Another Homeless Drug-Seeker

We have five patients and four nurses in my unit. It's been pretty much like that the entire week. So, why are nurses complaining? They're worried. They are thinking along the lines that if business is slow, we might go out of business. That is so silly. Don't they understand that we are an HMO?



I've been explaining all week how HMO's work. We are really just a big insurance company that provides its own health care. Customers pay premiums. If they get sick, they get treated. If they don't get sick, we just keep the money. So, if the hospital is empty, we are raking in the dough. That is a reason to celebrate. That means our employer can afford to give us raises and we have less work to do.



I don't expect this to last, though. A couple of the surgeons are on vacation, so the source of much of our business is only temporarily gone. In the meantime, I'm happy about the staffing.



There is one patient that is driving us crazy. Isn't that always the case? This guy is homeless and drug-seeking. The two seem to go together like soup and sandwich or ice cream and hot fudge sauce. His drug of choice is dilaudid and he wants it, badly. Other then being homeless and addicted to drugs, there isn't anything in particular wrong with him. I'm not even sure why he is here. We're not treating him for anything. His diagnosis is suicidal ideation, but we don't have a 72 hour hold on him, we don't have a sitter watching him and no effort is being made to get him psych care. He is simply here and we're giving him drugs.



He goes downstairs to smoke a couple of times an hour and no one follows him. If they really think he's suicidal, then why are we allowing him to walk around outside by himself? None of this makes much sense to me, but then what do I know?



If the admitting doctor truly thought that the patient was suicidal, then we should have put a hold on him. If he's not suicidal, then he shouldn't have been admitted. In the meantime, he is driving us nuts with his demands for more and more dilaudid. He keps insisting that we call the doctor to get him more drugs and then the doctor gets annoyed because we keep calling him.



The doctor on call happened be on the floor to see another patient and the homeless guy saw him and came out of the room to demand more drugs from him. The doctor said the usual, "I'll give you one more dose, but no more tonight." So, the patient gets his dose and 20 minutes later is demanding more. The doctor then orders another dose and again says that this is the last dose. It goes on like this all evening. The patient knows it means nothing when a doctor says that this is the last dose.

The patient has been threatening us with walking out and getting drunk if we don't get him his dilaudid fast enough. That is so funny, like we would really be upset if he decided to leave.