I recently had a patient who still had his discharge papers on him from a recent trip to the ED following an overdose. The instructions were fairly simple.
Please do not use fentanyl again. If you are looking for any sponsors or help we do recommend that you purse Narcotics Anonymous.
He admitted that he had in fact used fentanyl again, although that was not his issue right now. He had gotten in a fight with someone who he had caught stealing some blankets from his tent near the railroad tracks. He was banged up, his eye half swollen and he was cold and wet from the rain and had some miserable looking sores on his arms and legs likely caused by xylazine. We put him in the waiting room, and my shift ended soon after so I don’t know what happened to him – if he got any help at the hospital or was simply told “please do not get into a fight again.”
Emergency Departments have made great strides in recent years in tackling the overdose epidemic. Many of the hospitals have recovery navigators to help guide overdose patients toward either treatment or safe use. Some EDs even offer buprenorphine, naloxone take home kits, or even safe use kits. Still there are others that simply say stop using fentanyl.
That can’t be a best practice.
It made me wonder what other discharge summaries might advise patients:
Please stop eating cupcakes.
No more cigars and definitely no more ham.
Don’t even think about trying to ski down a Triple Diamond ski slope again.
Give up your triathlon dreams and starts collecting figurines instead.
Never eat at #1 Chinese again.
Quit your job. Your boss and all that stress are going to kill you.
Drop down and give me 20 pushups.
Learn how to meditate.
Stop seeing that crazy B——! (fill in your choice of b word).
Buy a lottery ticket, then move out of your crowded pollution-filled toxic neighborhood without access to fresh vegetables, buy a house in Bellaire, hire a personal chef and trainer, put cucumbers on your eyes while you sit by the pool.
Buy a dog who loves you.
Look both ways before crossing the road.