(this is a story, not a factual account)
I’m telling this story to get it off my mind. Patients don’t usually stay with me. I put my heart into the work when I’m on the unit, but I forget the whole thing by the time I get to the parking lot when I’m going home at 11 p.m.
It’s a good rhythm. You go home, read a book, have a glass of wine, and sleep without troubles. The next day you do it again
But Frankie stayed with me. He was 78, in assisted living. His wife had just died and he was in pain from hip surgery. He overdosed on his pain medication and the medics found him on the floor with seven Fentanyl patches pressed to his skin.
Fentanyl is a powerful narcotic and widely used in the form of dermal patches to relieve pain.
The patch releases the medication in a careful slow way and -- sometimes with unpleasant side effects -- it works.
But seven patches all at once will send you through the door, down the river and on your way to the next life.
Such a patient will not be left alone in the hospital, lest they try to harm themselves again. Standard procedure. Suicide watch.
Frankie was deeply asleep when I got there at 4:30 in the afternoon. Comatose? I don’t know the medical term. But past danger, I think.
Kelly was the nurse. She’s one of the angels. They make you feel good just walking in the room. I don’t know about the patients, but I know I feel good when she’s around.
Frankie had a heart monitor, just in case. These are four wire leads pressed to the chest, connected to a monitor room where someone could watch his pulse and breathing rate.
The monitor, besides being watched by a live person, is set with ding-ding-dings if the patient’s heart rate exceeds the parameters.
They have ding-ding-dings all over the hospital. You can’t relax for a minute.
So there’s Frankie, on his back, sleeping peacefully, with thick white hair closely cropped, a trim spade beard, round face, and good skin color. He looked healthy, if you asked me, and he was resting well.
I was sitting beside the bed and I turned on the TV to watch the baseball game -- kept the volume low. It makes good background noise -- the sound of a murmuring crowd.
No ding-ding-dings at the baseball game.
Maybe that’s what’s bothering me. How can anybody get any rest at this hospital? It’s a process of continuous interruption.
Kelly floats in and out of the room. She gives Frankie a bladder catheter. He barely wakes during the procedure. The urine bag fills up promptly. He needed a good pee, but he was too out of it to use the urinal, and the narcotic relaxed his muscles over much, so he wouldn’t just go without help.
If there’s one thing that matters around here, it’s urination. They get really worried if you’re not peeing, and they get happy if you do.
It’s all about moving the fluids -- things you’ve been managing by yourself since you were two-years-old, but when you’re sick you need help.
Kelly leaves. Frankie sleeps, I watch the game -- Dodgers and Phillies.
That’s it. Six hours and I go home. Only this time, when I get to the parking lot, I keep seeing Frankie’s peaceful face.
I keep thinking -- Frankie, you almost made it.
DISCUSSION: Depression and Suicide. (making no claim to any expertise on this subject) Everybody gets the blues now and then. But real depression is much worse than having a bad day -- real depression is staying in bed all day, being unable to leave the house, no appetite, insomnia, suicidal thoughts and suicide attempts.
One of the things I do at the hospital is suicide watch. Obviously, I don’t see those who have made a successful effort to end their lives. But I see the attempts and the failures. These are some mighty unhappy people -- everything’s going so wrong and they can’t even kill themselves.
Usually it’s an overdose -- a cocktail of legal and illegal drugs. The doctors would sure like to know just what it is you took when you get to ER -- perhaps if you pinned a note to your shirt before you passed out.
Either way, when you get to the ER, they give you the charcoal syrup which soaks up the poison. The charcoal looks awful, but it has no taste.
Don’t try suicide with Tylenol. A sufficient amount of Tylenol will kill you, but a less than sufficient amount will merely damage your liver, resulting in prolonged hospitalization and enormous medical expense. The opiates are actually better, because recovery can be fairly quick after a less than fatal dose.
Wrist slashing requires determination, and a failed attempt will leave scars that might embarrass you later in life.
As I said, I deal with the failures, and my medical knowledge is strictly anecdotal -- I only see the patients after they have been medically cleared -- when they just need to be watched.
The patients are almost always quite young, 20 to 35, and two thirds female. They are very withdrawn. They seem to be terribly embarrassed. They just lie in bed and I make no attempt at conversation.
I don’t think they want to die.
I don’t have much faith in therapy and social work, but that’s what happens after the attempt. You have to talk to somebody. This somebody comes into the patient’s room and an earnest conversation ensues -- as in, let’s find out what’s going on, and let’s see what we can do about it.
