Dilemma that warrants an adult discussion.  Be advised, post is long as freakin' War and Peace

I agree, Hospice is indicated. That's what my sister-in-law ended up choosing for my nephew. He was so damaged by the strokes there was no hope of his regaining any sort of quality of life, and yes, with the withdrawal, the addiction, and the problem underlying all of it (he did not WANT to be here), that wasn't likely anyway. There seemed no point in prolonging his suffering(s).

That said, the docs were full-on gung-ho until she called it. They'd already performed surgery on his brain, and were treating him with IV antibiotics to prepare him for needed open-heart surgery. No idea what that all cost in terms of dollars, never mind in terms of (everyone's) pain. Ironic that he could get all that medical treatment thrown at him without his consent, but never received the mental health care he so clearly needed for so long.

Margie

Marjorie Suddard said:  ... Ironic that he could get all that medical treatment thrown at him without his consent, but never received the mental health care he so clearly needed for so long.

Margie

So true. I really see this as a core problem with the way care is handled. I often see people near the end of effective medical care. Meth, alcohol, IV drugs, and poor life choices leading to heart failure, strokes, sepsis, and organ failure. Hospitals run up huge bills to treat peripheral conditions while doing nothing - or knowing they can do nothing - to fix the underlying cause.

It would be easy to say that a good family and access to care could solve a lot of that, but that is often not true. I know of a 16 year old that has been referred for mental health care multiple times and had in-patient care. There's a caring family with access to whatever care is prescribed, but problems persist. I still believe that early diagnosis/intervention  for 'behavioral health' is a good way to treat people headed towards this path, but not a cure-all. Medical science still has a lot to learn.

Marjorie Suddard said:

So glad to see this thread pop up again. At the time it first came around, my 32-year-old nephew had just died after a long history of intravenous drug use resulted in first a minor stroke, and then a major one because he left the hospital AMA multiple times to seek drugs.

Many of you made astute observations, but there was also a lot of flippant and heartless "advice" the first time around. Looking forward to another round of judgments from people who have obviously never watched a struggling soul self-destruct. Or maybe they have, and enjoyed it as much as they did when they tortured flies as young 'uns. Either way, perhaps now is a good time to get a soul of your own.

Margie

 

I thought I had updated this, sorry.  He kept walking on it and the R foot went to crap, had a BKA(below knee amp) and went to a skilled nursing facility for care.  Pretty sure he left there AMA also.  As is often the case, he has been lost to follow up.

Ms Suddard,

I have seen the struggling and self destructive show a bunch of times.  As I am sure you are aware, there are some people that you can't help, no matter what you do. The man in the story I told had numerous efforts to improve his mental health status.  That you can lead a horse to water but you can't make him drink aphorism has broad application.  There is a bit of gallows humor in the medical profession at times that sort of parallels a lot of the things in this thread.  I have always attributed it to people dealing with an uncomfortable subject the best they can.  This being the case, I tend to take comments with a grain of salt. 

Marjorie Suddard said:

I agree, Hospice is indicated. That's what my sister-in-law ended up choosing for my nephew. He was so damaged by the strokes there was no hope of his regaining any sort of quality of life, and yes, with the withdrawal, the addiction, and the problem underlying all of it (he did not WANT to be here), that wasn't likely anyway. There seemed no point in prolonging his suffering(s).

That said, the docs were full-on gung-ho until she called it. They'd already performed surgery on his brain, and were treating him with IV antibiotics to prepare him for needed open-heart surgery. No idea what that all cost in terms of dollars, never mind in terms of (everyone's) pain. Ironic that he could get all that medical treatment thrown at him without his consent, but never received the mental health care he so clearly needed for so long.

