I was wrong. The boy from across the street suffered a fracture of the shaft of his left femur rather than the surgical neck. He did have a rod put in yesterday, the surgery was successful and he is doing well. I went by and checked on him today and his mother and I talked about the accident. He will have to be on crutches for six weeks with only minimal weight on the leg but should have a complete recovery. As it turns out, just the day before he had had a wreck on his bike and already had scrapes on his right leg.

The Leadership Council voted to offer a contract to the oncologist inviting her to join our group. I voted with the rest of the Council after hearing more information about the business plan and projections for how many oncologists would be needed in our area. I also found out that the only oncologist in the area not affiliated with our group is very likely going to leave the area after June 1. Given this new information the correct decision was to bring in another oncologist.

The hospital service today was slow. Of course, the whole hospital is slow probably due to this week being spring break for the high schools throughout our area and the near 70 degree(F) weather we have had for the last 4-5 days. I only had three patients to see all day, one of whom I discharged and the other one I admitted this afternoon. Forgive my pessimism but the admission was probably a waste of time since it is the ninth admission for him to be acutely withdrawn from heroin, the second in a week. He has been using heroin since age 13. He is now 29 and has heart failure due to the multiple drugs he has been addicted to. Despite this, he keeps going back to the heroin despite all types of addiction treatment programs in the past. The last time he simply walked out of the hospital and went straight back to the heroin which is what I expect him to do this time. He says that nothing we give him gives him the "high" that heroin does. This is true, of course, and it is something he will have to overcome if he ever wants to truly get off the heroin.

The hospital service has picked up some but is nowhere near as busy as the last time I did it. Most of the patients at the present time are in for detoxification from one or more substances they are abusing. In this case, abusing means they are sacrificing everything(homes, families, jobs, etc) for the next dose of their substance of choice. Most of them have gone through this multiple times before and relapsed. We keep doing it though in hopes that this time will be the time they are able to get off the substance and stay off it. Odds are that for most this is not the time. I wish there was some reproducible way to predict with reliability if this was going to be the time they would stick with the treatment program. If there was, maybe those of us who have to see these patients over and over would not get so cynical about their chances of success. This cynicism is something we have to fight daily, trying to keep an open mind about these patients who consume so much of our time and resources.

What resources you say. Well, take for example one patient who is currently in. This is his ninth admission that I can count within the last two years, his second in the past two weeks. He is basically homeless, has no income source, and no possessions since all the money he can somehow muster goes to pay for heroin. Every time he says he is ready to stop using the heroin, he comes in for acute detox which is paid for by Medicaid funds. Then, arrangements are made for heroin treatment program, in his case a methadone replacement program which will again be paid for by Medicaid. He does not show, goes back to heroin and the cycle begins again. Medicaid is funded by our tax contributions of course, so his repeated hospitalizations are being paid for by all of us but since he does not work he is not contributing anything toward this cost. The hope, of course, is that one day he will, with treatment, become a functioning member of society, helping, with his taxes, to support Medicaid also. Well, he is not there yet. In his case, he may never be since he has a failing heart due to damage from the heroin over the years. Even if he is able to finally get off the heroin for good, his heart may not allow him to be employable.

What about time? A real life example. Tonight, I was supposed to pick my son and two of his friends up at 6:30 PM to take them to youth group at our church while the adult service was going on. At 5:45 PM I finish admitting a 15 year old girl with a severe asthma attack (by the way, she had just finished treatment for substance abuse also but that is beside the point). Then, I get a call from the Emergency Department saying that there is another alcohol abuser who wants to admitted again to get off alcohol. She had finished a two month inpatient treatment program two weeks before then went home and started drinking again (her pattern for the past 15-20 years as it turns out). This was her seventh trip to the ED in the past three days and now she wanted treatment again. Ask yourself how successful she will be in treatment this time. Anyway, I finally left the hospital at 6:40 PM and I still have more work to do in the morning regarding this admission. I try very hard not to resent this probable waste of my time and energy (here I am getting cynical again) and am very aware that if she had been having a heart attack I would not be complaining a bit about having to stay late and being late to pick up my son.

So, do I have an answer? No, I just needed to vent and you were lucky enough to come to my web page and read this. Thanks for allowing me to vent and I can only hope that tomorrow will be different but I doubt it.

My four days of hospital service are now over. The 15 year old girl with the severe asthma attack is better but still in the intensive care unit. The substance abusers are still in the hospital, one should be discharged tomorrow. He still says this time is different than all nine of the other times, we will see. Last night's vent helped me, I was able to deal with them rationally again today. Delanae made the point today that few of my readers would have much sympathy for me given the income we physicians make. Actually, that was not the point I was trying to make, that my readers should feel sorry for me. My point was more how much can we as a society and a nation afford to spend on people who go back to their addictions after multiple thousands of our tax dollars or private insurance dollars are spent on their treatment. These moneys are being spent multiple times on the same patients over and over. I was also venting about my frustrations with the time and energy I sometimes feel I waste on repeated efforts to get them to change. I know the potential for success is less than 50% and yet society still expects us to try, at least at the present time.

Tomorrow afternoon, I head to Eugene for a conference tomorrow on internet usage by physicians. I am driving down with our medical director and we will be having a dinner tomorrow night with the chief executive officer of the corporation that owns our group. We will be driving back right after the conference ends Saturday afternoon so I will not have an update tomorrow night. Hope everyone has a great Friday and it looks like our weekend here will be sunny so hopefully we can get the garden spot tilled Sunday afternoon after church.