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past entries
Saturday
Jan182014

on residency.

I have seen so much sadness in the past six and a half months.  I have done so many 'death exams.'  I've ruined more sets of scrubs with bodily fluids than I know what to do with.  But I love my job.  I've hugged more patients than I expected and spent more nights crying myself to sleep than I did as a teenager.  I've leaned on Jess in ways I never wanted to. 

Internship is a rite of passage for doctors--a notoriously hard year that most attending physicians shudder to think about.  Sure--its hours have grown shorter (now limited to 80 a week!), but it's responsibilities have changed, and the pressure to get everything right only grows.  I didn't realize how care free medical student life is (save for all those exams) until I had my first crop of patients that I was ultimately responsible for.  When I go home at night I am never settled, all I can think about is labs and x-rays and procedures and if my patients will cause trouble for the night float.  Will my 90 year old with atrial fibrillation be able to be rate controlled?  Or will she have a stroke?  Will my patient with the mystery cough and weight loss start to understand the gravity of his situation?  Or will he go out for a few smokes and breathe in the same fumes that likely set him down the road to lung cancer?  Most of the time, between 7PM (when I get home on average) and 9PM (when my lame ass goes to bed), I am a basket case.

Don't get me wrong, there is a lot of joy.  It's no secret around my clinic that I have a favorite patient and that her success (which is actually all hers, and very little mine) keeps me afloat.  The happiness I derive from the lives and stories of my patients makes everything worth it--three times over.  I have also never been more proud to be a physician, I have never felt like I have earned something quite like I earned this.  (Perhaps that's because I have lived a crazy privileged life and it could be argued that I haven't really earned any of my acheivements in their entirety.)  I am proud to stand among other doctors who have gone through the same trials and faced the same challenges.  It's like a big club of tough-as-hell nerds.

I should have been writing though.  I am sure my mental health has suffered for lack of reflection.  Several things have held me back--I am sure you know I will mention time.  Time has held me back.  I just don't have any.  And then the time that I do have is torn between QT with Jess (most of which I spend word-vomiting or crying/laughing about some patient/work story from the day), time at the gym (very proud when I work this in), or time in front of the TV/laptop (which, honestly, feels so good at the end of day).   Pretty much the last thing on my mind is being self-reflective, because I know I'll find a lot of reasons to be sad.  Here is a list of reasons I don't love myself at the moment:

  1. I have a bum left foot going on a month now.  Why haven't I fixed it/gotten it checked out?  Oh I don't know.  All the reasons above, and the fact that maybe if I stare at it enough I'll develop XRay vision and be able to see what's wrong without having to pay the copay for an MRI.   Also, I'm an MD.  Shouldn't I know what to do?
  2. Less frequent trips to the gym... directly related to #1.
  3. My disorganized presentations on days when I feel disorganized.  If I am feeling off on a certain day, it really shows on rounds.  And it's embarrassing.
  4. My proclivity for products with warmth and cheesiness--think pizza and mac and cheese.
  5. The fact that I preach self-love (within reason--I also believe in being the best you can be), but can't practice it.

So, in order to avoid self-hate, I try to keep things as light and fluffy at the end of the day as humanly possible.  This would also explain my distance from all things political this year.  I am pretty sure I'd have a melt down if I fully understood the state of reproductive health in this country, at the moment.  And so, avoid I have.  This feels like an admission of guilt, but I am pretty sure it's a tactic of self-preservation at the moment.

These feelings/struggles also explain my hilarious purchasing habits over the last six months.  There has been an uptick in acquisition of all things comfort: comfy pants, comfy undies, blankets, aforementioned mac and cheese, and anything that brightens my day or makes me happier.  I have also painted my nails more consistently in the past six months than I have done any other thing--maybe including showering.  At least my hands look good.  Don't look at my legs (hairy) or my roots (egregious). 

I think I will get around to recounting patient stories again.  At least, I'd like to.  Being a resident has also made me more acutely aware and paranoid about privacy.  The current plan is to share stories in a vignette fashion--meaning, they won't be about any of my patients in particular, but will touch on things I have seen in a more general way.  I'll probably start with end of life stories, because those have really dominated a lot of my experience thus far.


Oh I missed this.  I do love writing.  Hopefully I'll be back in the saddle soon.  Perhaps tomorrow.  I do have it off, but I also have nails to paint.

Thursday
Jun062013

PGH.

