Day 6 - Persona Non Grata

There are a certain number of patients who come to the Emergency Department that automatically illicit an audible groan from the staff as soon as their name appears on the patient board, or when you hear an EMS radio call out to a familiar address.  We certainly don't mention certain patient's names, as in "gee, I wonder what happened to So and So," because of the superstition that, like Beetlejuice, mentioning their name will conjure up the person.  These are our frequent flyers.

Some of them are drug-seeking.  Some of them are homeless.  Some of them are non-compliant with their medications.  Some of them are a combination of the three.  Some of them are simply pathetic.  And they don't die unless they die hard.

We've had these patients on the brink of death;  metabolic derangements, heart attacks, massive trauma, hypothermia, drug overdoses.  They get ICU care, or are flown out to specialty centers, spending days, weeks, months away.  And, then they come back.  They always come back.  Sometimes a week or so after arriving back home.  Sometimes a day or two after being released from the hospital.

I've always been respectful of my patients.  I call them Mr. or Ms.;  never by their first name.  Except for the regulars.  They're called by their first names.  "Ok, John, what's going on today...?  Did you run out of your meds?  Did you do a little drinking last night?  Did you make it to the doctor's appointment I set up for you a couple of days ago?"

What's scary about the frequent flyers is that we often bump them, sometimes repeatedly, to the bottom of the list.  They're the ones that get to sit out in the waiting area for hours and hours.  Some just leave and then come back later.  Some of them are patient knowing that if they make it to the back, they'll get the drug, prescription, turkey sandwich, taxi voucher they've been waiting for.  And their waiting is what can be problematic.  Because they're like the little boy who cried wolf.  That every-single-time-crying-screaming-dry-heaving cyclical vomiter might actually have a true medical emergency, and one of these days we're going to miss it.  He'll crash and burn and get admitted or transferred out of the area not to be seen again for a while.  They'll still come back though... they always come back.