fentanyl patches, and he liked it and wanted some of them too! (Fentanyl is a high-power synthetic narcotic delivered through the skin.... or IV in the operating room. It is easily as strong as the oxycontin, if not stronger.) He wanted more lorcet, since he was out.
Hence the good mood, I suppose. I mean, I don't know how he walked. Or stood, or even spoke. If he indeed took all his prescribed meds, (and lord knows, he may have been selling most of them and still had enough left to be high as a kite all the time), it is a wonder the added fentanyl that he decided on his own to use didn't kill him.
I chastised him for doing that. I told him it was against the law, and indeed was a felony, both for him to take it and for his brother to have given it to him. Not to mention it could have killed him, considering all the other narcotics he was taking. He became surly. He let a tear drip down his cheek. He started whining (oh gawd how I hate whining, especially from grown men!) about how severe his pain was, how I didn't understand how often he lay awake at night crying, and about how much he wanted to be dead. Yes, he emphasized to me, he just really wanted to be dead more than anything.
Oh dear. He shouldn't have said that. It was so calculated to make me just go all soft and buttery and sympathetic. I gave him the cold fish-eye and said, Bubba, you are a grown man. If you really wanted to be dead you COULD be. I went from there into a rant: You sure have plenty of drugs to do it with! And I bet you have at least 16 guns in your house! (here he interjected sadly that someone had stolen all but 3 of his guns -- which I ignored and continued) You are willing to risk not only your life and health taking all these drugs, but you are risking MY license! How dare you? I wouldn't risk my license for someone I liked, I SURE wouldn't risk it for YOU! I ranted on in that vein for probably ten minutes.
When I stopped to take a breath, he asked me, Does that mean you aren't going to give me any more lorcet today?
I was spent. I shook my head and left the room. I could still hear him complaining that he was out of lorcet and really needed more.
I am better this week. I haven't ranted at a single patient.
And finally, a warm and personal HI! to a special girl out there. :)
Subscribe to:
Posts (Atom)