Dear patient, who I will not be surprised to hear that you are dead

[MillCreek]

So I was writing a letter to a patient who has not been coming back in for followup.  In the past year, she has been admitted to our local hospital three times for sepsis, blood clots, syphilis and endocarditis, all as a consequence of heroin use.  She signs herself out of the hospital AMA and uses the indwelling catheter to inject more heroin.  She is currently on several antibiotics and anti-coagulants to try and clear up the endocarditis and not have a fatal blood clot. She is not coming back in for followup and to have the followup tests to measure her anticoagulant status. I am sending her a letter to make sure she knows there is a good chance she will fall over dead without followup treatment.

She is in her early 20's, is from a typical suburban middle-class family, has been to inpatient and outpatient rehab several times, her medical bills are well up into the six figures since she became an adult and all paid by the taxpayers since she is on welfare now, and only the miracles of modern medicine are the reason she is not dead right now.  I will not be surprised to get a call from the medical examiner saying that she has been found dead.  The only question in my mind will be if it is an overdose, infection or blood clot that kills her.

[Fly320s]

Are you required to write that letter?

[RoadKingLarry]

And therein is a huge contributor to the out of control cost of healthcare in the US.

[Scout26]

The only question in my mind will be if it is an overdose, infection or blood clot that kills her.

Are you laying odds ??

[Hawkmoon]

Office pool?

[Blakenzy]

1)Pulmonary embolism

or

2)Internal bleeding due to being on anticoagulants and drug dealer coming by to collect a due bill.

Depending on whether or not she is still taking her anticoagulant medication.

[T.O.M.]

Option 4...muder/rape - murder victim.  I imagine she is spending a ton of time in high risk areas if she's an active user.

[Ben]

Option 4...muder/rape - murder victim. 

https://www.youtube.com/watch?v=gGGDzEWvGRY

[T.O.M.]

https://www.youtube.com/watch?v=gGGDzEWvGRY

There's a lot I enjoy about that movie.

[Ben]

There's a lot I enjoy about that movie.

Yeah. Your line reminded me of the movie line which reminded me I need to watch it again. :)

[Northwoods]

I was more thinking of this one.

https://www.youtube.com/watch?v=bigZ1fmwD-Q

[K Frame]

To be perfectly brutal about it, it sounds as if this one is a foregone conclusion, so might as well get it overwith and stop prolonging the pain for those who still care about her.


"She is not coming back in for followup and to have the followup tests to measure her anticoagulant status."

So, without the P-time, she's running out of time.

[KD5NRH]

Does it have to be a letter?

I'm thinking a small video display and jus enough memory to play this:
https://www.youtube.com/watch?v=PVrEwCa8nSA

[never_retreat]

I have a friend that joined his local FD about a year ago. (he took off for a few years when he moved)
He is about ready to quit. 9 out of 10 calls are for a OD. Seeing the same people multiple times.
He's firmly into the *expletive deleted*ck it and let them die mode.

[MillCreek]

I have a friend that joined his local FD about a year ago. (he took off for a few years when he moved)
He is about ready to quit. 9 out of 10 calls are for a OD. Seeing the same people multiple times.
He's firmly into the *expletive deleted*ck it and let them die mode.

The most commonly used drug on our ambulatory crash carts now is Narcan.  For people/patients who come in off the street and accidentally OD in our restrooms and elsewhere on the property. We are probably doing this five times a month now.

[Fitz]

So I was writing a letter to a patient who has not been coming back in for followup.  In the past year, she has been admitted to our local hospital three times for sepsis, blood clots, syphilis and endocarditis, all as a consequence of heroin use.  She signs herself out of the hospital AMA and uses the indwelling catheter to inject more heroin.  She is currently on several antibiotics and anti-coagulants to try and clear up the endocarditis and not have a fatal blood clot. She is not coming back in for followup and to have the followup tests to measure her anticoagulant status. I am sending her a letter to make sure she knows there is a good chance she will fall over dead without followup treatment.

She is in her early 20's, is from a typical suburban middle-class family, has been to inpatient and outpatient rehab several times, her medical bills are well up into the six figures since she became an adult and all paid by the taxpayers since she is on welfare now, and only the miracles of modern medicine are the reason she is not dead right now.  I will not be surprised to get a call from the medical examiner saying that she has been found dead.  The only question in my mind will be if it is an overdose, infection or blood clot that kills her.

are you in the California bay area by any chance?

If so, tell my sister I said hello and please make her appointments.

[BlueStarLizzard]

Trying to save addicts from themselves is an exercise in futility. BTDT, not worth it.

[kgbsquirrel]

And therein is a huge contributor to the out of control cost of healthcare in the US.

[AmbulanceDriver]

The most commonly used drug on our ambulatory crash carts now is Narcan.  For people/patients who come in off the street and accidentally OD in our restrooms and elsewhere on the property. We are probably doing this five times a month now.

Portland is giving narcan buddy kits to addicts....   Basically, if your buddy OD's, give them this and call 911...   Of course, most of them don't know that narcan wears off more quickly than the heroin they od'd on....   So they don't call 911... So a few hours later, they have to call 911 when their buddy suddenly quits breathing again.

We're running on 5+ OD calls a day in Portland anymore...    Not nearly as many deaths, thanks in part to the narcan kits, but we're also I think seeing more OD's because the addicts are taking more risks with their dosages.

[MillCreek]

We are now sometimes giving multiple doses of Narcan due to the local heroin being cut with either Fentanyl or carfentanil. 

[KD5NRH]

I'm tellin' ya; might as well go to Narcan dart pistols.  Just have big open racks of them in front of all public buildings for folks to stock up.

[BobR]

Addicts are strange, they almost die, their buddy brings them back but instead of being grateful they get PO'd that their high was ruined so they shoot up some more. Then the Narcan wears off because the half life of it is shorter than the stuff they originally used so now they get a double whammy.....and die. Such is the life and death of a opioid narcotic addict.


bob

[KD5NRH]

Addicts are strange, they almost die, their buddy brings them back but instead of being grateful they get PO'd that their high was ruined so they shoot up some more. Then the Narcan wears off because the half life of it is shorter than the stuff they originally used so now they get a double whammy.....and die. Such is the life and death of a opioid narcotic addict.

So we need some ultra-concentrated Narcan.  In big darts.  Maybe just a heavy gauge needle attached to a funnel and a bucket.

[Fly320s]

I'm tellin' ya; might as well go to Narcan dart pistols.  Just have big open racks of them in front of all public buildings for folks to stock up.

Effective and fun.

[Fly320s]

So we need some ultra-concentrated Narcan.  In big darts.  Maybe just a heavy gauge needle attached to a funnel and a bucket.

Or.... let Jesus take the wheel.