Margie

That's the crux of the problem. No one ever addresses the why. I spent enough years working in mental health, and let's be real here- dealing with my own E36 M3, that I've started to defaulting to why. Why drugs. Why alcohol. Why face tattoos. I'm not here to pass judgement on anyone, but I always want to know why. And of course the obvious questions- what, if anything can be done to help them. The unfortunate reality is, some people do not want help. For whatever reason,  they've chosen the path they have, have accepted the consequences, and that's what it is. Compassion dictates that we should help. We want everyone to be healthy, and happy, and living a great life. The problem is, emotions are subjective, the same way toast is subjective. My happy isnt your happy. And the unfortunate reality behind that is, some people are truly happy being inebriated the whole time, knowing full well they're shortening their life spans to the point of sudden death. At it's very core, substance abuse is no different than driving a race car, or bungee jumping, or tempting the mods with a political thread. It provides a high, scratches an itch, provides stimulation.  The E36 M3 part is, sometimes compassion for another human and allowing them to be happy is allowing the very thing that takes them from us. Its incredibly unfortunate your nephew chose the path he did. I've had to watch others suffer and die myself and it's never easy. The only thing I can hope for is that they found whatever it is they were looking for. In that, I do hope your nephew found what he was looking for, and got his peace. 

Margie, I understand, and I'm very sorry for your lost. 

I have nothing more to say than that.

This guy turned up again at the ED, he treats the hospital as his primary care doctor to a large extent.  He is not taking good care of his colostomy or the ulcer on his tailbone.   He has been seeing mental health people regularly and was staying in a board and care facility prior to this admission.   Every single note by every single provider mentions his abusive behavior.  First time I have seen the term obstreperous in patient chart. 

He is likely to be there a while again.  He is a tough guy to find a place that will take him.

Toebra said:

 First time I have seen the term obstreperous in patient chart.

I think that's the first time I've seen that word at all, and I subscribe to a "Word of the day" RSS feed.

Toebra said:

obstreperous

That seems like something Johnny Cochrane would have said....  This here is pre-post-erious!  Re-dic-u-lous!   Ob-stre-perous! 

GameboyRMH said:

Toebra said:

 First time I have seen the term obstreperous in patient chart.

I think that's the first time I've seen that word at all, and I subscribe to a "Word of the day" RSS feed.

Well that’s getting added to my list of future band-names...

In reply to Pete Gossett :

Ulcer on his tailbone. poorly cared for colostomy. So- he's got two infected holes related to his butt and neither of them are actually his shiny happy person? That's a special kind of...special. 

The human body really is amazing. This guy has been having the figurative death rattle for months. I wouldn’t have given him 3 weeks from the initial post. 

mtn said:

The human body really is amazing. This guy has been having the figurative death rattle for months. I wouldn’t have given him 3 weeks from the initial post. 

It's sorta like a Chevy Celebrity. Runs poorly longer than most run at all. 

Toebra said:

obstreperous

I have nothing useful to add except that I’m glad there are people like you because I could never do what you’re doing and that at some point in the near future I hope to work my new vocabulary word into a report at work.

This hits close too home for me. My older sister (the only one I share both parents with) is an addict who gets free healthcare thanks to Medicaid. She has hep B and needs a liver transplant but when she's not in jail she's still smoking cigarettes, meth and heroin any chance she gets. She's my flesh and blood but when she gave up her kids I wrote her off. Her medical care in pills alone is staggering and she trades most of them for drugs, only using her sickness when she thinks it benefits her like in court or in jail. 

She will never get the liver transplant with her history and unwillingness too do anything to better her life but she still often ends up in the local ER and transported too OSU medical a few times a year. I'm not sure anyone can help her and I don't envy the caregivers she abuses because she has a terrible temper.

Ransom said:

In reply to Pete Gossett :

Perfect!

It's good to see everyone here really sticking to the point of America having NO mental health system whatsoever and paying for it in thousands of worse ways- i've worked EMS all my life, and right now my Midwestern states are having this great dawning realization that they simply cannot keep building these little systems within their own hospitals, as when it comes time to overflow or transfer a patient it's a massive undertaking in Bureaucracy alone. Hell, right now a local county got the final approval for a mental health crisis center ran out of the police station- only for our medical center to suddenly decide "Oh! We're doing that too!" right when they began to break ground just a county away! And this is in the same state 20 miles apart!

It's insufferable. I know damn well that making a functional state system would be a full time job for one person- and it would probably be a horrible job at that- but god, I'm starting to wonder where the breaking point is with this, when they finally make something cohesive. But this is America, and we know it's gonna take another outrage...

