Give a Foot They Take a Yard

The hospitalist and the surgeon were confronting the patient. He had blatently lied to them and they were unhappy about this. They were interested in transferring him to the Veterans Administration hospital. He wasn't going for that, oddly.

Initially he'd told them he'd already been to the VA and "they told him to just go home and let his black toe fall off." Instead he presented to our emergency department in pain and the doctor there admitted him. So it went.

Here he went through a period of violent delerium tremens. It would have been nice if he'd informed us of his alcoholism but he did not deem that sufficiently important. Nor did he seem to think that his cocaine and methamphetamine problems were worth admitting to, for that was part of his plan all along. His diabetes, which he did claim, was obvious enough, due to his sky-high blood sugar levels and the necrotic toe.

He was well-known to the VA, as was discovered when the fax machine began to spit out his records from there. He had signed a consent allowing us to pursue his charts from that hospital.

Sigh.

How ironic.

That's how our hospitalist and surgeon came to know that the VA had him scheduled for surgery to remove the ischemic toe. But they would not go heavy on the Dilaudid there, because he was a junkie. He came to us and lied to get a few days of narcotics.

Now he will lose the whole foot. The days he spent lying to us were critical ones. Necrosis progresses quickly sometimes despite aggressive use of antibiotics, and unfortunately he had wasted time. He should have gone to the scheduled surgery.

Instead of that, he chose to lay about and soak up our Dilaudid until his lies unravalled and the story became clear, and rather than accept a transfer to the VA hospital, where he would have to wait for surgery again but without access to the lovely narcotics he so desired, he left. If he'd been truthful it would not have turned out this way.

All this will cost him a foot. At least.

Our tax dollars will buy him a prosthetic one shortly.

Expect blowback.