Going Coo Coo for Cocaine in Medical School

For some reason or another, the topic of cocaine keeps coming up throughout my years in medical school.

No, I didn’t get busted. I’m better than that. I’m as clean as a whistle. I promise.

But cocaine use is real. And as a result, doctors will have to know about it. I can’t turn a blind-eye, even if I wanted to.

So in the spirit of accepting that illegal drug use is not uncommon, lemme tell you some stories about coke …

Cocaine as a Vasoconstrictor

The first time cocaine came up was during my second week of surgical rotation. I needed a stimulant to keep me up … I kid, I kid.

The resident was teaching (more like pimping) me about treatments for esophageal bleeding. So he asked me, “How do you stop the bleeding.”

Without thinking too much, I instantly blurted out, “Inject cocaine into the vessel. It will constrict the vessel and prevent bleeding.”

The surgical resident spurted coffee out of this nose.

Oh wow, the things third-year medical students say. I bet attendings got a lotta stories about the stupidest things they’ve heard from medical students.

So instead of saying cauterization or epinephrine (which are commonly-used medical treatments), I jump to an illegal drug — cocaine. In my defense, cocaine does cause vasoconstriction, so it could potentially work.

I mean … If the hospital somehow runs out of bovies, epinephrine, pressors, and other ways to prevent shock, you could make a quick drive to the nearest inner-city ghetto and pick up some “snow white.”

Can you imagine what you’ll tell the cop when he busts you?

But officer, you don’t understand. I need this for medical purposes. It’s the honest truth.

(And I’ve later founded out that doctors do inject cocaine. It really works wonders for stopping the bleeding. I guess this former medical student isn’t so dumb after all. So … ha!)

Interesting Fact:

Did you know that cocaine used to be one of the secret ingredients for Coca-Cola?

Chronic, White-Powdered Lips in the Psych Ward

I met “Young Gotti” during my psychiatric rotation. I’m not sure if his street name is derived from Yo Gotti (the rapper) or John Gotti (the mobster).

With the name “Gotti,” I don’t think he was up to any good. The previous night, he attacked another male patient — a known sociopath. Young Gotti told me that before he got into the hospital, he was dealing heroin, cocaine, marijuana, and weapons in the inner-city ghetto. Now I’m not sure if it is true, or if it was all in his head.

I just met him. And from our very first meeting, I asked him if he could get me weapons. He said yes. Wow, he’s trusting. I guess he’s not afraid that I’m a cop.

So I then asked him, “Why are you here?”

He replied, “I killed someone and the cops brought me there.”‘

“So who is making money for you? You know … Working your corner of the street?”

“My homies.”

“You trust them?”

“Yeah …”

“How do you know they won’t rip you off and take your money?”

He then got silent.

“What would you do if they ripped you off?”

“I’ll kill them!”

So much for trust. I may have planted a seed of doubt regarding his maybe-imaginary homies.

Young Gotti was an interesting enough fellow. I felt like I had him figured out — a ghetto dealer with psychosis. But there was one thing about him that I could never figure out:

Why the heck was there white powder / crust around his lips?

I asked him and he said it was Vaseline. Uh-huh … I don’t think Vaseline looks like that. Instead, I came up with another possibility … because he reminded me of this:

I wonder if the police did a cavity search on Young Gotti before he was brought to the ward.

The Causes of False Positive Results for Cocaine

I was on the graveyard shift in the ER. And strangely, the night was slow. I was just sitting there minding my own business, twiddling my thumbs. I wasn’t bother anyone.

The doctor turned to me and asked, “What causes false positives for cocaine in a urine drug screen?”

First, I thought, “Why do you gotta pick on meeeeeeeeeeee?” Then I thought seriously about the causes. I really had no clue. So I did some quick thinking. Cocaine is a stimulant. So maybe another stimulant can cause it.

“Uh … Ritalin?” I weakly answered. I am sure I was right. I mean … what else could cause a false positive reading for cocaine?

“Nope. You’ll have a positive reading for amphetamine, not cocaine.”

Alright, I’m stumped. He then asked the same question to the resident. She did not know the answer either. So I breathed a sigh of relief. At least I was not the only person who didn’t know.

The ER doctor said, “Ok, I’m going to tell you the answer.”

I quickly took out my little notepad and my pen. I was gonna write this stuff down. (I gotta appear somewhat interested, right?)

So here are the 4 things that cause false positives for cocaine:

1. Zithromax (an antibiotic)

2. Boston Market’s rotisserie chicken (a source of protein)

3. Robitussin (a cough syrup)

4. Sweet Eats’ vanilla-frosted cake (a local delicacy)

He then asked, “So what are the four things that cause a false positive for cocaine?”

I replied, “Zithromax.”

He added “… with cocaine. So what’s the second?”

I was feeling a bit confused. “Uh … Boston Market’s rotisserie chicken.”

“… with cocaine. The third?”

Oh, I see where this is headed. “Robitussin.”

“… with cocaine. There are no false positive for cocaine!”

I’ve been tricked! And then I scribbled out the notes I took. This way, I won’t tell a patient that maybe his positive cocaine results is a false-positive — possibly from having Boston Market just before coming to the hospital.

I did a little digging and found that the good doctor’s answer was backed up by WebMD:

And “cocaine is cocaine — you don’t get many false positives or false negatives,” says Petros Levounis, MD, director of the Addiction Institute of New York at St. Luke’s and Roosevelt Hospital in New York City.

Cocaine. You can’t love it. You can’t use it. You can’t escape from it. (It reminds me of women … I kid, I kid.)

For more medical school stories, visit the About Alex section and look for “Blast from the Past (Stories of My Medical School Days).”

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