In reply to GIRTHQUAKE :

My guess is that for the bulk of the people that need the mental help, just getting them to walk in is the biggest hurdle. Having it at a hospital would make that a lot easier. The police station is the last place they want to be.

And again, there is always the issue:  What if they refuse help? There are certainly severely psychotic people who have no interest in being "helped". It's pretty much the definition of psychosis!

At some point, there HAS to be involuntary incarceration. I know it is possible, but currently VERY difficult.

The biggest trick with mental health, and I know this from experience, is you need to want it.  If this guy doesn't want help, no amount of treatment is going to help him. It seems to me that he has absolutely no want for care, and is content to live his life the way he's living his life. You could have qualified services every 30 feet, but like Starbucks here- It doesn't make a lick of difference if I don't want to go in the motherberkeleyer. 

aircooled said:

And again, there is always the issue:  What if they refuse help? There are certainly severely psychotic people who have no interest in being "helped". It's pretty much the definition of psychosis!

At some point, there HAS to be involuntary incarceration. I know it is possible, but currently VERY difficult.

This is the crux of it.   Most of them will refuse help.  I think a 72 hour hold is about all you can do as far as involuntary.

I wonder how long he will be an inpatient last time around, probably more than a month, gotta be at least a grand a day

Next time I see Josh I will tell him you guys liked obstreperous

In reply to Toebra :

24 hour in the involuntary hold limit, but it depends on state and how many resources are tied up. Problem is also the same one about putting people in debt in jail- if you toss them in for instanity, where do you draw the line? If you get diagnosed with Alzheimers (this isn't a personal story) you can be commited to a facility NO MATTER THE STAGE, so even if you're very early stages you could be tossed into a locked ward without your consent if someone has legal rights over you. Say for instance, you're perfectly sane 95% of the time and currently suffer from blackouts and moodswings...

Worse yet is when they HAVE to let people go despite the limit. Most suicides occur because they are brought in by peace officers after calling 911, only to be told that the hospital has no space for them and they cannot stay there. Imagine being in that bad of a mental state, and being told a hospital won't take you.

In reply to gearheadmb :

It's a couple of things.

The County this is going into has 2 hospitals but both are on the "side" of the city, meaning the rest of the county has a 30 minute car/ambulance ride to get there at a minimum. The police station is at a far more central location- and they are also the ones who typically see suicidal patients first, when a family member or friend calls 911.

The other problem is dick-swinging. The medical center has a number of our state's richest to bail them out of money issues and they have done so regularly, and this is the first time anyone spoke of them having plans for it. It's a total blindside and I haven't found any doctor at my facility whom goes there who knows what's all going on- so I think it's something they "wanted" as a source for more grant money, but when the local county did the same they realized they had something to loose.

GIRTHQUAKE said:

In reply to Toebra :

24 hour in the involuntary hold limit, but it depends on state and how many resources are tied up. Problem is also the same one about putting people in debt in jail- if you toss them in for insanity, where do you draw the line?....

Well, NOT having a line is clearly not a good option.  The obvious answer (guess) would to be to have guidelines, presumably setup by some experts on the subject. Certainly it will not be perfect, but that is true of many things.

One thing that is clear though, especially in the extreme situations, the way it "works" now is clearly good for no one.  Take the severe psychotic example. The most likely way they will end up out of the population is after they attack, or kill someone (maybe themselves).  I fully understand we need to be compassionate with the people who have these issues, but we also have to be compassionate with the people who they might, or will, affect or harm. I, and I assume most here, have seen at least a few simply wandering the streets and wondering what might happen if they "wander" into someone you might care about.

Any useful changes in this area will certain involve some money outlay, but what is the cost we are paying now?  Even in monetary costs (hospital visits, police time etc.) I am sure the spread is small. When you add in other costs (trauma, assaults, death, quality of life etc.), even if you only include the people they affect, I am sure the expense becomes even more reasonable.

...of course... we can just wait until it gets so bad, something really terrible happens that hits the "news"...   <-- most likely scenario

aaaaand he left AMA again, probably wanted some meth apparently the dilaudid was not doing the trick for him

hard to find a placement, given his complex situation and exotic infections, he has spent probably 150 of the last 160 days in the hospital