This is just my bias, but I don’t see the point of “doing anything” about it. I’m quite glad to be alive myself, and I would recommend that status to anyone who asked.
But it’s your life, not mine. The social compact requires us to live until we die, so I would not help you if you wanted to kill yourself.
Having said that, I think the highest respect and kindess for someone is to let them be the way they are. Are you depressed? Yes, that happens. Do you want my help? Ask for it. Do you want my attention? Then do or say something that interests me.
I just don’t want to treat a patient as if they were pathetic. I stay in the room with them and we’re going to get through the day together. I can promise that -- we’ll get through the day. And we’ll see about tomorrow.
Now Frankie was different than the others, in my own limited experience. He was much older, for one. And he made a fairly serious attempt to die, taking seven Fentanyl patches. As I said, he almost made it. If they hadn’t checked his room for another hour, he would have been gone for good.
So what happened to him after I left him at the hospital? I don’t know. I suspect they won’t let him have his own supply of Fentanyl anymore, but will give it to him one dose at a time. He’ll get counseling, but I hope it comes with respect.
There’s a time when you might tell a younger person that she’s a fool and that she’s throwing her life away. That can be a good thing to say.
But the old folks -- you really shouldn’t tell them anything. They are way past the rest of us.
A doctor or a nurse, no matter how experienced or how well trained, will have no idea what it takes to be 78 until they get there themselves.
FACTS ABOUT FENTANYL (Wikipedia is the source) The opioid Fentanyl was first synthesized in 1960 by Dr. Paul Janssen. Its chemical formula is C22H28N2O. It is approximately 100 times more potent than morphine. It is used as an intravenous anesthetic.
In the mid 1990s, the Duragesic dermal patch was introduced, and the patch is now used for long-term pain management.
Fentanyl can be abused as a substitute for heroin. For that reason it is a Schedule II drug according to the Controlled Substances Act.
A Schedule I drug has no approved medical use. Schedule II drugs have approved medical uses, but are also illegally manufactured and abused.
Fentanyl, Duragesic, and their generic equivalents are often the first choice to control pain in cancer patients.
Fentanyl has side effects in 10 percent of patients -- diarrhea, nausea, constipation, dry mouth, sweating, and confusion.
Fentanyl and Duragesic are trademarks of Johnson + Johnson, one of the world’s largest pharmaceutical corporations. Sales of Fentanyl and Duragesic exceed $1.3 billion worldwide.
WHAT WOULD WE DO WITHOUT THE LAWYERS? An Internet search, in pursuit of information regarding a drug or medical procedure, will easily produce the website of a law firm which makes a living suing those same purveyors of drugs and medical procedures.
I found this website, YouHaveALawyer.com (a real website, I’m not making this up) which hypes the diligent adversarial talents of Saiontz & Kirk, a law firm in Baltimore, because, if you have a problem, it must be someone’s fault and they should be sued.
Take our fictional patient Frankie. It wasn’t his fault. He was depressed because his wife died. Surely the doctor knew that. Did Frankie have a history of suicidal thoughts and attempts? Did the doctor ask him?
And what about the pain management? Was Frankie carefully instructed in the use of his Fentanyl patches? Was he warned of the danger of an overdose and that it could kill him?
Or maybe he was told about the danger of an overdose, and that’s what gave Frankie the idea of putting on seven patches all at once.
Has the law firm of Saiontz & Kirk sent one of their attorneys to lurk about the lobby of the hospital where I work, to press his or her business card upon weeping relatives? “Aye, I will take up your battle, I will smite the physician and pursue the drug company, I will obtain damages. We will fight and fight until justice comes.”
Saiontz & Kirk is eager to help, dear citizen, if you have had any problems with your Duragesic patch. Call them today. You can find their number plastered on the side of the nearest Metro Bus.
ADOPTION. Now, I’ve finished writing about Frankie. I will send it to the Frog Hospital audience and then I get closure.
But I’m afraid not. I’ve done patient care for five years, not all at once, but a year here and two years there -- at a hospital, a psychiatric hospital, and a nursing home, but it adds up to five years.
In those five years, I have adopted about 12 patients. It just happens. These are the ones that get into my psyche, make themselves at home and just stay. That’s why I call it adoption.
I see their faces, and I mean going back thirty years, and I still see their faces.
It looks like Frankie has joined the roster, along with Rachel, James, Eddie, and the others.
Twelve patients are enough. You don’t want to encourage this adoption. You want to shake them off by the time you get to the parking lot, but it happens anyway.
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