January 11th, 2008 by Dr. Val Jones in Opinion
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Last night I watched the premier of VH1’s new “Celebrity Rehab” reality show with Dr. Drew Pinsky, an M.D. and popular TV and radio personality. Before turning on the TV, I had my own reservations about making a spectacle out of alcohol and drug addiction. But I hoped that the show would help to unglamorize the Hollywood drug culture and dissuade young men and women from idolizing bad behavior. As a physician who helped run a detox unit in New York City, I was also curious to see whether or not this “rehab” resembled real-world drug rehabilitation.
Overall, I was sorely disappointed. The only realistic part of the show involved actor Jeff Conaway (of “Grease” and “Taxi” fame), who was the most impaired and ill of the group. His speech and behaviors were typical of a man so wracked by drug and alcohol addiction that he needed a wheelchair for mobility. It was tragic to see him in such a self-destructive state, and witnessing his condition was a real wake-up call for anyone considering starting down that path. As for the rest of the stars, they seemed to be more interested in getting attention from the camera than turning their lives around and breaking their addictive behaviors.
The good
“Celebrity Rehab” may have some “shock value,” as it offers viewers some footage of individuals whose addictions have destroyed their lives. Although Jeff Conaway’s situation is certainly tragic and unappealing, the other stars still maintain some degree of “coolness” -which may be counterproductive for a young audience.
The bad
Overall, the dialogue is quite dull – which comes as no surprise since the individuals being videotaped were often inebriated or high on cocaine. The desire for true change does not come through in the celebrity stories, as best evidenced by a conversation between Dr. Drew and former professional wrestler Chyna (aka Joan Marie Laurer). Dr. Drew asks Chyna why she has come to “Celebrity Rehab,” and she responds with a shrug and says: “I don’t know.” Not compelling television.
I had the feeling that empathetic counseling is not Dr. Drew’s forte. In his attempt to show tough love mixed with detailed history taking, he comes off as aloof and uncaring. He is neither believable nor inspirational as a change agent. This disconnect makes it hard to believe that “Celebrity Rehab” is going to turn anyone’s life around.
Of course, the plush set, the comfortable celebrity quarters and the trendy clothing bear no resemblance to real drug rehab centers, where facilities are bare-bones and clinical and all patients wear standard uniforms. The lack of case managers, nursing staff and therapists was also notable – as the normal team approach was spun unconvincingly as a one-man Dr. Drew show. And of course, inpatient drug rehabilitation centers in the real world are NEVER co-ed.
The ugly
Some of the footage was so clearly contrived as to be annoying. Provocative pseudo “conflicts” were created in an attempt to maintain viewer interest. At one point, porn star (and attention-grabbing yet unrealistic 2003 California gubernatorial candidate) Mary Carey makes a fuss about having her dildos confiscated and then asks fellow patient Seth Binzer (lead singer of the rap-rock band Crazy Town) if he’ll have sex with her. This type of interaction really devalues the show and further undermines the credibility of the ongoing rehabilitation. Parents should wonder if exposure to this sort of material is more of a harm than a help to their tweens and teens.
In the final analysis, “Celebrity Rehab” has all the makings of a failure “me-too” reality show, relying on sensationalism to lure viewers. Recycled reality TV celebrities prance about the show in low-cut dresses while Dr. Drew makes uninsightful therapeutic gestures in a rehabilitation setting that’s not designed to truly affect change. I believe that drug and alcohol addiction deserves a more sincere and thoughtful analysis — something that an experienced documentary producer could achieve more effectively. I fear that the screenwriter’s strike will result in even more poor quality reality shows in the near term.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 8th, 2007 by Dr. Val Jones in True Stories
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Today a dear friend of mine told me a horror story about her recent trip to a hospital ER. She has kidney stones, with rare bouts of excruciating pain when they decide to break off from their renal resting place and scrape their way down her ureters.
My friend is a stoic person who also doesn’t like to cause trouble for others – so when she was awoken at 4am with that same familiar pain, she decided not to call an ambulance but rather drive herself to the ER. She also chose not to call her doctor out of consideration for his sleep needs.
She managed to make it to the triage desk at her local hospital and was relieved to see that the ER was quite empty. There were no ambulances in the docks, no one in the waiting area, and no sign of any trauma or resuscitations in the trauma bay. She approached the desk trembling in pain and put her health insurance card, driver’s license, and hospital card on the desk and let the clerk know that she was in incredible pain.
