The term “frequent flyer” is medical slang for somebody who regularly visits the hospital. For better or worse, frequent flyers are well known to physicians and other health care staff. These health care providers are tempted by assumption and sometimes perform a cursory assessment before doling out some stereotyped intervention.
There are several types of frequent flyers including young adults in the midst of sickle-cell emergency who are administered pain medications and fluids, people with bipolar disease who have a history of discontinuing their mood stabilizers and thus find themselves temporarily confined to the in-patient psych unit or homeless people with long histories of polysubstance abuse who are brought in by police after a most recent bender. This cautionary tale involves this last type of frequent flyer: A 39-year-old homeless man with polysubstance abuse and quadripelegia, who came into the emergency department with complaints of excruciating abdominal pain.
This man was well known to the staff at one particular Kentucky hospital. He had a reputation for being combative and noncompliant. When he first came into the emergency department, the emergency medicine physician ordered him an x-ray, which proved inconclusive, and then sent on his way. The next month, this same man showed up with a 4-day history of abdominal pain. The emergency medicine physician who served him made no diagnosis, and the hospital sent the man to a family member’s house by ambulance. The family member refused to accept the man, and he was sent back to the hospital. Social services then placed the man in a motel across the street where staff claimed he continued to scream in pain for another 5 hours. He was brought back to the emergency room covered in bloody vomit. At the hospital, two emergency physicians--including the one who had seen him hours earlier--ordered the man an enema and had him disimpacted. Afterwards, the man was sent back to another relative’s house. Of note, he claimed the hospital told him not to come back (a claim the hospital denies). Sadly, the man died 4 hours later from a ruptured duodenal ulcer.