No, not the day in February, that celebrates a meteorologic rodent, but the movie a few years back with Andie McDowell and Bill Murray. The TL;DR version of comedy is that Bill’s character is stuck on the same day, and it takes his correct approach to Andie McDowell’s character to break the spell. It is, as all of Bill’s roles, thoughtful and funny at many levels. I digress.

The vacation was a ton of fun and honestly very relaxing. Playing in beautiful warm weather, while it is the middle of winter and lousy air in Salt Lake City, is heaven. I wrote a ton more than I ever might and did it with a cocktail or a cigar or both in hand.

Back in the saddle, I have pretty much been a little dismissive of my blog. Still, I am back for my usual short bursts and occasional commentary, as well as the podcast. I will be working on increasing the volume as I paid for my annual renewal of the website.

Well, work has started to feel like an odd repeat lately. Being an extensive service, we have lots of repeat patients, but recently it has been the type, not the person. The person who needs alcohol detox at 0430 in the morning. This has been the case for the shifts since vacation and made me pose the question rhetorically; “why the hell is 0400 am the time to decide I am rolling in for detox?

The call time has become so predictable that I have been waking, without a phone call, at 0430, daily. Ugh, you would think that it wouldn’t have an impact on me, but it does and not really in a super negative way, just in a quixotic surreal way.
I mean, lets break it down. First off the bars in our lovely state close at 0100. This is a full 2 ½ hours later. Maybe a little sobriety makes a person start to think? Perhaps they are getting sick, I am never sure. I often ask, non-accusingly, why a patient decided to present to the ED when they did. More of a desire for what brings in the patient as opposed to scolding them for the hour. I kinda want to know the answer as there never seems to be a good one. I really don’t care about the workload, since I am working anyway; It just seems that it is always at the start of the shift and at 0400.

I get no real answer that explains this, just the sad, often brutal stories of folks that live in the grip of substance use. Some are straight forward and really could use the help and are trying and guilty about their relapse to people that trade one substance for another. When they see that we are unwilling to make the trade-off, they become upset. Let me give you a good example:

Detoxification from alcohol involves giving Ativan (a benzodiazepine) to help relieve symptoms of withdrawal. Some folks use it as a crutch and like the benzos as much as the booze. It is sometimes very tough to break this cycle, and often the patient just leaves, back home, and back to the same situation and the stash of their substance. It is painful, at times, as a provider to think about this, but alas, the reality is just that.

Sometimes we see new faces, but mostly it is the same few. Those patients that the ink is barely dry on their discharge paperwork are back in the same ED asking for the same detox. I can almost hear Sonny and Cher singing, “I Got You Babe” as I stroll into the ED to start a consult.

Often we are almost precisely writing the same history as the last visit. Not really adding nothing new to the patient’s care except giving them a bed away from the substances (until they get tired of not magically being cured and go AMA). Our hospital wanted to rename Against Medical Advice discharge to “Irregular Discharge” After a month and actually to listen to the syntax, they changed it. Not before, of course, all of the staff with dirty minds could not stop laughing when it was said. The double entendre will be the death of us for sure.

Well, off to save the world.

Be the kind of person your mom and your dog think you are.