I am happy to announce that Jess and I have finally arrived in Pittsburgh!  Our home is absolutely wonderful--great area, lots of space, park for Pita, fab neighbors, etc.  I am super happy to be in my new city and looking forward to it becoming just as great a place to call home as Michigan.  For the past two weeks or so I have taken advantage of exploring the 'burgh and I am finding that it will be a great fit for me.  (And hopefully for Jess!)  One of the coolest things about Pittsburgh is that it's organized by neighborhood.  Yes, it has your standard downtown with big buildings and people rushing around, but it is also home to many little downtowns, streets of shops and restaurants with their own unique feel. There are young neighborhoods, mixed neighborhoods, gay neighborhoods, hipster neighborhoods, fancy neighborhoods, and (of course) just 'hoods.  It wouldn't be a city without some struggle, eh?

In any case, I am glad to be here and look forward to doing a bit of writing before my program starts up.  Hopefully my next post will be about a little incident we had involving Pita.  Actually, it didn't really involve her at all, just her looks and the fact that they are suggestive of her (likely) pit bull heritage.  As a preview I will say Jess and I were sad and mad, but it all worked out.  However, it inspired me to do a little more research about rights and rules regarding breed specific regulations.  So!  More on that later!

I joined a gym yesterday--LA Fitness, formerly Urban Active.  I told myself (and Jess) that I wouldn't be joining a gym til I was sure I had time.  Then I remembered that even if I don't have time, I feel like there is a hole in my heart if I don't belong to a gym.  The start-up fees were hefty: a $140 joining fee and also the first and last month's monthly fee ($40 each).  The gym is a dream though!  It has all the amazing amenities of my previous gym (shout out WCC Health and Fitness Center!) and a lower monthly cost--approximately half to be precise.  So that is fly.  There is a pool, but it is 22 yards and they keep it around 80F.  (Swimmers: word, I know.  I won't be using it for fitness purposes.  Also, how the hell do you keep track of yardage?)  I am also pleased with the selection of machines, number of Spin classes, presence of yoga classes, towel service, and general young feel of the place.  Additionally, they have this place called "Cardio Theater."  I have never seen anything like it.  They play a movie each day in a dark, cool room and there are about 20 cardio machines in there.  Stacked, like in a movie theater.  So you can run and watch a movie. WHAT?!  So cool.

This morning I have my 'fitness assessment,' which I am dreading.  In terms of fitness personas, I have always identified as a former athlete/athlete.  I work out to feel powerful and fierce.  I have never had a perfect bod, so I abandoned that goal long ago.  My body right now, though, is so out of shape that it's pitiful.  I was explaining to the guy doing my 'intake interview' yesterday that I don't feel like I can tell my patients to work out unless I do the same.  Also, I fucking miss having defined muscles.  So: back to the gym I go.  I am a little nervous for this assessment; the guy doing it is a total meathead.  I met him yesterday.  He has NO neck.  And he was eating a tupperware of ground beef.  Yikes.  Hopefully he doesn't break my spirit.  Or maybe he should.  Good thing I got my new Lululemons to make me feel powerful/chic.

Also, a makeup review soon.  I am now a glossybox gal and plan on being diligent about the reviews.  Note: I said PLAN on being diligent.

Come visit!

Monday
May062013

my biggest secret.

I feel like a local news host, or a tabloid.  "CELEBS BIGGEST SECRETS REVEALED."  Except no one really cares about mine.  Especially because it has nothing to do with sex.  (Sorry!)

This blog, by and large, is about science and medicine and politics--realms in which I am very comfortable.  As I have mentioned before, I write to share, explain, and learn.  This blog has been an absolute godsend over the course of medical school, even if it has been underused at times.  My identity is pretty tied up in the things I am good at, as I suppose is true for most folks.  If someone posed the question "what do you do?", I'd say I take care of patient's physical and mental health.  If you asked me what I am passionate about, I would tell you that politics and social justice occupy the grand majority of my conversations and brain space.  If you asked me what I love to do in my spare time, though, I generally don't have an answer.  This could be related to how little free time I have had in the past 10 years, but I think it's also because I am totally embarrassed by my hobby: making myself look good through hair/makeup/clothing trickery.  I was going to just say: 'making myself look good', then I realized that would include being a gym rat which, sadly, I can't claim to be. 

Yes, it's true.  I am incredibly vain.  That being said, I promise that I keep my vanity to myself.  Though I may be obsessed with tightlining my eyes and straightening my hair and finding high quality denim, I do not expect the same of others.  In fact, I think I am most judgy of my beauty-snob cohort.  Why do they look so good?!  Because, despite the fact that I spend all of my 'play' money on my hobby, I rarely find the time to actually 'look good.'  I love buying high dollar concealers and beautiful tippy high heels, but on my days off you will likely find me in lululemon (also way too expensive!), browsing the aisles of Ulta and Sephora--probably drooling. 

