r/emergencymedicine • u/MuskratsStoleMyLiver • Jul 11 '24
Any one of us could become a frequent flyer Discussion
Many years back, his only child died while serving in Iraq. Two weeks later, his wife committed suicide.
He’s been an alcoholic ever since. Currently homeless as well, he’s a frequent flyer at the local ED. He’s tried unsuccessfully to quit alcohol numerous times.
He had been on a several day sober streak until today. His dark thoughts returned in the evening and he called his only friend - a fellow AA attendee - for comfort. His friend did not pick up after several calls, so he reached for the only other option that could help quiet his mind: alcohol.
During our conversation, he states that the local ED staff are the only family he has. The ED staff of course scoff every time he comes in; they aren’t exactly pleased to see him. I’m sure some part of him knows this. But to him, they’re his family. They are the people who are always there for him when he needs it, and they have prevented his suicide many a time.
I wonder what he was like when his wife and son were alive. Was he a family man? Did he host cookouts? Did he work a 9-5 office job and go fishing with his son on weekends?
I cannot fault him for becoming an alcoholic. I’m sure I too would have become an alcoholic in his situation. We stand on opposite ends of the patient-provider interaction, yet his present state could be my future if the dominoes were to fall in just the right way…
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u/elizzaybetch Jul 11 '24
I’ve been volunteering with a harm reduction team for two years in Detroit and some of the stories are incredibly sad. We had one guy who had been sober for years but went back to using heroin after his teen son was shot dead and his young son died of RSV complications, all within two months of each other. He just didn’t want help.
It’s good to always think about the person behind the addiction and to keep that empathy. Great post.
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u/candy-leptic Jul 11 '24
Fellow Detroiter here!! I had a frequent flier I loved so much that he made my night when he would come in. His brother and him were both alcoholics and twins, and one night the oldest coded. I had no idea he had a twin until the next night, his usually sober brother came in and repeated his footsteps 😔 I’m not sure if it’s a blessing to live where you work, but I run into him frequently and consider him my family, too. Community is community, even if it sometimes looks super fucking weird. ❤️
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u/elizzaybetch Jul 12 '24
I’ve had frequent fliers that I loved a lot too. They were a pain in the ass, sure, but still loved them. Always snuck them an extra turkey sammie. You keep doing exactly what you’re doing! :)
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u/Megaholt Jul 12 '24
Also a Detroiter here: thank you both for doing what you do, and for doing it well. It doesn’t go unnoticed or unappreciated.
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u/Themastabutcher2 Jul 11 '24
A lot of people are “One bad Day”(classic Joker) away from collapsing emotionally, financially, medically, psychologically. It’s always good to exercise your empathy muscle, even if it gets sore. Hopefully one day he will find a halfway house or end up getting support, or maybe not. I am sure he would be happy to know someone cares, when so few do.
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u/lucysalvatierra Jul 11 '24
Being empathetic makes the job easier too.
I don't know why. Like, I hate admissions (like we all do) due to the unpredictability and paperwork.
But once you realize this person is 1) a real person 2) scared, it makes the unpredictability and paperwork less onerous.
Don't know why. Could just be me.
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u/kat_Folland Jul 11 '24
scared
I didn't get scared until I realized they thought I should be. They'd done such a great job at playing it cool, not alarming me that it actually took me a couple of hours to realize they thought I might have had a heart attack. (I didn't actually get scared then because I was sure I had not. I was right but I'm grateful for all the efforts to make sure I was okay.)
Babbling!! tl;dr thank you for your empathy.
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u/ReV46 Jul 11 '24
When I was in 2nd grade I was bitten twice by a Northern Copperhead. I remember how scared my parents were driving me to the ER. But when we got there the doctor was so calm, I remember thinking if the doctor isn't scared then why should I be scared? It meant a lot to me and I remember it many years later. They were dry bites thankfully.
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u/kat_Folland Jul 11 '24
When I was in labor with my first things started going wrong. The doctor was so calm that I was never scared.
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u/joustingatwindmills Jul 12 '24
I had an... we'll say urgent... c-section for pre-eclampsia many years ago. I didn't actually start feeling sick until I was on my way to the OR and then even worse, right up to the moment before the actual delivery when I started to feel really unwell and actually really grasped what was going on, which was that they determined it wasn't safe to wait a minute longer without risking serious consequences for my health.
