For some reason I somehow manage to pick up all the weird patients. Today there were these two teenage girls, who presented with headache, nausea and pain.
They look like they're sick. Turns out the story is that they bought some heroin to inject up from a drug dealer they had not bought from before. They had heard that some of their friends got sick after buying from this guy, but did that stop them? No ... they even noticed that the heroin they got did not look like their regular dose of heroin (it was a little brownish), but did that stop them? NO ....
So 45 minutes later they fall really sick and turn up in the hospital emergency department not long after. As one of the poor doctors manning the subacute section there, I notice that the triage sheets for the next two patients to be seen have exactly the same history, so I bring both patients into a room at the same time.
Then the trouble really begins. They keep on wailing about how they are really sick. One goes on saying that she is so sick she feels like killing herself. On examination they both are febrile with a temperature of 38.0 degrees Centigrade, heart rates of between 120 and 130, normal blood pressures, possible abdominal guarding and no respiratory signs.
The one who says she feels like killing herself did seem sicker than the other one but she then asked for morphine. Intravenously. hmm...
They are offered panadeine forte (Tylenol #3 for you Yanks) and aspirin for relief of their pain but they refuse it saying they won't be able to keep it down. Strangely enough, they do manage to drink a cup of water each ...
Anyway, IV cannulas are finally put into their arms after a few botched attempts by yours truly (complaining and yelling never made my job easier) and they were calmed down with metoclopramide (an anti-emetic, for nausea) and some IV fluids.
The two girls were first seen in one of the rooms and they needed a bed in the acute section for monitoring (the plan became that they should be sedated until they slept it off as their condition did not seem dangerous). As it turned out, they had to wait for the beds to be emptied. As one bed became available, there was a short argument between them as to who would get the bed first.
"I'm going first."
"No, I'm going first. I'm sicker than you."
Anyway, they were sedated with some midazolam and kept quiet that way until they settled down.
What a couple of characters.
There was another IV drug user that I saw. This one was an older lady with a foreign body in the sole of her foot. She had stepped on a needle dropped on her kitchen floor by a friend of her boyfriend. Sure enough, the needle punctured her foot and got broken inside her foot. All attempts by her to take it out herself failed.
On examination, her foot was quite tender over the area where the needle had penetrated her foot. Otherwise, her foot was normal, there being no neurological or vascular deficits. X-Ray of her foot revealed a broken needle of about 5mm length embedded in her foot with at least 4mm between the tip of the needle and her skin.
One complicating factor was that the person who dropped his needle there was Hepatitis C positive. So this woman wanted a test for it. No sooner than I had taken blood from her, ordered the relevant tests for needlestick injuries, contacted the Sexual Health Clinic and asked about HIV prophylaxis and was going back to ask her if she knew what the HIV status of the needle-owner was that I found she was nowhere to be found.
She had disappeared. With that obviously painful needle still stuck in her foot. She had had a surgical registrar have a look at her, who was in the process of booking an operating theather session for her for the quick removal of the needle under X-ray image intensification and she had gone Walkies!!
She probably went to have another shot of heroin or something like that. They expected her to return ... hopefully before the embedded needle turns into a big abscess.
Sheesh. Drug users. Trouble. My thoughts about the two young girls was the pitiful thing was that, even though they went through what might have been the sickest they ever felt in their lives, they were still likely to go back for more heroin later...
*sigh* ... what can you do?