Our doors are always open 

By Kittane Vishnupriya, MBBS, Johns Hopkins Medicine 

“I appreciate you very much, but I have to leave,” said the patient. Belongings were packed and departure from the hospital was imminent. The patient, a 25-year-old woman admitted a few days earlier with severe multiple-drug withdrawals, required ICU care for a precedex drip that was eventually weaned. Intensive regimens of multiple medications remained necessary. Attempts were made to explain that treatment protocols were incomplete, and that a high risk of significant adverse effects persisted. Continued lack of treatment could lead to buying drugs on the street again—an outcome the said she had a strong desire to avoid. A triggered response made hospital stay impossible. Hearing a family next door repeatedly praying, and deep wounds that couldn’t be shared were cited as reasons. After best efforts from the charge nurse and counseling, agreement to stay was reached. 

I had another patient down the hall with similar clinical presentation, but this was a young man. He’d suffered through gunshot wounds, multiple abdominal surgeries, chronic pain, followed by years of substance use. He was also on a similar treatment regimen. I noted that his wife was constantly supporting him on the phone on video chat with him when I went in to see him. We always ended up having a good group discussion about plans for the day and treatments going forward.  

The next day, when I entered the first patient’s room, she was in tears. A beautiful picture showed the patient with two children. News from a lawyer said the children would enter foster care because she hadn’t become “clean” quickly enough. Sorrow and pain were palpable. Help and support were offered, and the patient seemed determined to complete the inpatient treatment plan.  

Later that evening, I walked to her room again to check in. She wasn’t in the room and her belongings were gone. The nurses and I searched the entire floor to no avail. She didn’t answer her phone and had left with IV in place; we notified security and police. In the heat of the moment, I felt so much effort from so many people including the ICU team, floor teams providers, nurses, and staff was probably wasted.  

But then, driving back home, I reflected on what had happened and some thoughts came to mind: 

1. Substance use disorders can be a lifelong journey for patients. They need every bit of support they can get. 

2. Behavior challenges are common with substance use disorders, and we should avoid judgements. Small things can trigger agitation and aggression.  

3. A trauma-informed approach both at the bedside and at system level is crucial.  

4. Constant family or friend support for the patient, when available, can be a huge benefit to treatment plans. 

5. Peer recovery coaches should always be part of a multidisciplinary team that includes addiction medicine experts, nurses, and psychiatrists.  

6. Setbacks are common and shouldn’t lead to judgement or labelling. The path to recovery is indeed challenging for many. 

I discharged the second patient after successful completion of inpatient treatments, and he was plugged into a supervised outpatient program. As for the first patient, we never heard back from her. I hope she’s ok and all I can say is that—If you need any help, our doors and our hearts are always open. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.