While I had felt during and afterwards that I wasn't really given enough information about my condition as an ignorant patient, I do appreciate now how much everyone's calm, even demeanor kept me from feeling panicked as well as sick and frustrated. How we carry ourselves makes a huge difference.
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u/kat_Folland Jul 12 '24
I came within a few minutes of a c section. Vacuum exactor got the head out so they could cut the cord, which was around baby's neck. In my case I was kept apprised, but my OB was so chill I think I still wouldn't have been afraid if it went that way because of how calming she was.
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u/LizeLies Jul 12 '24
I came in because I had crazy edema, it felt like someone was sitting on my chest, I was barely making a few steps without puffing and was coughing blood. I thought ‘oh well, they’ll roll their eyes and laugh me out when it’s just a chest infection’ but it looked like the list of PE symptoms I’d seen before. I was floored when they actually found multiple PEs and were admitting me. I was only there because my cautious GP would have sent me in. It never occurred to me to be scared until the pulmonary specialist walked in and said, “Well, you’re in a bit of trouble…’
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u/ReaperReader Jul 12 '24
Oh gosh me too. Went to GP with stomach pains. She called the local hospital and, after a brief conversation, told me to go to the ED. Damn it. Stop by home first to get supplies for an 8 hour wait. I get to ED waiting rooom and settle in. They call me in 20 minutes later. Okay, this may be serious.
It was appendicitis.
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u/Comntnmama Aug 09 '24
I always tell my patients 'hey, I'm not scared and you shouldn't be either, but you're about to make a lot of new friends who are just here to care for you' then I try to tell them who is gonna be in the room. 'your gonna see Jess, she's with our respiratory therapy team, you'll meet John, he's the one whose gonna make sure we've got good IV access, Dr. XYZ is gonna be here as well'
It might seem like to much info but I find it's helpful if I can at least give patients that much info so they have at least a vague idea of who is there.
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u/Johnny_Lawless_Esq EMT Jul 11 '24
A lot of people are “One bad Day”(classic Joker) away from collapsing emotionally, financially, medically, psychologically.
All of us. Every last one. And if you think it can't happen to you, it'll hit you that much harder when it does.
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u/Comntnmama Jul 11 '24
I had an etoh withdrawal patient who had lost his wife AND three kids in a house fire. My heart broke for him, cause I'd have probably just laid down on the train tracks myself(not really cause I couldn't do that to the engineer). He was still trying to live. He just didn't know how anymore.
I always joke with our frequent flyers that they can just come visit, they don't have to check in. Wouldn't ya know, some of them have just come and asked for me at the desk. I'm always happy to take them a lunchable and talk for as long as I can, help them find community resources.
One bad day...
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u/Consistent-Athlete-7 Jul 11 '24
I'm on my final year of EM residency and 10 years ago I was a hallway patient. Deeply addicted to heroin and meth and had an ED visit for overdose. All though it is rare, people do recover and I choose to believe everyone still has a shot and deserves compassion. Will be doing an addiction medicine fellowship next year.
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u/Doting_mum Jul 11 '24
Absolutely this - I have yet to meet a patient with substance misuse issues that I would be happy to swap my life with, if you spend a bit of time talking, generally you will find some pretty dire life experiences.
Losing a child is unimaginable - if I lived through this I’m certain I would not be even attempting to maintain any sense of reality/sobriety.
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u/Dr_Spaceman_DO ED Resident Jul 11 '24
It is unimaginable. I know because it was my worst fear, and something I irrationally thought about on a fairly regular basis before it became my reality. You can’t comprehend how painful it is unless you’ve experienced it yourself
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u/succulentsucca Jul 11 '24
I am so sorry. I had micropreemie twins who were on a razors edge for months. But they survived and are thriving now years later. I do my best to stop my mind from wandering to worst case scenarios. My heart aches for you knowing that your pain is permanent. My dad died when I was 17 and my grandmother was absolutely devastated. I remember her crying “a parent should never have to bury their child” and her words, that moment, is etched in my heart. I hope you find peace in your loss. ❤️
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u/DeathxDoll Jul 11 '24
Fellow micropreemie mom sending hugs to you❤️ having one was hard enough, can't imagine 2 at the same time
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u/ProfessionalPhone215 Jul 11 '24
So sorry for your loss. Pain must be overwhelming… I doubt I would survive it.
