The emergency room is a popular destination for both people seeking help- and people seeking drugs. Usually it’s pretty easy to tell the difference. When someone is 11 out of 10 on the pain scale- and allergic to everything besides dilaudid…that’s a good clue. “I lost my medications,” or “someone stole all my vicodin,” are common excuses that patients give for needing more pills. Sometimes it’s easy to spot the drug-seekers…other times, it can be very challenging.
A week ago a patient comes in for suicide watch. I spent the last part of my day with them, drawing blood, taking vitals, and getting them settled in. I got the feeling that they were a good person, in a tough spot- and really wanted to get help. In the emergency room, we get everything from people seeking attention- to people who have made serious attempts on their lives. It’s up to the social workers, psychiatrists, nurses and doctors to make a determination on the seriousness of each case.
The patient stated that they had thrown out their medications because they were worried they were going to overdose on impulse and I genuinely believed them. Tears and stories of troubled times convinced me that this wasn’t another attention-seeking -resource waster. I left at the end of the day before the fate of our patient was determined as far as long term care went- and thought nothing more of it.
Days later, I’m surprised to see the same patient- back again. I start through the same process but this time- something is different. I sit by as the social worker does the interview and I can sense deception from the end of the patient. The social worker is straight-forward and says that she thinks the patient might be drug seeking. The patient quickly denies and changes the subject.
I’m not sheltered, and have about as much street smarts as anyone. As I teenager, I ran with a bad crowd, and at times- the bad crowd ran with me. I know the tricks of the trade and the “tells” of a good liar. I’m picking up the vibe that this is a desperate-drug seeking visit.
The thing that really blew my mind about the whole experience was how much I had been utterly fooled on the previous visit. I felt compassion and empathy- a desire for the patient to experience joy and a change in life- the first visit. The second visit- my compassion never surfaced- I couldn’t believe it. Is my lie detector getting rusty? Are my streets smarts fading from lack of use? Am I losing my touch?
I don’t think any of those things are happening- we all get fooled sometimes- and addicts are some of the best deceivers- they have much to gain from the deception. We all get beaten sometimes- there’s always someone better out there. I realized that we were playing a game- I lost the first time (badly,) but I won’t get fooled again…