Remember how I said you get good at spotting the fakers?
He's exhibiting every sign of opiate withdrawal. Eyes dilated, tearing, skin has piloerection and goosebumps. Hypertension, tachycardia. Agitation, restlessness, perspiration. He's checking every box.
Right, but he said he doesn't take drugs and seldom drinks alcohol, so...
That's exactly what he would want you to believe if he was drug-seeking.
By getting him to admit his opiate usage.
Right. How do we do that?
By being smarter than the patient.
Got it. He said he isn't an addict, so why give him an opiate agonist to treat his withdrawal symptoms?
Because I don't believe him. And I know this will work. Then once he feels better, we can get him to admit to his addiction and treat him long-term.
TSTheresa Saunders
The psychologist spoke to me about becoming a petitioner to place David on an involuntary psychiatric hold.
TSTheresa Saunders
But can that be anonymous?
No. To call a 302 in the state of Pennsylvania, the petitioner needs to admit to having witnessed the concerning behavior, and you need a physician and a social worker to sign off, which both Kiara and I can do.
TSTheresa Saunders
What if I'm wrong?
Then you apologize. And we will help you explain that this came from concern for his safety. What if you're right?
TSTheresa Saunders
But if I become a petitioner, what am I doing to my son?
You are trying to get him the help that it sounds like he needs. David lost his father. That would affect anyone. But we are failing young men, because we don't teach them how to express their emotions. We just tell them to man up, and then we let them get their lessons in manhood from toxic podcasts. And these young men then feel isolated from themselves and society, and they find community and comfort in all the wrong places. David needs help. We don't want to fail him, too.
[about drinking] You ever think about quitting?
LCLouie Cloverfield
[chuckles] I'm not a quitter.
Oh, I know you're a happy drunk today. But one day, when your liver fails and believe me, it will fail you won't be so happy. It's not a nice way to go.
LCLouie Cloverfield
I'm digging my own grave. Let me.
I don't have to give you the shovel.
I'm already in a bad mood.
SGSecurity Guard Ahmad
I'm just getting some air.
[scoffs] Yeah, right. You're a terrible liar. Hope you're better at security.
SGSecurity Guard Ahmad
Hey, now you're just being mean.
You realize that this is the second person to accuse you of that today. - You starting to see a pattern?
No. But I am starting to see why Gloria's unhappy with your patient-satisfaction scores.
[Robby laughs]
You need something? Or you just here to ruin one of the few things that still brings me a little joy in life?
You don't want to work with anybody today. You must be in a mood.
[chuckles] Yeah. You're good. You're not that good.
...
You do help. You do make a difference. One asshole doesn't get to change that.
I think I'm done. [sighs]
Yeah. I know that one. And I don't blame you. I, uh...I-I-I-I don't know. I don't know. Maybe what I want and what the patients need isn't what's best for you anymore.
I just honestly don't know what I'm going to do without you.
You'll figure it out. You always do. You're a good man, Robinavitch. Don't let this place take that from you.
How you feeling, Mr. Pugliesi?
IPIvan Pugliesi
Oh, so much better. Thank you. You guys think that I could have a little bit more of that medicine, just for the few days that I'm out here? I just want to be able to walk my daughter down the aisle without shitting myself.
The medication we gave you wasn't morphine. It was something called buprenorphine, or BUPE.
IPIvan Pugliesi
Yeah, no, she said that. I mean, whatever you call it, Doc, it worked great.
It's a medicine specifically targeted to treat opioid withdrawal. That's why it worked.
IPIvan Pugliesi
Wait, I-I don't I don't understand.
All indicators are that you have been using opioids. That would include pain medication like hydrocodone, oxycodone.
IPIvan Pugliesi
I told them I don't do drugs. Wow. You lied to me.
I didn't lie. I said I was giving you a morphine-like drug that got rid of your cravings.
IPIvan Pugliesi
Well, you know what? This is bullshit. I mean, you know, I could sue all of you. You hear me? I'm not some junkie on the street. Look, look, I-I got a family. I got a job. I make good money. I, you know, I return my shopping carts. I pay my taxes. That sound like a drug addict to you?
Yes, because anybody can be an addict. You are proof of that. These pills that you were taking, they're not helping you with your pain. They are keeping you stuck in it. A lot of really good people struggle with addiction. It is a brain disease. But social environment and personal choice are also factors.
IPIvan Pugliesi
I don't have a problem.
The good news is that the brain is highly dynamic, as is the environment. But you need to stop now before the damage is irreparable.
IPIvan Pugliesi
No, screw this hospital, okay? And screw you.
Hey. Doctor Mohan -- Doctor Mohan will advise you on our proposed action plan. You can either choose to follow it or not. That is entirely up to you. I wish you luck, Mr. Pugliesi.
We're giving you a seven-day supply of a drug called Suboxone. We can set you up with a medic...
IPIvan Pugliesi
Fuck off. I'm not interested.
