Who was the cavalier physician who got this veteran re-addicted to opiates?
Some people say that if you’ve seen one junkie, you’ve seen them all. But this guy really did look different.
“What brings you to the ER tonight? . . . Mr. Johnson,” I said after quickly glancing at the chart. I knew why he was here. It was an unseasonably cold night, and it was raining. And he had no place to go. Better to sit in the ER and possibly get a sandwich.
“I need help,” he said, dropping his eyes to the floor.
No joke. I thought while shaking my head. It was good that he didn’t look up to catch the thinly veiled look of disgust on my face. His hands were covered with the red puncture wounds of infected injection sites. I was sure that arms and legs were a spider web of similarly red tracks.
“I want to get clean,” he said, finally raising his eyes to mine. There was a long silence as we sized up one another. If he was just yanking my chain, then he only wanted to stay in the ER a few hours or days while I searched for an empty bed in a detox unit, only to walk out as soon as he arrived at his final destination. If I got the faintest whiff of that, I was going to clear him medically and send him back out into the rain with a list of clinics to contact on his own. But he had been inside long enough now to dry out and get warm and he still had the “goose flesh” of withdrawal.
“How long have you been an addict?” I asked, testing his transparency.
“This time?” he said, half looking into the distance. “About two years,” he shrugged. “But off and on for over 40.”
“Really?” I was astonished. First, if it was true, I was amazed that he had survived this long. Because according to the chart, he was slightly older than me. And second, only two years and he looked this bad. He was a bag of bones. Most of his teeth were missing.
“Yea, I was clean for over 15 years. I owned my own business building and repairing houses.”
“Really?” Now I was shocked. This guy was a business owner? “Where do you live now?” I asked incredulously.
“In an abandominium,” he said with a sly grin. “I used to build those things. Now the rundown ones are just holes for rats like me.” He looked at me with steely eyes, then finally looked away.
“Do you have a family?”
“Had one, but they finally ran me off. I stole from every one of them, even my baby girl. Her husband finally said I couldn’t come around any more. He didn’t want the kids to see me. It was too hard trying to explain who I was.”
I just shook my head in disbelief. “You were clean for 15 years and then just went back to drugs? How did that happen?”
“I fell off a roof and broke my back. I got a whole slug ‘o meds and I was back on the train again.”
I was incensed. Who would be so cavalier with opiates with a history like this man’s? “Were you seen in an ER? Do you remember who started you back on narcotics?” I wanted to get on the phone and tell the doctor what they’d done to this man.
“Yeah, Doc. Actually, it was you. Don’t you remember taking care of me?”
My breath stopped for a moment as I slowly recalled his grimacing face looking up at me from the trauma gurney. “We talked about the Navy and the Marine Corps. I was a corpsman. And I remember you were a doc with the Marines. I thought I could come home and go to med school. Remember?”
“Oh, my God,” I finally exhaled. “I am so, so sorry.”
“It’s not your fault, Doc. I blame that Gook in Vietnam who shot me while I was bent over one of my Marines.” Now I was remembering his story. “And that damned bone doctor that you sent me to after the ER. I knew what he was thinkin’. He just didn’t want any calls from me over the weekend.” That’s right. We talked about the bullet that we saw on the chest X-ray. He had a compression fracture. But the orthopod didn’t want to admit him because it was coming up on 4th of July weekend. All his partners were out of town, and he didn’t have any other patients in the hospital. He didn’t want to come in to round for just one patient.
“That’s what got me in trouble in the first place. When the docs in Vietnam saw the Purple Heart and the Silver Star recommendation in my record, they just gave me any damn thing I wanted. The candy store was open.” He looked me in the eye and shrugged.
“I came home hooked on everything I could get my hands on. Hell, the Navy would have given me a Big Chicken Dinner, but you can’t quite do that to someone right after you give ’em a Silver Star.”
I had to chuckle. It was the first time in several years I’d heard of a Bad Conduct Discharge referred to as a Big Chicken Dinner.
“But did you have some other clean years before your 15 year stint?”
“Off and on,” he said gazing into the past. “But when I wasn’t shootin’ horse I was drinkin’. My wife stayed with me long enough to have three kids. But she finally couldn’t take it anymore.”
“And the fifteen years?”
“We were friends. She finally married a good man. But after the last few years she won’t even talk to me. Can you help me, Doc? I really need help, bad.”
Now I was hooked to this man. I thought about the Marine axiom that we “Never leave a man behind.” This whole thing started when this man risked his life for that motto. It was my turn to carry the wounded man to safety.
“Let me see what I can do.”
I was determined to find a reason to admit him this time. But after a long medical work up, I was left with nothing but plain old opiate withdrawal. The hospitalist completely stiffed me. But I understood. We were holding 22 in the ER. He needed a detox unit, counseling, and long-term follow up. Maybe methadone maintenance.
“I saw his workup was negative,” the charge nurse said in passing as I looked up from his chart. “You want me to give him the list of clinics and get him out of here.” It wasn’t her fault. She was just reflecting my normal procedure.
“No,” I said resolutely. “We’re going to find him a bed in a detox unit.”
“You know how long that will take, right?” She stopped what she was doing to make prolonged eye contact.
“Yeah, I know,” I said, taking a deep breath. “I know how long that will take. You start making a few calls, and I’ll get him started on a detox regimen. Oh, and I’ll get him a sandwich.”
Wow. Tough story. Clearly not your fault, though. Bad things happen despite our best intentions. Wishing this guy well and wishing you well too. Semper fi.
Great story, Mark!
Mark — an insightful tale, and an interesting turn when you said “I wanted to get on the phone and tell the doctor what they’d done to this man. ‘Yeah, Doc. Actually it was you. ‘”
I appreciate this patient’s service to our country and thanks for starting him on detox and getting him a sandwich!