What still gets me, however, is when someone's self-destructive behavior affects another. I could care less that my guy in bed 9 overdosed on methadone for the third time this month. But when the ED is full, and we have an 88 year old gentleman dying of colon cancer forced to be treated in the hallway, I get pissed. Methadone guy couldn't be pulled out because he would brady down to the low 40s and drop his sats every time he nodded off, and thus needed a monitored bed. With every other room occupied by patients who could also not be pulled out, my cancer guy was simply out of luck until we finally were able to move a patient upstairs.
It didn't help that as my perfectly polite and understanding gentleman suffered in the hall, Methadone guy ripped his IV out after receiving a Narcan eye-opener. At least his nurse took the time to explain the "two for one" rule: for every IV the patient removed, two more larger gauge lines would be put in as replacements. Nothing like bilateral 16s in either hand and the threat of a 14 to encourage compliance.