Right now, I am in a weird (wonderful) period between medical school and residency.  In 14 days, I will be Em Ketterer, MD (holyshitholyshitholyshit).  In the mean time, I have excessive free time.  As Jess and I will be moving to Pittsburgh, some of this time is being spent packing, planning, selling and buying.  However, the other 50% of my waking hours is dedicated to... makeup.  And clothes and jewelry and hair.  I have recently discovered the fun of makeup and beauty tutorials on YouTube.  I truly wish I hadn't.  In the past week I have wasted several hours watching really pretty women make their faces look even prettier.  I guess I shouldn't call it wasted time, after all this is my version of scrapbooking/sports/music, people.  I am admitting this to you.  I, Emily Ketterer, am a product snob.  I can ramble off the 5 best-selling MAC eyeshadows, I could tell you what your perfect beauty balm would be, I could teach you how to change the shape of your face with a few powders.  And yet... I walk around without makeup most of the time.

Maybe I should have gone to cosmetology school.  At one point in college, I told my parents that I wanted to go to Douglas J (an Aveda cosmetology school--very chic).  They laughed and told me I could kiss my college funding goodbye.  So I went to medical school (y'all know it wasn't that straightforward, but that's the short version). 

So instead of being embarrassed by my little habit, I have decided to embrace it and use the techniques I know.  I will be the perfectly coiffed resident who is also incredibly sleep deprived.  But my hair and nails and eyes will look impeccable.  Shallow?  Sure.  Happy?  Yeah. 

And now, I will share with you the bounty of my beauty booty!  Here are a list of my favorite things (right now):

Makeup:

1) Makeup Forever HD Foundation: This foundation comes highly recommended from just about anyone who knows and loves makeup.  It covers quite well but doesn't feel excessively heavy.  Depending on how you apply it, it will be sheer or the coverage will be more fully.  (Use a Beauty Blender for sheer coverage and a flat kabuki, Sigma is awesome, for full coverage). 

2) MAC Eyeshadow in Naked Lunch: This is perhaps the prettiest shadow I have ever owned.  It's a beautiful light golden pink that works well as a base for most looks.  It isn't too shiny, but it does have some golden flecks in it.  This is one of MAC's best sellers, and it will certainly always be on rotation for me.  (It's great for pale people!)

3) Dr. Lipp's Nipple Balm: Not just for nipples!  I am a total sucker for weird products, and this one just called my name.  It was in one of those little boxes near the checkout at Sephora and I had to try it.  One of my biggest beauty hangups is my super super dry lips.  They are chapped, cracked and bleeding almost year round.  I have tried pretty much every product you could name, but none seem to work too well.  I love the Nipple Balm not because it has healed my lips completely, but it is wonderful for covering them all night.  I religiously apply a healing balm at night and this is one of the only ones that stays on til the morning.  Progress!

4) Nars Exhibit A Blush: Now, this is NOT an every day blush.  If you follow the link you will see that it is BRIGHT red.  For a blush like this it is absolutely crucial that you have an appropriate brush for application.  I like the Sonia Kushak duo fiber stippling brush because it is not a dense brush and a very light sweep across the pan will give you PLENTY of color.  The reason I like this blush so much is that it is incredibly flattering on pale skin (also on very dark skin).  This is one of the few brushes that looks best when applied to the apples of the cheek.  If I am using Exhibit A, I will do a very light neutral eye and a nude lip.  I like to let the 'just pinched cheek' look be the feature of the look. 

5) Benefit They're Real! Mascara: I am one of those pale people that also has light-colored lashes.  They are there, but if there is no mascara on them, they look... short.  I appreciate a good mascara and have always found that paying the extra for a high-end brand is actually worth it.  This one has really got me hooked, though.  It does it all (lengthens, separates, thickens), and for me, it's good for every day wear.  It might be a bit too dramatic for those who are already well-endowed in the lash department, however.  Tip: when applying mascara, start at the very base of your lash and wiggle the brush side to side until the lashes feel completely surrounded by the brush.  Continue wiggling the brush as you move it up.  The strategy changed my life in college.  Maybe not, but it was pretty exciting.  It helps separate the lashes and get an even coat.