The clerk responded,
“Lady, I saw you walk yourself in here. There’s no way you’re in that much pain. Sit down and fill out this paper work!”
My friend replied in a soft voice,
“Please, can you help me fill out these forms? I can barely see straight and can’t concentrate well. I have a kidney stone and it’s excruciating.”
Tears fell softly from her face as the clerk rolled his eyes at her.
“Yeah, I’m sure you do. And I bet you’re allergic to everything but Demerol.”
My friend started becoming frightened, realizing that she was being pegged as a “drug seeker” and would be punished with a long wait time for pain medication. “Please let me just speak to the triage nurse.”
“Sure, sweetheart,” hissed the clerk. “I’ll get him when you’ve finished your paperwork.”
And so my friend sobbed as she tried to fill in her address, phone number, insurance information, etc. on the paper form at a hospital where she had been treated for over 7 years for ovarian cancer. All of that information was in their EMR, but the registration process would not be waived.
The triage nurse slowly emerged, still chewing a bite of his steak dinner. “What have we got?” He said to the clerk looking out into a waiting room populated only by my sobbing friend.
The clerk replied to him under his breath. The nurse rolled his eyes and sighed heavily. “Alright lady, let’s get you back to an examining room. Follow me.”
My friend followed him back to the patient rooms, doubled over in pain and was put on a stretcher with a thin curtain dangling limply from the ceiling.
She couldn’t control her tears. She couldn’t get comfortable and she moaned softly as she took short breaths to explain her past history. She handed him her business card, explaining who she was and that she was not faking her pain. The nurse made no eye contact, jotted down some notes in a binder, and prepared to leave the room.
“Listen, your crying is disturbing the other patients,” he said, yanking the curtain across the front of the room to block her visually, as if the curtain would make her disappear.
Hours passed. My friend had no recourse but to writhe on the stretcher and cry out occasionally when the pain was too intense too bear. She asked for them to order a CT scan so they could see the stones. The nurse ordered it, a physician never came to examine her.
Four hours later my friend was greeted by a physician. “You have kidney stones. One is in your right ureter, and there are others sitting in your left kidney. Do you need some Dilauded?”
“Yes please!” said my friend, hoping that some relief was in sight.
“Alright, the nurse will be here shortly.” Said the doctor, glancing at her chart without completing a physical exam.
The shift changed and a new nurse came in to place an IV. She was gruff and complained that my friends veins were too small. “I’ve never seen anyone with a kidney stone need this much pain medicine” she snapped with a suspicious tone.
Five hours after her arrival at a virtually empty ER my friend received pain medicine for her kidney stone. She is a cancer survivor and national spokesperson for patient advocacy. In her time of need, though, she had no advocate to help her. No, she received nothing for her years of service, for her selfless devotion to helping others, for her tenderness to patients dying of a disease with no cure.
That night, my friend did not even receive the benefit of the doubt.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 14th, 2007 by Dr. Val Jones in True Stories
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This story is from my intern year diary. It’s a quick snapshot of a patient who had overdosed on heroine, coded, and was resuscitated. I think about him sometimes… especially when I read about the rampant drug abuse problem in the US.
—————
I poked my head into the 4-bed communal room on the sixth
floor. The nurse had called to say that
one of the patients was agitated and required restraints. I was asked to assess the situation.
It was immediately clear to me which of the four patients required
my attention. In the far, right corner
was a pale young man, stark naked and thrashing about in his bed. He was babbling something about Ireland and how
he needed to get home. I had gathered
from a quick review of his chart that he had overdosed on heroine, was
resuscitated after coding in the E.R. and transferred to the floor for
observation as he detoxed from the overdose.
I approached the flailing body tentatively. “Hello.
I’m Dr. Jones. You appear to
be quite distressed. What seems to be
the matter?” I said as I pulled a sheet up from the bottom of his bed and
placed it over his genitals.
The young man, barely in his twenties, lay very still as I
spoke to him. He stared at my face with
bulging eyes, speechless for a full 10 seconds.
“Are you alright?” I asked.
“Where am I?” asked the man in a quiet voice.
“Where do you think you are?” I asked, using the opportunity
to assess his mental status.
