Not So Fast

The patient was sitting up at their bedside eating breakfast. Under the hospital gown they were wearing a pair of their own shorts. I noticed two syringes protruding from the right-side front pocket. The patient turned to take the pills, including their Dilaudid, and as they shifted the syringes slipped out and fell on the bed. I discreetly palmed these as I chatted up the patient.

One of the syringes was the little insulin kind with a built-in needle. It was not of the same variety that we used in the hospital; must've been one of the patient's own.



The other item was a plain empty five-milliliter syringe. There was tape residue and remains on the end of it, for whatever reason.

Another time I walked into the room just after the patient had been up to the bathroom. They were back in bed, and there was a tourniquet still tied around his arm; the arm that didn't have raging cellulitis. When I removed the tourniquet they said they didn't know how it got there. A little wad of bloody toilet paper covered the obvious injection site at their wrist.

The day before we'd put an empty needlebox in the room and taped over the opening. None of us were to use it for sharps disposal, because on previous admissions this patient had somehow managed to get syringes from one of these. But somebody had dropped needles in there on the nightshift. A lab technician who didn't know the patient, or a sleepy-headed nurse, whatever.

The lock that held the needlebox in place had been rigged open somehow, so I took away the whole thing. The team of residents was at the desk outside the "dirty room" so after I dropped off the sharps container I told them these little stories.

The lead resident walked to the patient room and told them that they should read up on Munchausen's, and of course the patient took great offense. A lifetime addicted to intravenous drugs was something they could handle, but carrying a diagnosis of Munchausen's Syndrome was not something they wished to bear.

There was a needle cap on the bathroom counter in the patient's room, and later when I took in their supper there was yet another cap on the bed next to them. And their "bad" arm was looking even worse. Redder and more swollen.

During the previous admission a nurse had discovered the patient skin-popping dirty and soapy basin water with a syringe they'd scrounged someplace. They'd just had surgery to treat an arm abscess and I guess they were unhappy with its healing process; it was apparently going too well. So they fixed that.



With patients like this one I always watch them take their pills, but maybe they had cheeked the hydromorphone and later dissolved it and shot it up. Or maybe they were just booting soiled tapwater to make their arm even sicker. Maybe both. Hey, why not?