there'll always be a place in my heart for a crack ho'
My hatred for crack/cocaine is well known. It's an evil and nasty drug that keeps me up at night and in the wrong way. But there'll always be a place in my heart for a crack ho'.*
I admitted one such lady, a lovely 19 year old. She cut herself on some "glass" (her crack pipe) a week ago. It didn't really bother her until she was arrested. When she got to jail, she then complained loudly enough to be transfered another ER and then to mine for further care. She was agitated, uncooperative and clearly crashing from her high. Still, I asked her the standard questions including, "What's the matter?, How did that happen?, How long has it been that way?," etc. I knew damned well what was the matter but wanted to hear her say it. Her interview was curt and she snapped only the briefest of answers to me. I ordered cultures, antibiotics, a CT scan to assess for osteomyelitis** and waited for the plastic surgeon to do his consult.
The next day, I arrived fully expecting the same handcuffed grouch. I was pleasantly surprised. Her handcuffs and guards were gone, she was awake and actually quite amicable. We spoke of her condition, specifically that she indeed had an infection of the bone in her thumb. She was worried about losing her thumb and I agreed that it was a possibility, but up to the surgeon to decide. I asked her why she waited so long to seek help. She of course explained that she was strung out on the crack and didn't rightly care at the time. I did my duty and admonished her to seek aid sooner the next time and to stop smoking the rock, if at all possible. She understood and agreed with my assessment that an opposable thumb was one of the major traits that separated us from the rest of the animal kingdom.
And so it went. Over the next few days, we developed a unique rapport that only happens when two people lower their guard just enough to discover that they are similar for all of their differences. I enjoyed our exchanges and she appreciated the fact that I wasn't an asshole like her surgeon. A visit that by rights could've only taken two to five minutes stretched to ten and then to fifteen. We spoke of the same things that most people speak of when they first acquaint themselves with each other: family, travel, jobs and so forth.*** It was good conversation, conversation that was punctuated by outlandish remarks that were compatible to our unique relationship and backgrounds.
We discovered a mutual love for travel. She's been to more places than I ever hoped to go. I lamented this fact and the whole free time versus money conundrum that we all faced. She replied, "Well, you have money now don't you?" I shrugged. "Well, you should spend it on me! I'll take you places--I'll be your Sideline Secret Pleasure!," she exclaimed with a gleam in her eye. Clearly, she had used that line before. I respectfully declined.
Our love for travel wasn't our only bond. She was separated from her family during the aftermath of Hurricane Katrina. They had evacuated to Alabama, she believed, but she wasn't sure. She came to Texas with her fiance, but was stranded when the engagement fizzled. I let her know that she wasn't alone in this matter as I was in a similar situation (except I had a slightly higher paying job), to which she replied, "that sucks." Sucked indeed.
I was trying to find a way to disposition her. She had no insurance and the surgeon was just sitting on her thumb, so to speak. She needed at least six weeks of antibiotics and wound care if she had any hope of saving her thumb. I was trying to find a way to arrange for it. I asked her if she could pay for her prescriptions, to which she said, "no." I asked if she could divert some of her crack money for the antibiotics and she told me that it wasn't likely as she liked crack too much. She did say that she had someone who might pay for it. He was one of her tricks, who then became more of a "friend" and she thought that she could get him to pay for it. I asked how she might wrangle that and she replied that she'd probably just give him a hand job and it would suffice. I couldn't resist and asked her with which hand...
I thought that she was a stripper at a local nudie bar, but she told me in no uncertain terms that she performed oral sex for a living. "Men just love having their dicks sucked," she declared, to which I replied, "Well, no shit!" We exchanged glances: hers was of the "I'm trying to get a rise out of you by saying something shocking, but I can't believe I didn't phase you" variety, mine was "yeah, I heard you and I'll go toe to toe with anyone" variety. We both shared a laugh. It was then that she realized that she was missing out on the weekend client surge and wanted to be discharged immediately. She had to get back to the jail to collect her belongings and to get ready for the night. I told her to hold on as I was trying to arrange for charity medications so that she'd at least have some antibiotics until she could arrange for more. She asked if she could leave and come back later. I told her that this wasn't a hotel, she would be leaving against medical advice and would have to check in via the ER again. She thought about her thumb again but decided to check out. I told her that I couldn't force her to stay but was sad that she was leaving. She signed out soon afterward.
Don't get me wrong. I'm no Captain Save-A-Ho'. I wasn't embarking on some Quixotian epic to try right the injustice in her world--my lance broke a long time ago. I did wield my pen to its full might to try to help her. Help her get her medications. Help her reunite with her family. Help her not lose her thumb. I would have done that for any patient. What got me excited was not our chit chat, though I did gain some insights that helped me help her. What galvanized me was that she was still at the beginning of her life and on the verge of wanting change. It wasn't too late and no permanent damage had been done to her mentally or physically. I see so many people at the ass-end of of their lives, when the window opportunity had shut long ago that I didn't want to miss an opportunity to actually affect an outcome. For once.
----
* Figuratively, not literally. I don't want them anywhere near my blood stream.
