Point of view, November 26, 2004

What ever happened to being responsible for yourself...owning up to your actions and mistakes, and holding yourself accountable for the circumstances of your own life? Sometimes I wonder, would people think I'm the most insensitive, uncompassionate, heartless doctor if they were privy to the ramblings of my internal monologue?

At King we have lots of traveling nurses. Mostly I welcome their presence because they bring "new insight" that lots of the native King nurses lack. Yesterday RN Wendell told me that I was one of the best doctors he'd come across in his travels. Other staff frequently gives me similar compliments...and the patients express gratitude, which is what makes it all worthwhile.

However, there are those people who...really are accustomed to doing whatever the hell they wanna do, with blythe disregard for consequences. And they need to be checked from time to time.

For instance, there's the 55 y/o alcoholic african american male, brought in by paramedics complaining of abdominal pain. History of alcoholic liver disease, gastritis, and chronic pancreatits. He reeks of alcohol, and is mildly intoxicated. We (taxpayers) spend thousands of dollars on his workup, and after 8 hours in King's ER, we determine he has acute pancreatits. Now, as he's sobering up, he becomes belligerent and demanding (specifically) demerol 100 mg IVP. What the hell?? Well, he's certainly not gonna get that from me tonight. After a couple of critical patients are stabilized he's up and fussing about how *we* can't let him just be in pain like this.

His response is "you bitch, I shouldn't have ever came to this fucking hospital."

Me: "Then leave." Did I go out to the street and drag you in here? Does he think he's hurting my feelings by leaving? (We actually call our yellow AMA forms "the golden ticket).

Him: quiet for a minutue "you alright doc...I'ma sit down...but how long do you think it'll be?"

Or the trauma patient who comes in all shot up. Dr. Spevack saves this guys leg after an extended operation. In the ICU the following week, the guy is pissed about...whatever...and starts going off on Dr. Spevack. "This fucking hospital sucks, you suck, I can't believe I got an infection...yo mama is a ho...so forth and so on." Dr. Spevack lets him finish...and then responds: "man, I fuckin' saved your leg and that's how you talk to me?"

With his baby's mama at the bedside he responds, "yeah, that's true." YEAH, asshole, that's true!!

So the above stated alcoholic decides to sign out AMA. "Well, I ain't got no where to go."

Me: You can't stay here.

Him: Well where am I gonna go?

Me: That sounds like a personal problem. You can wait in the waiting room until the morning, then go to a shelter.

Him: You can't just kick me out.

Me: Well, sir, this isn't a hotel. You're a grown man, I'm sure you'll figure it out.

It's a shame, but no wonder, that this guy has no-one to call. But if you were in the waiting room having an MI, you'd want to trade places with this guy too...so you can see a doctor, and he can come on out and deal with his social issues. His medical care is over, either by discharge or by his own choice, and the ER has limited space and resources. We need to get the sick people from the waiting room into the ER, and the not sick people out.

Or what about the lady who calls 911, is taken to St. Frances. Is triaged to the waiting room. Decides she's dosn't want to wait...goes outside and calls 911. Is taken to King. Is triaged to the waiting room (especially after EMS tells us she just left St. Frances). Leaves, calls 911 again so "she can be seen faster." What patients don't understand is, they are *seen* as soon as they walk in the ED. If their complaints are minor, or not as severe as the rest of the people, they wait.

Or the family who calls 911 to dump their mother anytime they wanna go to a movie. Or the woman who calls to "get rid of" her drunk boyfriend when he passes out drunk...again. Or the criminal who's caught committing a crime...then decides to complain of chest pain to avoid going to jail. Our EMS cannot refuse anyone a ride to the hospital...eventhough a few years ago they could. They used to assess a person, provide appropriate treatment, and if indicated, transport them to the hospital...consulting with the online physician if necessary. Too bad our society is so litigious and reactionary, because now they have to offer everyone a ride to the hospital, no matter the complaint or issue.

People come to the ER with their $400 i830 Nextel phones, in their Escalades with the Sprewell spinning rims, decked out in Fubu with Prada handbags...but can't pay 4 bucks for Tylenol to ease the discomfort of their 4 year old child...or pay $50 for healthcare or an ER visit? Who's holding these people accountable?

Or the government funding housing. It seems to me that if I (i.e taxpayer) give you a place to stay...I state the terms up front...you agree...then break those terms, you shouldn't get mad when I kick you out. No gang activity (graffiti, shooting/violence, felons hanging around with each other, etc) is a fair "rule." And even if it's not, you agreed to it. You're living in a place that I own, and you don't keep it clean, you don't follow the rules, and then have the nerve to get mad when I bring in police to "clean up" the place. It ain't yo shit...let's not get it twisted.

I'm not a left wing liberal, or a cross-hugging/burning conservative. I just believe what I believe, and whatever people decide to call it, so be it. Yes, there should be access to healthcare for everyone...but measures should be in place to hold people accountable. Granted lots of social problems that we face in the ED is simply a reflection of society at large..but they need to be dealt with.

Ultimately, people need to be held responsible for *something.*


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