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.

THEN I PUT UP MY HANDS. He shut up.

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.

They did kill her after all

Has everyone heard that two of Anna Nicole Smith's doctors (one being her primary care doc and one being her psychiatrist) and her main man Howard K. Stern have been charged in with her death? Well, you have now.

And

I am really shocked about the whole deal. But not for the reasons you may think.

For those that are new, I am a psychiatric nurse practitioner. I have the power to prescribe medications including the ones that resulted in Ms. Smith's death. I remember reading through the list of meds that she was taking when she died. They included multiple pain medications and benzos (anti-anxiety/muscle relaxants) and a few hypnotics (medications that make you sleep).

I was not shocked at her medication list.

I have seen lists like that many times. It's called polypharmacy and it is very common in the United States. Sometimes, people demand a lot from medication. They can demand that it fix everything that upsets them. Somes, people also have underlying addictions to alcohol and other drugs and when they try to sober up, they seek out prescription meds to fill the void. Some are not willing to take no for an answer.

I have a lot of experience with this. And I say no. Which RESULTS IN THIS POST.

But, I am one of a million prescribers out there. Not all of us are such high minded folks. No pun intended.

When the addict won't take no for an answer, they will find another prescriber. Sometimes they will see two or three prescribers, often using different clinics, different pharmacies, all to fill their addiction. They will seek care under different names. That way, the pharmacies won't catch on. Other addictive behavior includes lying to the prescribers to get early refills, saying things like, "the pill bottle was in my coat and i gave my coat to good will" or "it was in my pants and I washed it" or "it was in my car and my car was stolen". All bullshit addict talk. All bullshit addict game playing. All sad and part of the problem.

I have been a nurse long enough to see this kind of addict behavior a mile a way. Which is good, as I am not part of the problem. I am part of the solution.

Yet the doctor and the psychiatrist that tended to Anna Nicole? There is no way they did not understand what they were doing. Which was killing her. And they were doing it for greed and personal gain. And I am shocked people. Shocked they were charged. Noone calls out prescribers for polypharmacy. We all kind of sigh and pass it off.

I really think I have become too complacent with all of this. With seeing the laundry lists of multiple meds. I need to be more vigilant with my patients' care. Call attention to medication lists that will kill them. Either way, I hope the doctors get the chair.

It's a good thing the doctors were charged. Maybe that will help all of us pony up more. Be better at what we do, which is help people.

Let me end with another blogger's summary of the incident, which is supurb. It is from the site, What Would Tyler Durden DO? http://www.wwtdd.com/ It sums it all up just fine.

Anna Nicole Smith died on February 8, 2007, at the Hard Rock Hotel in Hollywood, Florida, from an overdose of the sedative chloral hydrate combined with three different types of the sedative benzodiazepine. Her autopsy said her death was not homicide, suicide, or natural causes. Unfortunately for her lawyer Howard K. Stern, the autopsy doctor is not a cop, and the cops make a frowny face when you give a drug addict barrels full of psychoactive drugs whose primary function is to slow down the central nervous system.