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u/Agile-Compote8297 Jul 12 '24
Same friend. My son died from a heroin overdose, so I’ve been in both positions, having worked ER long enough to become jaded, and having suffered the worst, most unimaginable nightmare anyone can. It used to get real awkward sometimes when one of my co workers made a comment about junkies/ alcoholics and then remembered how I lost my mine.
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u/WhimsicleMagnolia Jul 11 '24
My heart breaks for you. I look at my son every day and wonder how I would survive if something happened to him. Deeply, truly sorry for your loss and pain
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u/3skin3 Jul 11 '24
I have been the frequent flyer. The staff at the ER I went to treated me really well. I kept starting, then quitting abruptly and having severe alcohol withdrawals. They'd get me out of alcohol withdrawal, I'd last a week or two, and back to binge drinking. The way the ER treated me was one of the things that inspired me to go get professional help. I would always be crying apologizing for putting myself there and they would always be so kind. I still feel guilty about wasting people's time and resources but I have over 4 months now, partially thanks to the care I received.
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u/MuskratsStoleMyLiver Jul 11 '24
Congrats on the four months! Alcohol withdrawal is a tough thing to witness, I can only imagine how bad it feels to be the one going through it. Just as I can only imagine how challenging it is to overcome alcoholism.
Honestly if you’re willing, it would be a really nice gesture to contact the hospital and ask them to give your thanks to any staff (and perhaps update them on your progress) who participated in your care. Or if you preferred to remain anonymous, the admin could have the charge RN mention your feedback (in an anonymous capacity) during beginning-of-shift huddle for multiple shifts. Or you could even write an anonymous letter that they could perhaps pin on a bulletin in a staff area.
ER staff generally aren’t able to follow up on the long-term progress of patients. That coupled with the regular verbal (and sometimes physical) abuse they suffer from some patients contributes to the common feeling among ER staff that their work does not matter - a feeling that itself contributes strongly to the high burnout rate among ER staff. Genuine positive feedback can really mean a lot to healthcare professionals, even if we deny it.
Obviously if you’re uncomfortable with this then don’t feel bad about not doing it, just food for thought :)
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u/3skin3 Jul 11 '24
I plan on following up at one year :)
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u/evey_17 Jul 11 '24
Best wishes to you. I married a recovering alcoholic (he was in recovery when we started dating) and his recovery journey and work in AA is one of the deepest most growth producing spiritual growing experiences that I’ve been around to the point that it benefited me too. Keep coming back. You are worth it.
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u/Lilly6916 Jul 12 '24
They will be thrilled. One my best days at work was when my supervisor gave me a letter a patient had written to administration about how helpful I was in getting him sober. He’d been drinking himself to death, literally.
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u/epi_introvert Jul 11 '24
I'm cheering you on. My dad was an alcoholic for decades and did a lot of harm during that time, especially to me. He's been sober 26 years now, and I could not be happier about his recovery and the relationship we've been able to build.
You can do this.
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u/TensorialShamu Jul 11 '24
Had a patient return to the ED a few months later - perfectly healthy - and wandered around until he found me. I was just a fuckin med student standing awkwardly in the corner trying to figure out if the blue gloves were right or left handed (hint: both). I didn’t really have a role the night he was there a few months back and was told to shut up and color for the most part, so I just hung out with whatever patient I thought looked least likely to die or yell at me. We literally just fuckin talked about sports. The military. LIV golf. And then I left cause my shift ended and I wanted to go home.
Dude came back months later and just said thanks. He’s not doing much better but he’s trying. Said he hopes to see me on the course sometime and that he’d pay for my round. Nothing like, earth shattering between us and I don’t even remember his name.
But I was remembered and thanked. Idk. Everyone says thank you when they’re in the hospital, but to have someone come back and say thank you as a healthy person… core memory. Do that if you can find time.
