How can you tell if a meth user is lying?
They open their mouth.
-Emergency medicine consultant
I've cone to the end of my first three months in emergency. I only have 4 more months in ED for the year after this. Perhaps it's not really something to celebrate then. But I'll tell you why I am.
When I was preparing to go do my mission trip / medical placement in Africa, I had to undertake some preparation. As a casual "Missionary" I was informed that a short trip would be interesting and a great way to learn from and be involved in a new culture. Of course, when you first arrive it can be quite shocking. Wait a few weeks and it becomes a comfortable contrast. Wait a few years and you'll find you feel at home.
But in the middle ground there, there is a danger period. You're no longer at home, but you're in a place that feels foreign. Things that were peculiar at first become frustrating. And those that give up at that point, and go back from where they came, often leave bitter and resentful. So time is important. Either stay a short while, or dig in.
As a general medico my life is portioned out to me in three months blocks. Three months of emergency, or three months of general medicine, three months of ortho and so on. So every quarter I uproot and find a new home. My experience so far when one is posted in a demanding rotation is one of perpetually leaving just as things are about to get really frustrating, and being happy to move on.
This time though I'm doing back to back rotations in the same place. Six months! But when the alternative was worse I'm totally okay with it.
I leave that preamble floating in the milieu because I've actually found the last few weeks of work quite tiring. Part of it is the shift work - the perpetual poor sleep and disruption to a normal social life. But the major grind is the patients. Specifically the patients who are only patients because of their own stupidity and often neglect. Most recently though, my bugbear has been the meth heads.
The other week I had a patient, who having lost everything in his life because of his drug abuse went off to detox, for the fourth time. He presented to ED, noting that after 4 days in the community he was having panic attacks and didn't feel safe at home. He remarked that he was being watched by his now ex partner. Healthy paranoia right? That's fine. You're off the drugs, which is a great life choice. You're not suicidal, go see your GP tomorrow yada yada. Send him home. He returns home, has a panic attack and calls an ambulance. I have the misfortune of seeing him again, only this time he reports that actually he started using meth again and is just tripping badly. Very paranoid and wondering if he should kill himself and was too embarrassed to tell me the first time around.
At this point all I want to do is scream and declare that I don't care. You're only suicidal and paranoid because you're on meth. You're only alone because of meth. You've only lost everything because of the meth. There is a very strong cause and affect between your issues and meth. Not to mention that you've had four presentations exactly like this over the last three months! Why now is this my problem!? At some point you have to take responsibility for yourself don't you?
But instead I gave a few stiff words, make him cry and then let the mental health person say he can stay for the night. I accept this, because I feel I'm too early in my career to let someone go home and kill themselves on my account and I don't want to get sued. But I guess on some level it's also the right thing to do.
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| Morning handover - I come to work for the pajama clothing and sneakers |
So I cite that example about things that have been grinding me down in emerg of late. I've had a few people lie to me about their drug use, and annoyingly at times I've believed them. Like the other day when I had a twenty year old who for all intents and purposes was having a heart attack neglected to tell me about his methamphetamine use, until he was at the next hospital and mum was out of the room. Found that out from my housemate...
So what does it all mean? Who knows. Opportunely though We've been working through Ecclesiastes at church. It's the book of the Bible that was written on a Monday morning, so to speak. Fascinating book and something to wrestle with. But I've found the words oddly appropriate at times. I'm thinking of replacing my old mantra of 'people are idiots' with "meaningless, meaningless."
Here's an exerpt for your perusal:
2 “Meaningless! Meaningless!”
says the Teacher.
“Utterly meaningless!
Everything is meaningless.”
3 What do people gain from all their labors
at which they toil under the sun?
4 Generations come and generations go,
but the earth remains forever.
5 The sun rises and the sun sets,
and hurries back to where it rises.
6 The wind blows to the south
and turns to the north;
round and round it goes,
ever returning on its course.
7 All streams flow into the sea,
yet the sea is never full.
To the place the streams come from,
there they return again.
8 All things are wearisome,
more than one can say.
The eye never has enough of seeing,
nor the ear its fill of hearing.
9 What has been will be again,
what has been done will be done again;
there is nothing new under the sun.
10 Is there anything of which one can say,
“Look! This is something new”?
It was here already, long ago;
it was here before our time.
11 No one remembers the former generations,
and even those yet to come
will not be remembered
by those who follow them.
So what does that all mean? Well... I'll let you know when I'm done wrestling with it. But I'm optimistic that by the end of six months in ED, it will feel like home and all of these issues will continue to float right on.
