The man who shit himself

A few nights ago I had my most unpleasant patient ever. EVER. This was not the 25 year old with a wrist abrasion and a minor skateboard accident asking for percocet. This was not another 46 year-old woman with chronic generalized abdominal pain and depression. This was not the irritating and hopeless alcoholic, again drunk with a bump on his head. This was not the 5 week old pregnant girl who called the ambulance because she has some mild cramping. This was not the bipolar 66 year old who comes to the ED every week for a variety of complaints then treats the staff like chopped liver and refuses care. This guy was worse, believe it or not.

A 43 year old man with Crohn's disease. He was discharged the day before from the hospital for "mild Crohn's" exacerbation. He had a several thousand dollar work-up while in the hospital, GI consult, CT scans, the works. Today he got kicked out of his shelter, supposedly for shitting in his bed overnight. Sure loose stool from the Crohn's, but this is not uncontrollable cholera-level diarrhea.

The guy is parked in the hallway right by the workstations and will not let a single staff member walk by without asking for something. He refuses having an IV for fluids, although to be honest it was not really necessary. He openly confesses to me that he has never worked a day in his life because he was "spoon" fed by his mother. He's not used to being in a shelter, "if you know what I mean, man." I don't ask him why he's in a shelter. I can make up the story that is probably pretty close to true. I don't ask him because even asking him the simplest question, like "what did you have for breakfast" turns into a 5-minute nonstop ramble about everything except what I want to know. He wants pain medicine. He wants he diarrhea to stop. He wants some food. He is back because he didn't get the "right treatment." Whatever that is. Can please tell me sir?

Then he shits in his bed. In the hallway. All over, disgusting loose stool. Didn't bother attempting to get to the bathroom. Didn't bother to say "Hey guys, I'm feeling like one's going to come loose, can ya' help to the bathroom?"

The nurse takes him to room and calls me in. I find him sitting in his stool. He starts blathering on and on about his "diarrhea." I can't get him to shut up. I ask him to clean himself up. He makes up more stupid reasons why he can't do this. I mean who the hell does this? I tell the nurse to leave him and say I won't talk to him until he cleans up.

So now he's clean, back in the stretcher. The aides did it by the way. I tell him exactly what I think, well almost minus a lot of expletives, that he's like my 2 year-old son who also shits himself but at least wears a diaper. "I can't wear a diaper man, you know what they say to me at the shelter." No, not really, but it's gotta be a whole lot better than having shit everywhere.

After 7 painful hours in the ED I get him out with some antidiarrheal meds. Admission was not an option. He walked out smiling, like he was happy with his care, what a shit-eating grin that was. Discharged at 10 pm. 15 minutes later the triage nurse calls me and says he's back, complaining again that he didn't get the right treatment. I say tough. He's malingering. He has no place to sleep tonight. To bad for him, but he doesn't have medical condition that needs hospital treatment, a doctor, and a nurse right now. What he needs is some sense of responsibility.