Depends on who you ask.  I have not had the writing muse as much and have taken a break to see if I can shake writer’s block.  The summer has been a bit of a sh*t show.  Broken foot at the beginning, a motorcycle that should have been fixed in April, weird ex-friend drama, and of course life.

As a younger nurse who was not too far from his military discharge, just the job causes drama in your life, not to mention all the other goings-on. If you work as a frontline healthcare worker, you get the concept of work drama.  You are feeling great when you leave home and you walk into a shit show (I left the star out, we’re all adults the coarse language while not essential is part of me) (and on a nursing unit, sometimes literally) (No third thing really the other two looked lonely). If you are ill-equipped in your own life, the drama can be much.  Like for me, coming from a regimented life to the chaos of a nursing unit…eye-opener and a ton of compensation… (eh, forget it compensation jokes are too easy).

So, for chaos, this weekend has been full of all kinds of wild crap that we see as hospitalists.  Like I was told it can be crickets or a nightmare.  This set of shifts was, in fact, a nightmare (of sorts, except no black horse). Lately, it seems that we are taking care of a lot of “methamphetamine detox” requests.

To channel the late Joan Rivers, “Can we talk?” (by the way a very funny woman)

Everyone knows that I am a huge advocate for recovery. I will go to the ends of the earth for someone who asks for it.  I have seen the effects of dangerous drugs and addictions firsthand, so it makes me very empathetic. Don’t mistake my empathy and concern as a reason to be a jackass.  Most people that are high tend to be a jackass or do jackassy (I can’t believe jackassy is a real word) things.  The latest is the patient who presents to the ER, consults are called and by the time I get there, he is gone AMA too, “get something at home.”  What he “needed” at home was another hit off the meth pipe before he was admitted.  See what addiction does, kids?

So back to detox on meth.  Do you know what a detox on meth looks like? Time.  That’s it, time.  There are no mitigations to ease withdrawal, no special care plan measures… nothing.  The only thing that is really done for someone acutely intoxicated on meth is behavioral drugs to prevent them from smashing up an ER or nursing floor.  That’s all… So, why are we detoxing them when really, they need to, “sleep it off,” (Oh honey if I could only “sleep off” the bad shit in my life). Yes, the addiction is still there, the cravings, etc.… but it is a time thing and my level of intervention is minimal.

So, why admit them to a locked ward? We only like to admit people to a locked unit that need that level of care.  Are they a definite danger to themselves?  Maybe.  Are they a danger to others? Maybe. Psychosis? Also a maybe.  The last one is always the excuse to push an admission… We can smoothly transition them into treatment.  Yeah, I get it, but really it is kind of a BS reason to admit someone to a locked unit.

But nursie poo, we would never do that at our, “for-profit” hospital.  Exactly, you wouldn’t.  There is no money in this for them and insurance companies balk at this. I work in a system that has truly unreasonable masters 535 +1 that all have a different idea about how we should render care and why we are doing it wrong.

Plain and simple we are enabling the behavior and giving up bed space to people to, “sleep it off.” (most likely to avoid any headlines about our patients)

Yes, I am sympathetic to the issue and will try my damnedest to help someone see the way.  I am also realistic in the fact that while everyone wants to be saved, must do everything they can to avoid it.

Fixing it is tough, but necessary. As a collaborative group, we need to visit our plan and present one voice.  This includes both sides of the house. When you see something that is broken, it is up to you as a medical professional to bitch about it (just kidding).  After you are done bitching about it, you need to help fix it.  Bitching only creates drama and the relief from venting is very temporary.  The next patient through the door will restart all those feeling.

Moral injury occurs to frontline staff who are forced to vent, and not allowed or encouraged to “fix” the process.

Hopefully, the muse gets better folks.  I hope you had a great summer for me.