“I’m somewhere in Ireland,” he said, head turned
towards the window with a view of the Chrysler building.
Seeing that his reasoning was not intact, I replied kindly,
“Well, actually you’re in a hospital in New
York City. You
took an overdose of heroine and your heart stopped…”
“Wow, that sucks,” said the man, sincerely surprised by the
news.
“We were able to resuscitate you in the emergency room,” I
added.
“Cool,” he said, as if the event had transpired in another
person’s life.
“So right now you still have a lot of drugs in your system
which is why you feel confused,” I said, “I think it will take several days
until you return to your normal state of health.”
“Sounds good,” nodded the man.
“Do you know where you are right now?” I asked, suspecting
that his short-term memory had been completely lost.
“I’m in Amsterdam,”
he said, undisturbed by his delirium.
I sighed as I realized that nothing I said to him would
register for longer than a second or two.
“Such a young person, what a waste,” I thought.
The man started to thrash about in his bed again.
“What are you doing?” I asked.
“The back stroke,” he said, surprised that I didn’t know.
I glanced at the man in the bed nearby. He was watching our interaction with some
amusement. He had been reading the New
York Times with a book light. He was a
private patient on a heparin drip for a deep venous thrombosis behind his right
knee. I nodded at him and shook my
head.
Weeks later I heard that the young man’s thoughts were no clearer than they were that night, and that he was transferred to a nursing home for long term care. The brain damage that he suffered from his drug use (and lack of oxygen during his cardiac arrest) had caused permanent, irreparable damage. Another tragic victim of a brain on drugs.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 14th, 2007 by Dr. Val Jones in True Stories
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Several years ago I was taking care of a pleasant elderly woman with a heart condition on an inpatient unit. One morning I went into her room to check on her and I found her sitting up in bed, clutching her purse and crying.
“What’s wrong, Mrs. Johnson?” I asked, perplexed.
She blew her nose in a Kleenex and replied, “Someone stole my insurance cards, my money, and my credit cards! They were in my wallet just yesterday evening – and this morning they’re gone.”
I paused for a moment, considering the order of priority in which she reported the missing items, glanced at her telemetry monitor (her rhythm was regular though her heart rate was elevated from crying), and asked if she knew how this might have happened.
She told me that she suspected that a certain patient had sneaked into her room in the middle of the night and removed the items from her wallet.
“How do you know it was that patient?” I asked, growing suspicious.
“I’ve seen her sneaking around at night in other people’s rooms – a couple of nights ago she was in here digging through my roommate’s dresser drawers.”
The suspect was a 38 year old woman with a known history of heroine abuse, who was admitted to the General Surgery service (conveniently boarded on our Internal Medicine floor) from the Emergency Department to complete an acute abdominal pain work up. This woman had already terrorized the surgical intern assigned to her case (as I had heard on rounds the day before) by chasing her around the hospital room with a hypodermic needle. Security had come to restore order and had found a stash of heroine and some needles in her bathroom that had been brought in by her visitors the night before. The team decided not to discharge her because they had discovered a large abscess on her ovary (from an advanced and untreated sexually transmitted disease) that they felt obligated to drain and treat her with antibiotics. Of course, on the morning of her scheduled surgery she ate breakfast, making it unsafe to put her under general anesthesia. These games continued (sneaking food before surgery, refusing surgery or medications, then changing her mind, then claiming to be homeless with no safe discharge plan, etc.) so that her length of stay grew from days to weeks.
“And now,” I thought to myself, “she’s using our hospital as a flop house, victimizing MY patients on the same floor – stealing their belongings in the middle of the night?!” This was the last straw. I told Mrs. Johnson that I would get to the bottom of the matter.
And so I waited for the victimizer to leave her hospital room for a scheduled test – I sneaked into her room and went through her bedside table drawers. Lo and behold, my patient’s ID and credit cards were stashed in a box with a bunch of other IDs that clearly didn’t belong to the woman.
I called hospital security, and we reviewed all the items that she had stolen. As it turned out, she was admitted to the hospital under a stolen Medicare card (the woman had claimed to be on disability). Her name matched with our records of a 67 year old woman, so we knew that she had been admitted under another’s name – and the admitting clerk had not noticed the age discrepancy. A careful record search turned up the drug user’s previous admissions under this alias. This predator had been gaming the system for years, eluding detection!
