Tuesday, May 18, 2010

Ah, seekers

Ah, another night of saving lives again in the ER. If by "saving lives" I mean fighting drug seekers for all I'm worth...

Dude (at 0200): My pan-crits is actin' up agin! I'm in pain lady, I needs med-sin now!

Shrtstormtrooper: Well if it's pancreatitis, I'd better hang a lot of fluid on you. Did you drink or do any drugs today or recently?

Dude: Hells no. Imma in so much pain though, you gotta help me.

Shrtstormtrooper: You've got your fluids running, I'll send this bloodwork and I'm going to need a urine sample before we can do anything.

Dude (at 0300): Lady, I can't pee! I needs somethin for pain now!

Shrtstormtrooper: I've told you 8 times already, I'm not even going to think about pain meds for you until you pee. House rules. Here's your urinal, and don't call again until you've peed. I'll ask you again, any drugs or alcohol tonight? No? Okay then.

Dude (at 0345): I peed. Now can I get some, what's it called, da-lau-dah or somethin?

Shrtstormtrooper: Not until the tox screen is back, you know this. It's the same drill as the 36 other times you've been here this year. By the way, let me hang that next liter on you.

Dude (at 0415): Oh mah god lady, I need somethin for the pain now! It hurts so bad!

Shrtstormtrooper: *click* on the callbell.

Dude (at 0430): Imma gonna throw up! Bleeeaarrrrgghhhhh! See! I'm throwing up!

Shrtstormtrooper: You just spit up a little in the basin. But here's some zofran so you don't get sick again...

Shrtstormtrooper and Doctor (at 0445): Dude, we'll ask you again - any drugs or alcohol tonight?

Dude: Naw! I just needs somethin for the pain!

Shrtstormtrooper and Doctor: Well, your BAL is 120 and your tox screen is positive for cocaine and marijuana. Here are your discharge papers. Stop drinking, stop the cocaine. You're killing your own pancreas, and I will not give you pain medicine to help you until you help yourself. You skip your pain management appointments to come here, and we will not tolerate that. See your pain management doctor, stop the alcohol, and then come to us if you have breakthrough pain. And don't lie to us about drinking and drugs. It doesn't help your case at all.

Dude: This is bullshit, man. Why couldn't you have just told me this three hours ago? I ain't leavin until I get some pain medicine.

Dude (as he is being dragged out by security): Buuuuuullllllssshhhhiiiitttt! You's a nasty ass doctor, I don't never wanna see you again! You don't help me none, so what if I get drunk at hom-

I couldn't hear the rest of the rant because we kicked him out of the department. Sans pain medicine.



Laney said...

A win for the E.R then!!

Anonymous said...

How do you know he wasn't really in pain? Maybe he used the alcohol & cocaine to ease the pain?

Em said...

Oops sorry - I must have hit the wrong choice - the comment above is mine. I was just curious as to how you knew, definitively, that this patient wasn't really in pain?

shrtstormtrooper said...

Thanks for reading through the blog - I hope you enjoyed it!

As for whether or not he was in pain - I can't say whether or not someone is in pain. However, the ER is not the place for pain management. Pain management clinics are. And when a patient skips his pain management appointments to smoke crack and get drunk, and when it's the thirtieth visit in two months for the same thing, and when he is verbally abusive to the triage staff, and when he lies about the aforementioned crack and etoh, and when he is noncompliant with his disease management...well, we don't just hand out dilaudid on command. Pain or no.

It's an emergency room, for emergencies.

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