Tuesday, March 23, 2010

Then my morning sickness starting yelling at my patients

So, I'm a psychiatric nurse practitioner. I work with crazy people every day. Which I love.

What I don't love is working with addicts. Well, lemme rephrase that. I don't like working with addicts that haven't worked on their addiction in any way, shape or form. Addicts that have surrendered I like. Those that have gone to AA/NA I like. Those are the type of people I can work with. Cause they see they have a problem.

What I mean by that, is that some addicts don't see a problem with their substance use despite all evidence to the contrary. Despite having six owi's, having lost multiple jobs/marriages or having had multiple detox stays at yon hospital. Those are SIGNS OF ADDICTION. THEY INDICATE A PATIENT HAS A PROBLEM WITH alcohol or other drugs. I'M NOT MAKING IT UP.

IT'S NOT MY DEFINITION OF ADDICTION PEOPLE. That is the definition of addiction. Continued use of substances despite repeated adverse consequences.

So, addicts come to me cause I carry a prescription pad. I can prescribe controlled substances. I don't though. Well, not very often. This is disappointing to the active addict in my office. And I do my best, be my most polite, use my most motivational interviewing technique to CALL ATTENTION TO THE BIG ELEPHANT IN THE ROOM. That they are seeking drugs to feed their addiction.

And I won't participate in such tomfoolery!

The problem is, is that addicts can be very forceful. Or try to be forceful anyway. They get loud, stand up and curse. They'll claim malpractice on my part or get weepy. They'll act out by harming themselves. They threaten and/or call me the b word. All of which is the addict's brain talking. I don't take it personally.

But the thing is, now a days, from the time I wake up until the time I fitfully fall asleep I feel like I'm gonna throw up. I'm tired and wrung out. I have but no patience for my addict patients.

SO after the forth addict came to me this week, being forceful as all get out, I kind of lost it. My powers of gentle persuasion, logical explanations, offer of multiple different medications, all of that fell on deaf ears. And my patient kept arguing with me. For 25 minutes.


In a clear and very loud tone, with my face all flush, I said, "THIS is my final offer. WE do x or y. Or there are 4 other prescribers in this office and many more in this city. You are hear voluntarily, you don't need to be here. Either choose a plan or see someone else. BUT I am not discussing the xanax again."

Cause really, those in active addictions cannot be reasoned with. So my futile attempts at logical and patient centered interventions fell on deaf ears. Maybe I crossed over the line. I should have kept my cool. But, I'm only human. But, I need to be more direct I think. 25 minutes is way too long to argue. So, maybe next time I'll blend the direct approach though.

And that's the thing, there will always be a next time. Cause 80% of all addicts have some sort of mental illness. :)

ok, good. feels good to get that off my chest. Now, if you'll excuse me, I'm gonna throw up.

10 Left a message at the beep:

Heff said...

Have some pot and chill out, dude.

Mrs. Holly Hall said...

dude, totally.

B.E. Earl said...

I love the Charles Nelson Reilly pic. Is that from Final Girl's site? She's a fan too.

Mrs. Holly Hall said...

yes! it is, prol'l should have given props.

but dammit. too sicky to even type this post.

barely got the energy to hyperlink!

The Savage said...

You go Nurse House! errr Hall!

Mrs. Holly Hall said...

That's Nurse Practitioner House to you!

er Nurse Practitioner Hall!


Maureen@IslandRoar said...

Wow, it doesn't seem fair to have to be so patient when you're pregnant and nauseous. Definitely don't wait 25 minutes next time before getting out the can of Whoop-Ass.

Anonymous said...

whoremorns rock... *chuckles* notice the spelling...

would make the crazy get better if they only knew....

Mrs. Holly Hall said...

What the Hell Sir Thomas?

what? I don't understand what you are saying?


Bruce said...

I am still sort of fixated on this first sentence: "I work with crazy people every day. Which I love....", man talk about dedication.

This whole thing stirs up an old memory in my mind.....which I think will be come a blog in the next day or so....stay tuned, I will give you a shout back when it is done.

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