Tuesday, January 11, 2005

i'll hook you up

Yesterday on call, at around 2am, we got a call from the satellite pharmacy that they were almost out of methadone. Which is kind of a weird call to get at that hour, like, "Oh...I'll alert the media," until you consider that we had a DNR end-stage cancer patient on the floor on a methadone PCA running at some unbelievably high basal rate with equally astronomical bolus doses. The nurse came running up to me frantically after this conversation, sat down (you know it's bad when the nurse has to sit down to tell you something--either that, or they're just kinda tired, it being 2am and all), and said that with the current supply in the pharmacy, and at the rate that the patient was going through the pain meds, we maybe only had enough methadone to last until maybe 4 or 5am. There was a large supply of methadone in the main pharmacy, but that wouldn't open until around 8am, and the satellite pharmacist said that he couldn't get access until then.

Aside from the disbelief that the overnight pharmacy in a gigantic children's hospital with a 40 bed PICU and a 30 patient oncology service would RUN OUT OF METHADONE, I was more than a little alarmed at the idea of putting this patient through any more pain than he already was experiencing. But the kid was using a fucking shitload of methadone. His nurse and I quickly projected how much extra we would need to get him through the night, and figured that we needed to locate an extra 400mg somewhere in the hospital to bridge the hours to 8am, with a little bit of a buffer for escalating breakthrough pain. 400 milligrams. My friends, this is a GIGANTIC AMOUNT OF METHADONE. Consider that heroin addicts usually get 20-120mg a day on methadone maintenence, and then consider that this kid was getting at least that amount every hour. Fucking cancer.

Anyway, since the pharmacy seemed to be fresh out of the good stuff, I decided to run on up to the PICU to see if they had any extra stores that we could use for the night. With all their post-ops, they had a lot of kids on methadone drips, and therefore hopefully a healthy stash. However, hand in hand with that, with a lot of kids on methadone drips, I didn't know how much methadone they could spare. I ran from one end of the building to the other, talking to all three wards in the PICU (when did our PICU get so fucking huge, for crap's sake?), and at the end of all my wheeling and dealing, I had in my hand two vials of methadone, totalling 400mg.

"Do I need to, like, sign something to get this for my patient?" I asked one of the PICU nurses, not wanting to get anyone in trouble for taking something out of the unit Pyxis for a patient on another floor.

"Nah, it's OK," the nurse said, punching in her security code, unlocking the drawer of narcotics.

Running back down to the oncology ward, my hads full of enough methadone to kill a horse, I started to get all nervous. What if some crazed drug fiend cornered me in the elevator and stole all my patient's methadone? What if I got a shiv in the ribs for all my trouble? For that matter, how did the PICU nurses know that I'm not some crazed drug fiend? I could have made up that whole story about my dying patient and the PCA and the pharmacy running out of methadone. I could be running out of the hospital now to peddle pharmacy-fresh methadone to junkies on the street. And then I could finally quit this lousy day job.

I dropped the five million tons of methadone off with my patients nurse, telling her, "This should be enough for the rest of the night. Don't even ask how I got it, it involved prostitution." And then I walked , relieved to be unburdened from the responsibility of guarding that much opiate with me wee hands.

The patient was able to sleep for the rest of the night.

Currently reading: Meh, between books. What to read, what to read?

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