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You know those adult patients who get admitted “all the time” and “every resident knows them”?
I will tell you something you don’t know. 1/
I will tell you something you don’t know. 1/
Most of those “frequent fliers” weren’t born that way.* 2/
*I know, peds. I know...
*I know, peds. I know...
When you’ve been around the same institution as long as I have, you learn the “natural history” of the “frequent flier.” 3/
It usually starts with a catastrophe. A major trauma. A single critical illness. Often with a loss of irreplaceable bunches of cells: neurons, cardiac myocytes, glomeruli. 4/
For this, many patients are innocent bystanders. And sometimes victims.
Remain compassionate. 5/
Remain compassionate. 5/
From there, there is usually a conspiracy of
- chronic infection
- medication side effects
- financial ruin and homelessness
- untreated addiction
- etc. etc. 6/
- chronic infection
- medication side effects
- financial ruin and homelessness
- untreated addiction
- etc. etc. 6/
I know how this looks as a resident when you pick up the story in the middle. Same admission as last week.
You get the feeling this started 20 years ago and will end 20 years from now. 7/
You get the feeling this started 20 years ago and will end 20 years from now. 7/
Incorrect. 8/
You are witnessing the crescendo in the patient’s illness. Something that will usually end soon.*
9/
*a year or two at the most
9/
*a year or two at the most
What happens?
Some of these patients finally stabilize. Get housing and support and find a new balance point.
Great treatment for addiction and get better.
Get incarcerated.
Die. 10/
Some of these patients finally stabilize. Get housing and support and find a new balance point.
Great treatment for addiction and get better.
Get incarcerated.
Die. 10/
I’ve been around a public hospital in the US for 15+ years and I’ve seen maybe 20-30 of these patients who end up with 50+ admissions per year.
11/
11/
Most of them are not around any more. 12/
Know when you care for these patients you are not witnessing their way of life.
More likely you are witnessing the end of their life. 13/
More likely you are witnessing the end of their life. 13/
Or you are standing on top of a moment when you could change this pattern.
Do not lose hope.
The Evil Demons want you to lose hope. 14/
Do not lose hope.
The Evil Demons want you to lose hope. 14/
Instead try to figure out the linchpin from the cycle.
And remove it. 15/
And remove it. 15/
All the while keep yourself observant. 16/
Patients admitted many times for the same thing often end up dying of something completely different. 17/
Try to avoid getting lulled into complacency. 18/18
