Thursday, December 30, 2010

Sometimes You Can't Do a Dang Thing

Sometimes if someone doesn't want to help herself, there is really nothing you can do.
Case in mind, this 26 year old woman with type 1, who was admitted with yet another case of diabetic ketoacidosis. Her 3rd in December, and her (I kid you not) 18th hospital admission this year.
Now, sometimes these can't be avoided, as many of my patients know. Try as you might, illness, bad infusion sites, idiopathic, these things happen. Sometimes, however, when a patient stops her insulin, and stops her glucose checks, and in the same breath that complains about cost of meds (and mind you her healthcare is funded by yours and my tax dollars!) she remains a 2-pack a day smoker.
This admission I happened to be oncall. And in an attempt to figure out what the problem was, I gently asked her in her ICU room while she was watching CSI and pretending to be oblivious to the world, what insulins and how much she was supposed to be taking. Because, between her family physician's notes, her ER admission record and the nurse who had her that shift, her story kept switching from having been on Glargine, then Detemir with Lispro insulin, then premixed insulin, then Regular insulin.
And so, when she ignored my questioning, I gently said I had to turn off the TV to talk to her, at which she yells at me, "Why do you all ask the same God-damn questions everytime about my medications every time I come to the hospital?"
To which, I'm ashamed to say I lost my cool and almost-yelled back, "Because every God-damn time you come in, you tell us something different!"
I hate to yell at patients. And in my 9 years of being a doctor, this is the 2nd time I recall actually yelling. But sometimes, really, if a patient is determined to kill herself (and at the taxpayer expense, for her $9000-a-day ICU stay) our of sheer ignorance, ambivalence, or stupidity, then there is really nothing you can do. And one of these days, she's going to succeed, too.


Anonymous dhssraj said...

i wonder if it is ethical for the govt to stop paying for delinquent patients such as this. because ultimately theyre depriving healthcare to others. probably not.

1:26 PM  

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