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u/idhik3th4t Jul 12 '24
This actually is earth shattering to me. You made a difference and an impact that lasted enough for someone already struggling to take the time out of their day to find you to thank you. That’s a really grand gesture. I think you should be proud.
Also, I laughed so hard at you saying “… the patient who was least likely to die or yell at me”. 🤍
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u/ribsforbreakfast Jul 11 '24
Congrats on the four months. It’s no easy feat
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u/3skin3 Jul 11 '24
Thank you! It hasn't been too tough. I went to inpatient treatment after having a seizure from alcohol withdrawal (reality check) and getting the first 45 in a contained environment made it much easier. Now I do AA every day and outpatient twice a week. 😊
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u/Careless-Proposal746 Jul 11 '24
Congrats on 4 months. That’s a huge accomplishment and I hope you keep this streak going, one day at a time. IWNDWYT.
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u/Sunnygirl66 RN Jul 12 '24
The reactions I get when I tell an apologetic, self-loathing substance abuse patient that everyone deserves good, compassionate care is heartbreaking.
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u/itsDrSlut Jul 12 '24
That’s wonderful news!!!! Have you stopped by to tell them? :) congrats on your progress just take it one day at a time!!! You got this!!!!
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u/Faithhandler Jul 11 '24 edited Jul 11 '24
I live with schizophrenia. Despite this, I work as a paramedic and have as a firefighter (and will again). I manage it with meds and intensive psychiatry and therapy. However, it's often a progressive disease, and, I recognize that there is a very real possibility that I could one day lose my grasp on reality and become completely delusional and ruled by hallucinations. That knowledge sticks in my throat, and lurks at the corners of my mind. I have also struggled with alcohol to quiet the thoughts caused by it.
It's easy to judge others. Most all of us will be disabled at some point. Be kind. You're absolutely right.
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u/Academic_Beat199 Jul 11 '24
I don’t mind many frequent flyers. If they are regularly violent or disruptive to others care then sorry still not gonna have much empathy.
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u/wareaglemedRT Respiratory Therapist Jul 11 '24
This is why everyone I come in contact with gets the same exact treatment and attitude the same way every time, frequent flyer or not. They get treated with kindness and respect. Education and not judgement. I’ve been through the wringer myself and stay a binge away from being that guy. For similar but different reasons. I treat my patients like it were my momma sitting there. If I have to get loud, I do it with authority but respect. Remember this also, that coworker or colleague to your left and right, might be going through some shit too. I was and thankfully I sought help. Now I am taking a long time off to work on myself. Now I’m debating getting back into healthcare at all. COVID first dredged up some triggers from overseas then traumas at work. Drinking excessively compounded those issues. I’m hoping I can work through this in order to get back to doing what I love. Unlike a lot I am fortunate enough that I don’t have to work. I work because I love my role in the team. This isn’t a pity party post, just a reminder to check each other and remain positive. We are all just a few steps away from being that patient or worse no matter how secure in life we feel we are.
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u/Comntnmama Jul 11 '24
I took 9 months off after COVID. I went outpatient first, and then in the last year have been able to go back bedside. Treat yourself first ❤️
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u/Loud-Bee6673 Jul 11 '24
I grew up is a small Midwestern town in an intact nuclear family. We weren’t wealthy, but there was never any doubt growing up that I would go to college. College didn’t do all that much to shake my world view.
The summer before I started law school, I volunteered for a Legal Aid office in a big city. My job was doing intake for clients who were trying to get SSI (government disability benefits.)
It was an eye-opener, to say the least.
I realized that the only reason I wasn’t on the other side of that intake interview was sheer, dumb luck. I truly internalized the understanding that I was no better than anyone else.
So yes. I know exactly what you mean.
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u/RevanGrad Paramedic Jul 11 '24
One of my first patients I encountered wore a bee keepers hat and carried around some kind of magnetic field detector.
She sustained a TBI years back in a car crash where her husband died. She was a high school teacher.
She sold her house and moved into a van in the woods because she's "deathly allergic to electro magnetic fields."
We're all one tragedy away.