6) Sonia Kushak Eye Definer and Rimmel London Kohl: I know I have mostly only posted high-end stuff (I won't lie, it makes a different 75% of the time).  These two eyeliners, though, are pretty standard for me.  Kohl is the only kind I find that I like because it's soft on my lid.  I find applying eyeliner pretty painful, so it's important to me to find a soft kind that won't pull on my lids as I apply it.  Both of these work great (I like the line of colors Rimmel has), but they can get gloopy by the end of the day.  Just depends on if you're a sweaty beast like me!

Hair:

1) Pantene Pro-V Overnight Miracle Repair Serum: I LOVE this stuff.  It is not really a serum in terms of texture, more of a gel-creme.  There are a lot of overnight serums that can leave you a little greasy and are designed to be washed out in the morning.  This one doesn't have to be!  Considering I am lazy and hate showering in the morning, it's great for me.  It just makes my hair very soft and I was incredibly surprised to find that when I went to bed with straight hair and this product in it, I woke up with perfectly straight hair.  Normally, my hair in the morning is full of kinks and definitely requires some styling.  Not with this stuff!  Love it.

2) Fekkai Technician Color Care Mask: I discovered this stuff via a sample at Sephora.  What really got me hooked was the smell!  It's like candy or something.  Yummy, but not overpowering.  This is great for anyone that colors their hair (bleach or color, doesn't matter).  I am a big fan of masks and tend to use them once a week or so.  This one has been my favorite for about five years.  Surprising, because I never keep anything that long!

3) Tigi Pro Fat Curl Styling Stick: I actually had no idea how expensive this was until I googled it to find a link for y'all.  Shit!  I got it on super duper clearance ($30?) when BeautyFirst was closing.  I was an early adopter of curling sans clamp.  I watched a tutorial many moons ago and was amazed to see how different the curl looked without using a clamp.  I saw this iron and decided to give it a shot.  Dang!  It's awesome.  I hope it lasts me a long time. 

 

I think I'll stop there.  That's enough vanity (sharing) for one day.

Thursday
Mar212013

the ER--part 2.

*Please note, the names and details of patients/staff/friends/family have been changed to ensure anonymity.  I have attempted to stay true to the nature of the stories in as much as their identities can be concealed.

Since the last one was kind of a downer, I am going to relay a (semi) uplifting story next. 

There are a surprising number of people who come in with 'vaginal pain' as their chief complaint.  Aside from being quite vague, it's almost always an indicator that the case will be a doozy.  People don't just come in to the ED with vagina questions--they come in because something went wrong.  Down there--as they say.

I actually like these cases.  I am not a huge fan of doing pelvics (probably because I am also not a big fan of getting pelvics!), but I love women's health and I am always eager to improve my skills.  I want to learn how to make an annual exam as painless as possible--and that requires practice.  Sorry ladies of Southeast MI, I do appreciate you letting us learn how to be doctors.

This particular woman came in with 'eye pain,' though.  When I went to see her, she was sitting perfectly comfortably on a bed, playing with her cell phone.  The nurse had already alerted me that this young lady was also worried about some kind of STI.  I understand--you're embarrassed, but you might as well get it out of the way by being up front in triage.  In any case, I went to see her in an area where we had absolutely no privacy.  I alerted nursing that we would be needing one of the individual rooms to perform a pelvic exam. 

"So, eye pain?" I asked, with some intonnation that I knew about her other issue.

"Uh, yeah." She looked me up and down.  I was probably only about eight or nine years older than her.  I was also not looking particularly good.  I don't do the best job of getting dressed when the uniform is scrubs; it's like the comfort of wearing such slouchy clothing spills over into my hair and my face and I just look terrible for months.  

I introduced myself as the med student that would be taking her history and performing her exam.  I told her that an attending or resident would be supervising the pelvic and that if she had any questions, there would be someone to answer them.  I also let her know that we'd be moving to another room for more privacy.  

Once we were alone in the other room, I was surprised to hear how cheerily she reported that she wanted to get tested for STDs [sic].  I asked her if she had any particular concerns and she explained that she had recently suffered her first bout with genital Herpes and she wanted to get tested for "all the other ones."   I asked if she was worried that she might have something else and she shrugged, muttering that she was not all that concerned. 

"Do you use protection during sex?" I asked.

"No," she said.  Her response came quickly, was straight-faced, and unapologetic.  I am not saying I expect an apology on behalf of all health care providers, but I mean, wow.  This is one bold young woman, I thought.

"May I ask why you don't?"

