Challenges of the challenges

No one ever prepares you when you are in school of the challenges you may have ahead of you.  Some of the challenges are unknown.  You are given tools to assess both through questioning and physical exam. The next step you are taught to make differential diagnosis and plan appropriate diagnostics and interventions. Are we ever to prepared to face the  the emotional challenges of patient's ..their demons...their addictions and past emotional problems  that mold them into  persons that they themselves can't face or deal with.


My week was spent working with a patient only experiences through the year could possibly prepare you. I can read about substance abuse, PTSD, anxiety, depression...but when you deal with a patient who has physically caused harm through his own hand of use of IV drugs...you need to dig down deep into the overall experience you have in your possession..rid yourself of making assumptions


IV drug use ..skin popping..do you know they can cause infiltrating infection to you skin...do you know you can potentially cause life threatening infection ...loose you limbs and even death

But you come to me to help you....Time, energy and empathy go into deriding the dead and infected skin from your limbs....time, energy, comfort and empathy go to into providing pain meds and dressing changes to help wound healing after dead and infected skin have been removed surgically

You are given over and above the pain medications that are allowed by CDC requirements and you want more....

You know what the consequences are if you jeopardize your care...but you do  it anyway...Leave the  prior to skin grafting that would protect the exposed muscle and nerves that are left after the infected overlying skin is removed ....saying you are going to another facility who provides conscious sedation during wound care....you leave saying you won't use any drugs until you get to the hospital


I go over and above to seek out a plan that would be amenable to you...go over risks vs benefits of leaving at this point..knowing the lost of your limbs and even death are possible


You....deny drug seeking behavior....you leave ...and don't go straight to a hospital


You are out there with your demons and your addiction.....when do you get it and enough is enough

For all those who work with the patient's who are suffering addiction....you know what I am talking about....you think they get you and  you get them....but some just are ready.


Be patient....and be there when they are ready to make the change