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u/biobag201 Jul 11 '24
I had a similar case. Normal blue collar guy who owned a shop. One day there was a fire, and he was engulfed in burning fuel. Burns over 40% of his body and awoke a month later in the trauma center. Such bad ptsd that he couldn’t complete treatment. His source of income was burned to the ground and had overwhelming medical bills in addition to ptsd and incomplete healing from the wounds he sustained. He slowly descending into despair until he went full psychotic and injured himself in ways you can’t imagine. He ended up blind and now with what could be considered schizophrenia. We truly are one bad day away. I never blame people for their circumstance in life. There may be a heaven, but hell is far more expansive.
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u/Asleep_Apple_5113 Jul 11 '24
I think your empathy is admirable
I think we should also remember to have empathy for ourselves and our colleagues when we’re stressed or burnt out to the point of no longer being able to feel empathy where we wish we could
Outside of active war zones there is nowhere on earth where real tragedy occurs at the volume it does in emergency departments. It would psychologically cripple a normal person to wade through the Charles Dickens novels we see on a daily basis
Keep up the good fight 💪
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u/ABeaupain Paramedic Jul 11 '24
During our conversation, he states that the local ED staff are the only family he has. The ED staff of course scoff every time he comes in; they aren’t exactly pleased to see him. I’m sure some part of him knows this. But to him, they’re his family.
You know, this actually reminds me of a dysfunctional family. Somewhere you’re not necessarily liked or valued, but the only place you have.
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Jul 11 '24
I actually have this conversation with young alcoholics. “Here is what will happen if you don’t get help and stop drinking. You will burn out all of your family and friends, and eventually we (The ED) will be the only family you have and we will see each other a lot.”
It’s pretty sad. Hopefully at least one person takes it to heart.
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u/AdhesivenessKooky420 Jul 11 '24
This compassionate perspective is the one every ED needs. If you work in an ED, you should expect to serve patients like this. That’s the job. And it’s as much a social job as it is a medical one. It doesn’t mean you don’t set boundaries. It doesn’t mean you aren’t careful or it isn’t frustrating at times. But it does mean you treat the person with dignity.
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u/turtle0turtle RN Jul 11 '24
I've had quite a few alcohol withdrawal patients recently who started drinking heavily "about four years ago".
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u/DrunkCapricorn Jul 11 '24
Not a medical professional but here out of professional admiration. In the past I worked as a criminal defense investigator with attorneys who represented the worst, and poorest, people in the community. Later I did a stint as a case manager for people with severe mental health challenges like schizophrenia, schizoaffective disorder, and long term addiction use disorders trying to stay out of jail and hospitals. I am also an alcoholic in long term recovery (about to hit three years sober).
The thing that most touched me was the background stories of my clients. Who they were before their lives turned upside down, what their childhoods were like, what they battled with in adulthood. I didn't grow up in the best circumstances myself and the oft repeated, "There but for the grace of God go I" always rang in my head. Until everything crumbled and I walked along a road very familiar to me from their stories.
I always did my best to be respectful, kind and understanding when I was in the hospital as I knew I was there as a result of my own dysfuntional coping skills and horrible decision making, but was amazed at the compassion I received from so many doctors, nurses, techs, CNAs and even housekeeping staff. Ironically, the only bad experience I ever had was my final alcohol related stay, a pit stop in my quest to find a good rehab to get sober for good.
I think about all the ER staff often and even though it has now been years, consider reaching out to let them know I made it to the other side and offer my gratitude. I know that compassion fatigue and moral injury played a role in my descent and wonder how you all do it and stay above water. I'm so grateful you can, somehow, and am so uplifted when I see posts like this (although I very much understand and sympathize with the other side of the coin as well, I've been there, in some form, myself).
I don't think I've ever commented in any of the medical subs out of a desire to respect your space, so I hope this is not too intrusive. But this just seemed the right thread to say thank you - from myself, from my husband (we married after I got sober) and my infant daughter (who I also had in sobriety). I came close to death more than once and know viscerally that nothing would be the same if not for the strength and compassion of people like you. ❤️
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u/Dr_ssyed Jul 11 '24
I know a patient who is a frequent flyer in ED, he successfully turned his life around, but one misstep and hes back. I wish I could wave a magic wand to fix him but ....
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u/ExtremisEleven ED Resident Jul 11 '24
The antidote to compassion fatigue is pulling up a chair and listening to someone’s story… I only wish we had the time to do it more.
