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I
got this story from a friend who works as a nursing aide at the
hospital here in Santa Barbara..... slightly edited, but his words.
By Philip Deutsch
You Almost Made It, Frankie
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 Kelly is 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.
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 kindness 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.
Editor's Note. I drew this diagram of Fentanyl over morning coffee.
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 and 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 and 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
and 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.
But
what has money got to do with it? The lawyers can get you money all
right, but what is Frankie's life worth at age 78. In cold blooded
dollars his life is not worth a penny -- a good man, a man who is loved,
but not productive in any economic sense, an expense actually.
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 -- at a hospital, a psychiatric hospital,
and a nursing home -- 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 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.
Editor. So that's Philip's account and I hope you found it worthwhile. Happy New Year to all ! ! !