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I’m really tired today after coming off of working three days in a row. That may not seem like a lot to the regular work-a-day folks, but when you’re in healthcare, the hours are often long and arduous. I’ve worked about 40 hours in the past three days, and I work in a busy Emergency Department in Portland, OR. Every day that I worked, the ED was on divert — meaning ambulances were directed to not come to us because we were so busy.
When I left work last night, there were 30 patients in the waiting room. Many had been waiting three to five hours just to be put in a room; the wait time to see a physician after being roomed was even longer. Staff scurried about looking haggard, pulled in a million directions. At one point I counted 17 patients in the department that had been admitted to inpatient services waiting for a bed, but since the hospital was full they continued to board in the ED. Multiple patients were there with mental health crises that had landed them with psych holds.
Over the past week, many of the patients I cared for were in the hospital because of drug abuse — usually heroin and meth — or mental health or some combination thereof. Most of those patients were also homeless. Another nurse’s patient was put up for discharge back to the streets after she faked an illness in order to come in and sleep indoors, and as I walked by the open door of her room I saw her rummage through the cabinets, stuffing her patient belongings bags full of hospital supplies. She asked me for a fourth cup of coffee and a third boxed lunch when I pulled the hospital pillow out of her bag and told her that she can’t steal supplies from the hospital and she needed to leave. “I just need another cup of coffee, man! I spilled my last one. I need coffee with like four sugars and six creamers.” I told her it was time to leave.
Another homeless guy on heroin came in with some respiratory complaint and was kept overnight for observation. When the provider went to discharge him, he claimed he was going to go kill himself once he left. Social workers were called to talk to him about mental health resources in the community — it was pretty clear he did not actually have any suicidal ideation — but he threatened to jump off a bridge if we discharged him. He ended up staying four days in the ED between his stay for observation and the time it took to arrange his admission to the psych hospital.
Earlier last week, a patient came in for treatment of her abscesses due to daily heroin use. She said she really wanted to get clean, and she was worried that she couldn’t get into rehab if she had an infection. This was one of many admissions to our ED. Multiple times she tried to leave the department (IV in place) to “go to the cafeteria” and the “gift shop.” When she was told that wasn’t allowed, she started yelling and swearing at us, as though we were abusing her. Her son and his friend came to visit, bearing a Pop Tarts box. Another nurse noted some suspicious activity, and when she went in to investigate, the patient was drawing up heroin into a syringe her son had brought. She tried to say she had changed her mind and wasn’t going to shoot up after all, but when the nurse said that she would be calling public safety, the patient stuck the needle into her arm, making eye contact with the nurse the whole time. She then ripped out her IV and told her son they needed to get out of there now.
These are just a couple stories from all that I dealt with this weekend. I estimate about 33-40 percent of the patients I see are drug addicts, homeless, and have serious mental health problems. Injection is the most common way of using, which leads to all sorts of health problems that send people running to the ED for help. Many of these patients present to the ED over and over again with the same infections. IVs have to be placed using ultrasound because even the most experienced ED nurses can’t get a line because the patient’s veins are so sclerosed.
After about 24 hours since they last used, they go from cooperative and apathetic to antsy and abusive as they start jonesing for their substance of choice. I am constantly yelled at for not treating their pain, for letting them suffer, thinking that the hospital should be providing enough oxycodone to satisfy their two or three gram a day habit. Often these people have a “family emergency,” leave against medical advice, or just leave while no one is looking. Our social workers work tirelessly to help people get off the streets and into rehab. I cannot tell you how many times I have had patients decline placement in a shelter in favor of being on the streets. Much of transitional housing has high vacancy rates because of the no drugs and no drinking stipulation.
Walking in downtown Portland is not safe. I personally know two people that have been stabbed by homeless guys on the street with no provocation. A man was arrested for a stabbing after he said that his wife, Taylor Swift, told him to kill the guy that happened to walk by. Tent cities are everywhere, and one cannot drive through downtown without seeing shopping cart after shopping cart being pushed by someone mumbling to themselves.
There is a big call for legalization of drugs by the left and the libertarians. But how does that work? If we legalize drugs, making them easy to obtain and removing the stigma, how will that decrease the number of people coming to the ED with MRSA abscesses and endocarditis? While I agree that people have the right to make their own choices in life, how do we handle the stress placed on the country by these addicts? This patient population rarely has health insurance, or if they do it’s Medicaid, and they rack up tremendous hospital bills for their 48-hour stay in the ED to get treatment for their infections. The taxpayer pays for it any which way.
While decriminalizing drugs might save money from the prisons, courts, and police, it does up the cost of healthcare. We cannot turn patients away from treatment. There is no “three strikes and you’re out” policy in the hospital that allows us to tell a patient that we’ve already treated them three times before for injection-related infections so we can’t treat them again. Hospitals, nurses, and doctors would be sued six ways to Sunday if we did.
I’m all for individual freedoms, but I cannot see how legalizing drugs will do anything but hurt our society.