As I walked through the hallway of the Emergency Department, my eyes fell upon one particular gurney that was parked against a wall. It was a typical night in the ED. People were flowing through the doors and patients were being “roomed” in the hallways. As I looked at this gurney’s occupant, I cringed. The pale face with wrinkled skin and sunken eyes was all I could see. The body was covered up with a blanket. But that face was unmistakable. I knew the face — or at least I thought I did. I didn’t want to take the risk of being recognized so I quickly walked passed. I cringed, knowing that I’d have to walk back this way on the return trip.
When I passed the gurney for the second time I realized that the patient was asleep. This time I paused at the bedside. I noticed her wrist was exposed. And on that wrist was her identification badge. The name confirmed my fears. This was the very patient our team had discharged one week earlier and showed up in the ED the very next day with discharge papers still in hand. This was the patient whose medical record would reveal multiple visits to the ED for the purpose of obtaining meds.
If you’ve read this far and are wondering why I was so fearful, it’s because I feared that the patient would be a “bounce-back.” A patient becomes a bounce-back when they return to the hospital within the same calendar month after their discharge. When this happens, should the patient need an admission, they go back to the team that originally took care of them. The theory is that it provides continuity of care as the team is already familiar with the patient and his or her issues.
As I continued on with my work, I knew I didn’t want this bounce-back. I didn’t want the patient back on our team. She had been hard to work with in the first place. She had terrorized the nursing staff. She had frustrated her sitter. She had tried our patience. She had refused treatments. She was a difficult patient.
Like I wrote earlier, she was a frequent flier. I am not sure her repeated admissions helped her. Sure, she had physical ailments. And we could help the occasional exacerbation. But they were chronic conditions that we wouldn’t cure. To me, it seemed that the most pressing issue was her mental health. I suspect, and I’m no psychiatrist, that much of her behavior would improve with more attention to her mental health. But sadly, the system we are in affords little help to who need it, and even less to those who don’t think they have a problem.
As I begin to wrap up this post, I admit I am struggling. I don’t know where I am going. I suppose it is borne out of a frustration that is without an avenue of release. There’s nothing that I can do to help patients like the one above. And as I go into Internal Medicine, I am sure I will encounter many more people who, though suffering from significant medical and mental illnesses, will try the patience of those taking care of them.
Perhaps, this is just my weekend, off-day rant.