I asked the security guards to help me interview other patients on the inpatient unit to see if they had experienced anything out of the ordinary over the past few weeks. What we found was astounding. Several frail elderly patients described similar night terrors (being unable to stop the woman from going through their personal items at night) and one gentleman with advanced AIDS, who was admitted for treatment of severe pneumonia, reported that the woman had attempted to molest him in the middle of the night when she was high and in a hypersexual state.
Thanks to our investigation, many patients had their belongings returned to them (though some of their jewelry was not recovered – the woman probably sold it for heroine to her visiting dealer), and I heard that the predator was caught by the city police after choosing to leave the hospital against medical advice.
I don’t know what happened to this woman after that, and I doubt that the police were able to detain her for very long. I felt horrible for the patients who had been victimized in their ill and vulnerable states, and I wondered what kind of lasting psychological damage that this woman had inflicted upon them, especially poor Mrs. Johnson. I also felt frustrated and vulnerable – unable to really protect my hospital from future assaults. What could I do, stand in the Emergency Department each night to identify her if she chose to return? I can only imagine that this woman is still up to her old tricks at a neighboring inner city hospital near you…
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 11th, 2007 by Dr. Val Jones in True Stories
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I’m afraid you’re going to need a box of tissues for this next post. My good friend Carolyn (she is the Cancer Center Manager at Revolution Health – and has a great blog) sent me a link to a story she wrote about a school program developed to raise awareness of the dangers of drunk driving. It’s called: “Fatal Choices – Shattered Dreams.”
Basically, the entire school goes through a detailed reenactment of a fatal car crash where several classmates are killed. Part of the program requires that all the kids (and their parents) imagine the goodbye letters they’d write if they knew they would be killed in a drunk driving crash. Carolyn and her daughter wrote these letters to one another, as they imagined this horrific scenario:
Dear Mom & Dad. I really don’t know what you are supposed to say in a good bye letter. I couldn’t even imagine waking up one morning and not coming back to see you later that same day. Today, that unimaginable thing became a reality. Dad – if I could go back to this morning knowing what the day would bring I wish more than anything that I just would have said I love you instead of griping about stupid things. I truly do love you and hope and wish that after my death, you can move on, heal and live an amazing life full of happiness. Mom – my only regret with you is that I did not even get to see or speak to you this morning. I would give a lot just to be able to see you this morning. You are the one person that I would not mind being completely like when I grow up, if I would have grown up. You are more than just my mom, you are the one I can talk to and count on. I love you so much! Both of you mean the world to me and I would give anything just to be able to say good bye. I love you with all my heart and I hope that after my death, everything will be OK. I wish you both the best life you could possibly have and please live it the way you would with me there – with happiness, excitement and adventure. Thank you for everything you have given me. You are the absolute best parents I could have asked for. I love you forever, wherever. Erica
Here’s what Erica’s mom, Carolyn, wrote:
We thought we had a lifetime to talk to you, call you on the telephone or e-mail you, but this will be the final time we will write:
Dear Erica, This is not the proper order of things – parents bury parents and grandparents. We are not supposed to bury our children, but yet, here we are saying good-bye for the last time. We hope you left this world knowing that we loved you more than life itself. If either of us could trade places with you, we would do so without hesitation. Our lives will never be the same. They say time heals all wounds, but not this one. We have holes in our hearts since you are gone, and we will be this way until the end of our days. We will never see you graduate from high school. We can imagine the smile on your face as you are with your friends when you leave high school for the last time as a graduate. We will miss seeing you swim in college, something we know you were looking forward to. We’ll never see you graduate from college – beginning what for most is the start of a lifetime of rich and fulfilling experiences. We will not see the love you show for others as you proceed with your career as a neo-natal nurse. How many babies will never know your soft and caring touch? We will never see you walk down the aisle with the love of your life. We will never hold your children. But the most tragic thing of all Erica, we will never hold you again – something we cannot bear, but must now deal with. Puffy, Puppy and Kissy are with you in your final resting place. We hope that whatever journey you take from here on – that they bring you comfort throughout eternity. Remember us as two people who loved you so much that even in death, we want you to be comfortable and at peace. Good-bye for the last time, Erica. This is not the proper order of things, but we will love you forever.
This sort of program and reflection may truly save lives… Do what you can to support this initiative.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