"I don't know.  I never have.  And I have never gotten pregnant.  I don't think I can get pregnant.  But now I got these warts and I'm all like, damn.  Maybe I should get tested."

There were so many things that I wanted to address in what she said.  I chose to ask another question first.

"Do you use any kind of birth control?"

"No, and I ain't never been pregnant." 

She confirmed my worst suspicion.  By her history, this young woman had been sexually active for about five years.  She has had numerous partners and has never used condoms.  The possibilities that ran through my head were chilling.  Is this really the first time she's been tested?  EVER?!  What if she has some advanced cervical change?! Does she truly believe she can't get pregnant?  Why did her primary care doc not address these issues?  All the while I am trying not to let my face convey my fears.

"I know you have probably been told this," I said, "but you're taking some pretty big risks by not using protection.  I am concerned about a number of things.  First, you can get pregnant.  Unless you were born without a uterus and ovaries, you can definitely get pregnant--there's a first time for everything.  If you don't feel like now is the right time to have a baby, you should really think about some kind of long-term contraceptive.  Second, having unprotected sex--the kind without a condom--is putting your health at risk.  HIV rates are growing for young women in Detroit, and herpes, Chlamydia, and gonorrhea aren't going anywhere.  Has anyone talked to you about the Gardasil shot?"

"No, what's that?"

"It's a vaccine, kind of like the ones you get when you are a kid, that protects against the four most common strains of HPV--two that cause warts, and two that can lead to cervical cancer.  It's like my favorite vaccine ever!"

She laughed and looked pensive.  We performed the exam, which was pretty painful for her due to her herpes induced neuropathic pain.  Though the outbreak was waning, it was still quite evident.  In addition, she had some yellow discharge that looked more pathologic than physiologic.  We ran all the necessary tests, the attending put in his two cents, and he left the room.

I was about to leave to, but as I reached the door she said: "What do it mean?"

"What does what mean?" I asked.

"Herpes.  Like what do that mean.  Is it gone now?"

Her doctor hadn't bothered explaining anything about her disease to her.  He just gave her the acyclovir and sent her on her way.  We talked for a long time.  She had so many questions--it was as if she had been waiting for someone to talk to her about her body.  We talked about a bunch of STIs, her risks, the rise of HIV in Detroit, how these diseases are transmitted and why women are more vulnerable.  I asked her if she had ever asked a man to use a condom, and she admitted that she had not.  When she was younger she just wanted someone to show her affection, and sex ended up being a way to fill that space in her heart.  Unfortunately, these encounters had only lead to unhealthy relationships with most of the men she'd been with. 

Eventually, a nurse knocked and gave me a look that said, "what is taking so long?"  I had kind of forgotten that we were in the ER.  I had reverted to my primary care persona, taking too much time.

It was a really revitalizing conversation though.  In light of having matched it made me so happy that I would have the chance to be a family doc. 

Oh yeah, I matched!  Not only did I match, I matched into my first choice, a Family Medicine/Psychiatry residency in Pennsylvania.  It's a dream.  I will be able to ride that line I love so much.  Jess is relieved that we are going to her city of choice--she loved it when we visited during interview season.  I am still having to remind myself that it's actually happening!  We're going to look for houses in a few weeks.  WHOA!

Thursday
Mar212013

the ER--part 1.

*Please note, the names and details of patients/staff/friends/family have been changed to ensure anonymity.  I have attempted to stay true to the nature of the stories in as much as their identities can be concealed.

A lot of people have been waiting for me to post about my experiences in the ER.  Or maybe I flatter myself--maybe no one said that at all.  Regardless, it seems like everyone wants to hear crazy ER stories.  There are plenty to share.  Perhaps too many.  However, the joy I normally take in sharing patient stories is pretty much demolished by the pervasive desperation and abandonment I sense when I am there. 

No, I will not get off my social justice soapbox. 

There are a few stories I can share (with critical changes made to protect privacy) that really illustrate why I have found this month so hard. 

On one of my first evening shifts this month, I was sent to see a man whose chief complaint was "arm pain."  We get a lot of pain visits.  I think everyone knows that the ER becomes a regular haunt for many people who are addicted to various forms of prescription meds.  I don't find this as frustrating as my colleagues, though it can still be challenging to deal with addiction--especially in an acute care setting where the only thing that separates one patient from another is a curtain.  We all have our perceptions, but I would argue that we need to do a better job of interrogating those perceptions--does this assumption come from a place of fear or lack of knowledge?  Does it come from a place of privilege or stereotype?  Or does this assumption come from pattern recognition (a really important tool in the doctor world)? 