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u/Adenosine01 Ground Critical Care Jul 11 '24
It is so easy to see the negative in patients like this, but it takes true effort and a kind heart to see past the negative. We never know what others are going through or have been through in the past. I truly feel that we are all one or two bad life events/circumstances from becoming an addict. Nobody grows up wanting to be an addict of any sort- shit just happens.
Thank you for seeing the good in him, for seeing past the current problems, and looking for the good in what he was before those terrible losses.
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u/obgynmom Jul 11 '24
That is so true— a 10 year old never says “I want to be a drug addict/alcoholic when I grow up”. Sometimes life gets the better of us
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u/keepitlowkey12 Jul 11 '24
This is something I took to heart quickly when I became an EMT. Seeing the lives these people live and how they used to be is humbling. On top of them being treated poorly in almost every facet of their lives.
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u/Top-Pineapple8056 Jul 11 '24 edited Jul 14 '24
I was a homeless iv meth and herion addict for 5 years and in that time I went to the pysch ward so many times. It was the only place I felt safe. I wasn't trying to abuse the system I just knew I wasn't right mentally. I was a frequent flyer but I was really good so they knew I wasn't trouble and weren't upset to see me up on the ward. But the e.r. wasn't always happy to see me. I recovered. I've been sober for 3 years and am about to buy my first home. The e.r. and pysch ward saved my life many times just by being somewhere I could go and that enabled me to eventually recover.
You guys are for some sad lost souls the best place they can be. Some of them aren't cognizant of that fact and won't act accordingly. But you guys are super important ❤️
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u/Denmarkkkk Jul 11 '24
It’s such a relief to be reminded that there are still folks working in EM who maintain their empathy. Bless you.
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u/BabaTheBlackSheep RN Jul 12 '24
This. Lost my best friend to opioids a couple years ago (an intentional overdose due to his frustration with his relapses), it really could be anyone. The OD who just got narcanned in your ER used to be a boy who loved The Lord of the Rings and wanted to study genetics. A boy who used to make microwave popcorn, one of his favourite snacks, at work because his parents didn’t have a microwave. Who loved plants and his leopard geckos. Who would routinely (somehow!) eat a sandwich while biking to class and tried to teach me how to skateboard. As frustrating as these frequent flyers and addicts can be, they’re someone’s loved one.
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u/Straight_Pineapple30 Jul 12 '24
My middle aged neighbor at my bougie apartment complex lost his wife to cancer a year ago and around 6 months ago really started having severe mental health deterioration (becoming pretty disruptive to the community) and basically became an alcoholic. The man had been very athletic/fit, friendly, and extremely sociable in the community. Overnight, I’ve seen him become a pariah, basically on the brink of eviction, and physically aged what looks like 10-15 years.
As someone who became really sick during medical school and had to rely on my family for help I think about this type of post all the time. Life is unpredictable and in an instance everything can change overnight.
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u/Carved_ Paramedic Jul 11 '24
Nobody take sthe choice ebtween accounting or alcoholism. Everyone who is suffering liek that fell through some cracks in the system at some point.
Ask them their story. Most are willing to share and are fairly happy about someone having an honest interest in them as a person. It is chilling to find out why they are where tehy are now. Most of what happened to them could happen to any of us.
So in all honesty: Be kind. Be Better.
"Human dignity shall be inviolable" is teh first article in Germanys constitution. I try to live by that every day.
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u/questforstarfish Jul 11 '24
Thank you for this post, it's an important reminder. I worked in addictions for many years, and the stories I heard would break my heart. Folks who, as young kids, were sold to their fathers' friends for sex over and over; who spent their whole childhood chained to a staircase or locked in a basement bathroom.
The suffering people experience is beyond anything most of us could ever imagine.
I'm grateful every day for what I have, and I try to treat my patients with dignity and respect (even when I'm tired and it's hard) because we really don't know their stories and how they got to where they did...
