This place is nuts!

Today we had a really annoying lady come in today likely seeking narcotics. She was angry, she cried, she told me how she was just passing through town and needed a refill on her phenergan/codine cough syrup that she just can't live without. She showed me her last bottle that she had filled 14 days ago. It was a 500mL bottle and it was empty. She wanted something for her neck pain too. As it turns out she just got her MRI results before she left California that showed this, that and the other was wrong with her neck. Well, she's also on 4 psych meds, 4-5 pain meds and some other stuff I can't remember. I relay all this to my preceptor who comes in and lays it on the line to her. No narcotics on the first visit. But she can have flexaril and Tessalon Perles for her muscle spasms and cough. She complains about not being to afford them, some problems with her Medicaid in CA, and while grumbling storms out of the office without getting any of her scripts.

Later a guy who I stitched up last week came back to get his stitches out. But he brought his psycho girlfriend who complained about the crappy job I did, the fact that they had to pay another office visit, that I released her bf to light duty at work after 3 days and he went to heavy duty right away, that I should have know better that he couldn't possibly work at all given his occupation as a line cook. Turns out he's also a gopher who "has to" carry and lift heavy foodstuffs or something. Oh and he "has to" wash dishes. After a few hours in the rubber gloves he got keep his hands dry - his hands were likely very macerated anyway. And he stopped using the brace we made for his hand to keep his wound stable, His gf gets entirely bitchy with me from the get-go and starts to berate me and argue with me about who knows what really - mostly how it's my fault her gutless, stupid boyfriend can't take care of his wound properly. Well, after taking out 2 stitches I could see his lac wasn't healing at all. I put some steri-strips down and told him not do anything with his hand if he wanted it to heal. In the meantime, this guy's girlfriend throws a shit fit, the office manager calls the cops and my preceptor throws a very intense, profanity laden shit fit of his own in front of the patient, other patients, and the entire staff. I had to pull him away from the patient (for the second time during my rotation there) as violence would have ensued, and then I finished dressing the patient's hand. The patient's girlfriend ran off and he was stuck answering to the cops.

If this sounds disjointed or confusing, I am ok with that because that is how I still feel having been involved in this crap.

Family Practice, continued

I stayed home today with my son who is sick. My wife had to travel to California for work so it's another boy's day home.

The clinic I am at is very interesting. There are so many chronic pain patients - I can't believe it. 75% must be on vicodin, percocet or MS contin. I feel that the vast majority need these medications but there are a handful that just piss me off. When you've seen these type of patients you'll know what I mean but until then it is difficult to really grasp what these people are like. Manipulative, mean, argumentative, and nasty. I hate dealing with these people. I do mean Hate. And their sense of entitlement regarding coming in late, demanding early refills, refusing to comply with the requirements of continued care and lack of decent interpersonal skills makes being around them a chore.

On a similar note, it seems that the majority of our patients are heavy smokers. The stench of cigarette smoke they carry on them is so overwhelming that I seem to be able to smell it hours after I leave the clinic. The thing is that a lot of them don't want to quit smoking, but they come in frequently for URIs, HTN, asthma and COPD needing O2 and med refills. They complain about all of their health problems and not having money to pay for decent food or health care yet they spend $100-$300 a month on smokes! My parents are heavy smokers and I grew up with the chain smoking mentality. I also realize that smoking may very well be one of the most difficult addictions to break. These people (including my parents) still piss me off with their lack of resolve, self-control and common fucking sense. If you are going to smoke 2 or 3 packs a day, what in the hell good do you think O2 or inhaler is really going to do for you? The spectrum of the human condition and experience is infinitely vast and often impossible to relate to. I "get it", but sometimes I still don't really "get it."

Family Practice

So now I have started a FP rotation in a rural mountain town. Today was stressfull but mostly draining. The PA I am with got into an argument with a patient with no patience. She complained he was taking too long and he told her not to give him any crap today. The argument ended with her refusing to quit smoking or follow his advice and with him frustrated and furious. He walked out of the exam room and left me to smooth things over with her which I was able to do for the most part after 20 minutes. We then had a lady in late her late 60's complain that after a year and a half of practicing anal sex with her boyfriend she wanted to know why her perieneum hurt soo much and if we could fix it. We tried. I was left to counsel a young man with pneumonia who decided to break down crying to me about his grandma and aunt's ilnesses and concerns. After I got those under control and returned with his rx for a chest x-ray and antibiotics he broke down again about the feelings he had for his high school sweetheart who resides in another state and who he hasn't seen in years. He feels they still have a relationship but isn't sure and as a result has put off having sex with a few of his cousins until he knows for sure what is going on with his "girlfriend." This guy in his 30's was sobbing and I was the only one there to talk to him about his nutty-ass problem. Add to this some drug-seekers and "I'm and hour late but you need to see me anyway" types and I left there drained and wanting to have a few stiff drinks. My real wish was that there was a chlorox handi-wipe I could stuff into my skull and wipe my brain clean. Some cheap red wine will have to suffice.