If you work in an ED, you know what a "frequent flier" is. It is a patient that visits on a regular basis and unfortunately, usually one that you are not happy to see. I can remember a number of them that we have had in our department over the years. One was a 40-ish female smoker and drug user with severe asthma who came in several times weekly sitting straight up on the ambulance stretcher, grasping the nebulizer mask with that panicked look of someone who can't breathe. She had very poor veinous access and on several occasions, an IO had to be performed (a catheter straight into the bone). We would stabilize her breathing and she would go outside to wait for a ride… and smoke. On several of her visits she begged to be intubated due to the severity of the attack and she a few times she actually was. On her last visit, she never made it off the ventilator.
Another woman I remember was also in her 40’s, was a bilateral amputee, and a prostitute. She looked pretty worn, and definitely not the part of a lady of the evening, but from what I hear, she had been beautiful. Her disease had been peripheral vascular disease, causing her to lose both legs and have multiple infections. She would make her rounds of the different hospitals and ER’s looking for pain medicines and antibiotics. She has passed as well.
Most of the frequent fliers that we see currently are our intoxicated residents, usually homeless men. They are picked up by the police for passing out in the wrong public place or making a disturbance. Their blood alcohol levels are probably 150-200 as an average, and the ER is not supposed to let an intoxicated individual leave until they are under 100. There lies the dilemma. The protocol is that they should also have a sober individual to accompany them. We groan when we see them because they are almost always reeking of alcohol, sweat, vomit, and other unmentionable things. They curse, swing their fists and demand things. We give them some IV fluids, and if they are relatively stable, send them back on their way. One man fell during a drunken evening and broke his jaw, necessitating his jaw being wired shut. He could still drink alcohol through a straw. The next time we saw him, he had fallen backwards and broken a cervical vertebrae.
Yesterday, I was the lucky recipient of one of our fliers, one who has been in our department 4 times in 3 days. He is a long term alcoholic and heroin user and claims to have lost everything. He had a large mason tool in his belonging which we discreetly moved so it wouldn’t become a hurled missile. When asked why he was back this time, he said, “I think I have heat stroke”. It is very hot if Florida and he had been wandering around but I saw no cramping or classic signs of heat stroke. The day before he had been to the ER twice, the second time because he had fallen right outside our department. I tried to contain my frustration, as we were quite busy, but as he rambled on, I really had had enough when he said, “I really just want attention”. I promptly left to go take care of my dialysis patient with the distended abdomen.
I was less than friendly to him and did not pay him much attention. The doctors are not patient with these folks and we do little to help them. We also can't watch them constantly and can't force them to stay. When I returned to the room he was gone and when I left for the day 30 minutes later, he was standing on the sidewalk, aimlessly walking up and down. I pretended I didn’t see him and hurried to my car. But I must admit I felt a bit ashamed. Could I have done something more? I feel that I have helped thousands of people in the almost 20 years of nursing I have done. But the ones I haven’t helped are the ones that stick out.