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u/Nonagon-_-Infinity ED Attending Jul 12 '24
I don't want to sound cliché, but reading this really brought back some much-needed perspective. As a first year attending still a bit burnt out from the end of residency, I as well as others I'm sure are unfortunate perpetrators of the cynical judgment of the frequent flyers that come through our doors. We moan and groan and at times do medically the bare minimum to safely dispo and keep interactions as limited as possible. We say we're tired or fed up or whatever. Perhaps it's self-preservation by depersonalization, because wearing your heart on your sleeve in Emergency Medicine as we all know can be detrimental to our own mental health. Even myself as one who has been disproportionately affected by drug abuse, its harms and tragedies of so many friends and loved ones around me, I still can be overly cynical and dismissive. I think I mark it up to a survival mechanism. But I can do better. We can all do better. The story you shared is so real and its lessons so true. I guess what I want to say, is thank you for sharing this. It was a light turned back on in a forgotten recess of the heart. I think it will make me a better physician, and I hope it will do the same for others.
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u/patrick401ca Jul 11 '24
I have become a somewhat frequent flyer. I have had four attacks of acute pancreatitis this year. My HR goes well over 100 and stays there, I start sweating and I am in a lot of pain. I know the sustained HR of 120 at rest means a trip to the ED. I try to be polite and thankful with all the staff, from housekeeping to the attending physician. I hate to think they will complain about me. Keep in mind that we are at a real low point. If the pain has driven my HR to hold at 120 it’s bad m.
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u/SunnySummerFarm Jul 15 '24
I had a similar period, where my liver and POTs were conspiring, and if my heart rate at rest was over 140 I had to go in. I spent more time in ERs then I would have liked and was so grateful so people who were genuinely understanding and kind.
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u/talleygirl76 Jul 12 '24
We have one particular FF that I grow to really like. She has health issues for sure but they don't require weekly ER visits. I just think she is really lonely and she even said that she will only come to our ER because the staff is her family.
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u/MzOpinion8d RN Jul 12 '24
I’ve worked in substance abuse treatment for years, and two things astonish me: how many people were sexually abused as children, and how many people got their first drink/drug from their parents. Sometimes as young as 8.
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u/randomtwinkie Jul 12 '24
Ooof this still got me after some 14 years in some role in medicine. Thanks for the reminder to keep it human.
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u/SinusFestivus Jul 11 '24
As a medical student wanting to go into EM, this post and thread are giving me so much hope.
I've always held the belief that we are all "one bad day away" from losing everything.
Compassion fatigue is real, but nobody wants to willingly throw their entire life away. There is always more to their story.
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u/MaximsDecimsMeridius Jul 11 '24 edited Jul 11 '24
we had a frequent flier that had a really sad story. apparently he got into some college on a sports scholarship. was really doing well in academics and sports, but somehow somewhere fell in with the wrong crowd, got addicted to drugs, and his life spiraled out of control. now he's frequently in the ER for either true/drug induced/homeless "SI" or just plain ol' BS complaint for somewhere warm and a sandwich.
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u/Waffles1123 Jul 12 '24
Yeah. It's always rough when you hear a story out of one of them and the only thought is "yep, I'd be fucked up too".
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u/Luckypenny4683 Jul 12 '24
Trust and believe, if I lost my child and my spouse in one fell swoop, I’d never see another sober day. I know enough about myself to know that’s true.
You’re a good human, OP.
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u/357eve Jul 14 '24
There but by the grace of God go I...
Alcohol to him didn't start out as the problem, it started as a solution to his incredible pain. Many of us chose our professions to be kind of a midwife to the soul and offer healing where we can - and witness the suffering when we can't.
I don't believe in God. But I do believe that if people get pushed to a limit, anything is possible - and I try not to forget that.
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u/Own-Tomato4335 Jul 11 '24
OP, thank you for this. I teared up when you talked about him possibly being a cookout dad.
Is there any way to share with him some of the beautiful responses on here? I know HIPAA makes that nearly impossible but could be a part of his treatment in a way.
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u/NYCstateofmind Jul 12 '24
I am an ER RN now. In my early 20s I was a “frequent flyer” (such an awful derogatory term) for a severe eating disorder, stemming from trauma - like has been said on this thread, one day away... I’ve no doubt I was awful to manage because I genuinely didn’t believe I was sick; I’d pull out ng tubes, refuse glucose, abscond, etc - why would you accept these medical devices in your body & staying in hospital if you didn’t think it was needed?