This particular man was not even lucky enough to get a bed.  *Mr. Henry was sitting in a little row of chairs, cradling his painful arm with his other arm.  He looked ragged and exhausted.  He was an old black gentleman who had spent the past six years on the street.  He had the odor of homelessness that I have become so familiar with--a mix of urine, dirty underwear, and sweat.  I do not say this to add some sort of 'ick' factor, but to share with you how hopeless the patients' situations can seem. 

When I sat down I could immediately tell that something was indeed wrong with his arm.  It was swollen and warm, the skin was tense, and there was an area that appeared to be a locus of infection.  This was one of the times the pain was completely legitimate.  Legitimate pain happens more often than most people want you to think.  Especially people who are suspicious of the poor and programs like Medicaid.

As I talked with Mr. Henry, I noticed he had a blunted affect--which basically means his face held no expression, it was blank and never reacted to his own pains or my questions.  He also made little eye contact and appeared to be ... down.  As I went through the list of questions we ask all patients, we came to a section on substance use and he cut me off, saying he had a drinking problem, quite emphatically.  Considering his previously limited range of expression, this stuck out to me.  Maybe he wasn't just here for his arm--though it needed attention very badly.

"May I ask you how your mood as been lately?"

"My mood?" he asked.  He seemed genuinely confused.

"Well, you seem a little down to me.  Is there anything in particular that's on your mind?" I asked.

"I just... I'm just ... tired.  I'm a bad man," he said while looking away from me.

I proceeded to ask him why he thought of himself as 'bad,' and he went on to list the various ways in which his alcoholism has impacted his life.  He explained that he is no longer on speaking terms with any of his family and he has never met his grandchildren, that he is homeless and sick all the time, and that he has no friends.  If my heart was capable of breaking, it broke right there in that hallway. 

As I've stated in previous posts, addiction is a disease like any other.  MRIs and CAT scans have shown that there are physiologic differences between the brain of an addict and that of someone who is not prone to addiction.  Studies have even shown that the offspring of addicts react differently to various pleasures than those who have parents without any history of addiction.  But when you are hospitalized as a result of alcoholism, no one visits.  No one brings flowers.  Even the nursing staff seem to write you off.  It's a disease that only burns bridges, and one for which there is no cure. 

I asked Mr. Henry if he was interested in ending his relationship with alcohol.

"Yes, oh God yes.  It's just that every time I try I get those seizures and have to come here only to get bumped back out again."

Mr. Henry is talking about the DTs, Delirium Tremens.  The DTs are one of the more ominous signs of alcohol withdrawal.  These seizures, which can be preceded by irritability, rapid mood changes, confusion, and hallucinations, can actually cause death.  These symptoms are typically in full force 72 hours after the patient's last drink.  Many alcoholics become familiar with the symptoms that lead up to these seizures and end up drinking--even though there is a strong desire to quit--simply because they feel so terrible and there is a fairly easy solution: alcohol.

What Mr. Henry wanted was a supervised withdrawal.  The first few days after a person stops drinking are the most dangerous.  If one is able to pay (insurance or cash), they can withdrawal in a hospital where medications are administered in a step-wise fashion to help ease the transition and avoid seizures.  Typically, Benzodiazepines are used in this process.  Benzos, another addictive substance that works much like alcohol, act as a substitute for the booze.  As the body adjusts to a new normal, the benzodiazepines are stepped down and eventually stopped.  Of course the biggest challenge comes when the patient leaves the hospital and encounters all his old haunts. 

Mr. Henry seemed ready, though.  I believed that he was truly interested in quitting his habit.  After a quick physical exam, I went and reported the case to my resident.  Of course, I mentioned the arm and the antibiotics we could likely use to treat the infection, but I was much more interested in discussing this guy's willingness to quit.  I was shot down.  Hard.  Apparently it's not the ER's business.  I mean, I get it, it's not like this hospital has a ton of social workers available to find resources for this very desperate population, but still.  This man wanted to improve his life and we were essentially saying, "OK, good luck with that!" 

The man left with a prescription that he probably doesn't have the money to fill.  Before he went, I looked up a few resources in the community for handling addiction.  I gave him my sincerest wishes for luck in the process, but I knew that's not what he needed.  He needed money and agency--an ability to advocate for himself.  Both of which he didn't have.  I sat down in a chair and watched him limp out.  I felt like I had given up on him.  It was terrible.

That's when I knew that ER wasn't right for me.