** Infection of the bone.
*** Perhaps this may seem too personal, but I'm the Malcolm X of the medical world. I will use any means necessary, including the sharing limited personal anecdotes, if I believe it will help the patient understand and comply.
I admitted one such lady, a lovely 19 year old. She cut herself on some "glass" (her crack pipe) a week ago. It didn't really bother her until she was arrested. When she got to jail, she then complained loudly enough to be transfered another ER and then to mine for further care. She was agitated, uncooperative and clearly crashing from her high. Still, I asked her the standard questions including, "What's the matter?, How did that happen?, How long has it been that way?," etc. I knew damned well what was the matter but wanted to hear her say it. Her interview was curt and she snapped only the briefest of answers to me. I ordered cultures, antibiotics, a CT scan to assess for osteomyelitis** and waited for the plastic surgeon to do his consult.
The next day, I arrived fully expecting the same handcuffed grouch. I was pleasantly surprised. Her handcuffs and guards were gone, she was awake and actually quite amicable. We spoke of her condition, specifically that she indeed had an infection of the bone in her thumb. She was worried about losing her thumb and I agreed that it was a possibility, but up to the surgeon to decide. I asked her why she waited so long to seek help. She of course explained that she was strung out on the crack and didn't rightly care at the time. I did my duty and admonished her to seek aid sooner the next time and to stop smoking the rock, if at all possible. She understood and agreed with my assessment that an opposable thumb was one of the major traits that separated us from the rest of the animal kingdom.
And so it went. Over the next few days, we developed a unique rapport that only happens when two people lower their guard just enough to discover that they are similar for all of their differences. I enjoyed our exchanges and she appreciated the fact that I wasn't an asshole like her surgeon. A visit that by rights could've only taken two to five minutes stretched to ten and then to fifteen. We spoke of the same things that most people speak of when they first acquaint themselves with each other: family, travel, jobs and so forth.*** It was good conversation, conversation that was punctuated by outlandish remarks that were compatible to our unique relationship and backgrounds.
We discovered a mutual love for travel. She's been to more places than I ever hoped to go. I lamented this fact and the whole free time versus money conundrum that we all faced. She replied, "Well, you have money now don't you?" I shrugged. "Well, you should spend it on me! I'll take you places--I'll be your Sideline Secret Pleasure!," she exclaimed with a gleam in her eye. Clearly, she had used that line before. I respectfully declined.
Our love for travel wasn't our only bond. She was separated from her family during the aftermath of Hurricane Katrina. They had evacuated to Alabama, she believed, but she wasn't sure. She came to Texas with her fiance, but was stranded when the engagement fizzled. I let her know that she wasn't alone in this matter as I was in a similar situation (except I had a slightly higher paying job), to which she replied, "that sucks." Sucked indeed.
I was trying to find a way to disposition her. She had no insurance and the surgeon was just sitting on her thumb, so to speak. She needed at least six weeks of antibiotics and wound care if she had any hope of saving her thumb. I was trying to find a way to arrange for it. I asked her if she could pay for her prescriptions, to which she said, "no." I asked if she could divert some of her crack money for the antibiotics and she told me that it wasn't likely as she liked crack too much. She did say that she had someone who might pay for it. He was one of her tricks, who then became more of a "friend" and she thought that she could get him to pay for it. I asked how she might wrangle that and she replied that she'd probably just give him a hand job and it would suffice. I couldn't resist and asked her with which hand...
I thought that she was a stripper at a local nudie bar, but she told me in no uncertain terms that she performed oral sex for a living. "Men just love having their dicks sucked," she declared, to which I replied, "Well, no shit!" We exchanged glances: hers was of the "I'm trying to get a rise out of you by saying something shocking, but I can't believe I didn't phase you" variety, mine was "yeah, I heard you and I'll go toe to toe with anyone" variety. We both shared a laugh. It was then that she realized that she was missing out on the weekend client surge and wanted to be discharged immediately. She had to get back to the jail to collect her belongings and to get ready for the night. I told her to hold on as I was trying to arrange for charity medications so that she'd at least have some antibiotics until she could arrange for more. She asked if she could leave and come back later. I told her that this wasn't a hotel, she would be leaving against medical advice and would have to check in via the ER again. She thought about her thumb again but decided to check out. I told her that I couldn't force her to stay but was sad that she was leaving. She signed out soon afterward.
Don't get me wrong. I'm no Captain Save-A-Ho'. I wasn't embarking on some Quixotian epic to try right the injustice in her world--my lance broke a long time ago. I did wield my pen to its full might to try to help her. Help her get her medications. Help her reunite with her family. Help her not lose her thumb. I would have done that for any patient. What got me excited was not our chit chat, though I did gain some insights that helped me help her. What galvanized me was that she was still at the beginning of her life and on the verge of wanting change. It wasn't too late and no permanent damage had been done to her mentally or physically. I see so many people at the ass-end of of their lives, when the window opportunity had shut long ago that I didn't want to miss an opportunity to actually affect an outcome. For once.
----
* Figuratively, not literally. I don't want them anywhere near my blood stream.
** Infection of the bone.
*** Perhaps this may seem too personal, but I'm the Malcolm X of the medical world. I will use any means necessary, including the sharing limited personal anecdotes, if I believe it will help the patient understand and comply.