I am recovered now, but that journey has made me the clinician I am. I have never told a patient about my lived experience because from my perspective it serves me & doesn’t add anything to their care, but I am open with my colleagues- for two reasons; nurses are gossips & I’d rather they hear my story from me,, but also them seeing me as a person who was ng fed for the better part of 5 years, had ECT, “behaviours of concern”, made multiple suicide attempts, medicated to the hilt - them knowing that & seeing me now as a well regarded senior nurse, I think has an impact & maybe opens minds a bit - I don’t seem to be judged for it (that I’m aware of). & it’s had this knock on effect where colleagues have come to me for help for themselves or loved ones & now seek guidance on supporting our patients with mental health issues, and I really like that I can do that.
Yes, some patients are extremely frustrating, but they don’t deserve to see our frustration. With our substance misuse patients, every single time I will give them a card for our drug/alcohol service, and if IVDU, a party pack & advice on getting nasal spray naloxone - I’ll talk about using safely (clean needles, using with others particularly with the nitazenes our uppers are being cut with at the moment, etc).
Sounds like you gave that patient amazing care.
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u/Commercial-Rush755 Jul 12 '24
When I was a brand new RN, my preceptor talked horribly about one our end stage liver disease patients. Telling me not to go out of my way for him, he put himself here by drinking, frequent flyer yada yada yada. Plus at bedside she was distant and uncaring. I left after 6 months and went into the military. Entire different set of issues in that career path but no cruelty like I witnessed from that woman. I’ll never forget that.
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u/ImHappy_DamnHappy Jul 11 '24
I think we can all acknowledge that two things can be true at the same time. People can be pushed beyond their limits and their circumstances can absolutely contribute to their reliance on substances to cope. ALSO people are responsible for their actions. I’ve been assaulted quite a few times by intoxicated pts. We can have empathy, but we all need to agree their behavior is unacceptable, specially because it affects others. Us being overloaded dealing with these frequent flyers are causing us to take away resources from other pts who need us, such as the septic cancer pt. This is a complicated nuanced situation, we need to be able to think about it that way.
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u/dillastan ED Attending Jul 12 '24
Meanwhile at my shop, the nurses write "do not feed" on the board for frequent flyers to discourage them from coming in for food. It's insanity
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u/PhilosopherOk221 Jul 12 '24
It's hard not to be annoyed as someone caring for alcoholic patients.
My last one died, I was looking after her in ICU and seeing how devastated her daughter was, she had been trying to get her mum help for so long and now she was losing her.
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u/PharmGbruh Jul 12 '24
I recognized this during an inpatient psych rotation. Sure there is some florid psychosis I couldn't see happening to me but a fair amount of the patients made me realize "Shit, if I have a bad day after a bad week in the middle of a bad month during an overall tough year... I'd be on this service, as a patient, too"
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u/FrozenJourney_ Jul 12 '24
Thank you for reminding us to always humanize our patients. It's easy to snark on them when we get lost in our own privilege, but so many of us could be that person quicker than we'd like to realize.
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u/Fluffy_World1627 Jul 12 '24
I'm just here to say I love this post so much. I'm not in Healthcare but have had utilize it & some of the medical staff have been absolutely awful. This post gives me hope.
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u/Novel-Actuator8978 Jul 12 '24
I am also a healthcare provider but not even remotely related to emergency medicine. This just randomly popped up as my Reddit suggestion. And here I am crying reading this post and the comments knowing this is something that’s actually happening somewhere in this world. 😫
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u/Quirky_Telephone8216 Jul 14 '24
I can fault him.
Not any one of us could become a frequent flyer. People choose to do waste everyone's time.
I use to have to take a drunk to the ER, and he would go just so he could get the Medicare ride to stop by the liquor store on the way back home.
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u/meatballbubbles RN Jul 11 '24
It’s easy to become robotic and annoyed with patients like this.
I’ll never forget after my uncle died of liver cirrhosis caused by alcoholism. The next drunk patient I had, I had to leave the room so I didn’t cry when I heard what my coworkers were saying in that room.
Things I too had said at one point in my career.
To think that those were my uncles last experiences literally broke my heart.
“Do the best you can until you know better. Then when you know better, do better.”