Weird things with pills

Some people, while looking for thrills,

Aren’t choosy when it comes to their pills

They get stoned and then drunk,

Or droned and then stunk,

And face horrible hospital bills.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In 2010, I danced back from the brink of burnout and traveled for a year doing temporary medical assignments from Barrow, Alaska to New Zealand’s South Island.  I’m now working at a Community Health Center part-time, which has come to mean 54 hours a week.

People do weird things with drugs.

I won’t say where or when this happened.  The patient in the ER claimed to have confused pills (an antidepressant) prescribed for someone else with a common analgesic (ibuprofen), supposedly for joint pains.

The incident happened in the context of partying with friends the day before.  As the gentle interviewing process continued, the number of recreational drugs ingested doubled, then quadrupled.  I didn’t bother to ask about dose; no one can count after they’re high.  Some of those recreational chemicals were legal, some were illegal, some were legal for someone else, and I didn’t want to know who.

Med school trained me to be a doctor, not a judge; HIPAA mandated that any information I get from a patient can’t be revealed to anyone else without their consent, not even to the police.  In fact, if I started to report all the illegal drugs my patients use, I wouldn’t have time to attend to sore throats and runny noses.

But the patient’s story kept changing, not surprising given the degree of intoxication.  The other party in the exam room kept showing me the prescription bottle and saying, “You can really see how someone could make that mistake, can’t you?”

No, I couldn’t.  And I said so.

And as hours passed, the patient’s behavior got more and more bizarre, and less and less congruent with an antidepressant overdose the day before.  Eventually, the patient had a bed in the ICU, nurses had bruises, police arrived and applied handcuffs, large doses of tranquilizers found their way in the bloodstream, and I had spoken with the Clerk of the Court to get a 48-hour hold.

Less than 24 hours later I had the chance to discuss the case with a couple of clinical pharmacists.  We looked at the drug involved and the length of time it takes to clear from the system and the physical findings.  We agreed that the two people had left out large parts of the truth.  I had to admit I had looked at the antidepressant bottle but hadn’t looked at the pills.  Could I vouch that the bottle contained the antidepressant in question?

No, I couldn’t.

For the most part, patients tell me the truth as they see it.  Sometimes they just lie.  The more I thought about it the less I wanted to take the story at face value.  After all, I find it more likely that someone who had just had a “couple” of beers, an unknown amount of marijuana, and a dubious dose of amphetamine would take something else on purpose rather than by accident.

Following Poison Control’s explicit directions, I treated the patient, let time take its course, and watched the patient improve.


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