Don't Mind My Track Marks

This past week at my residency was spent training as discharge pharmacist. Basically this position consists of going to patients' rooms when the doctor writes the discharge medications and counseling the patient on these new meds. It's a pretty easy position, and one of my favorite - mainly because it gets me out the basement and face-to-face with patients. I spent a significant amount of time on the psychiatric floor at my facility this week. One of the guys I discharged actually kind of scared me. It think it was the way his eyes appeared to bug out of his head and rotate...in opposite directions. Apparently, 72 hours with no heroin will do this. This particular individual was admitted because he tried to shoot heroin into his lower leg and ended up giving himself a nasty infection. I still don't see how he thought he could hit a vein in his calf muscle...but that's beside the point. When I went to counsel him, I didn't know he was detoxing from heroin. I thought he was a PTSD or depression patient. He invited me into his room, which I kindly declined. I offered instead to speak to him in the day room (a room enclosed in glass that is monitored quite closely by the psych nurses). He reluctantly agreed. He didn't care about his antidepressants or his antibiotics. He was mainly concerned about receiving a cream for his "bug bites." I returned to my office and phoned his psychiatrist. She prescribed an antifungal cream, which I found an odd choice for bug bites. I decided to read his chart to find out what exactly was going on. Great idea! For those bumps on his forearms were NOT bug bites, but rather infected track marks. I wanted to go back up and tell him to stop injecting into those sites, but figured it was a lost cause. He looked like he had lost venous access in his arms ages ago...and this probably explains why he was trying to shoot heroin into his calf muscle. Perhaps his eyes were rotating in his head due to the fact that he's probably injecting into his eye lids?? Who knows. I am definitely losing some of my naiveness...and I have become quite good and hiding my "Oh my God, you did what?!?" face. Trust me, some of the stories patients tell me make it quite difficult to hide the face.