Wednesday, June 3, 2009

Repeat Business

I think I've said it before.

My ER is quite a magnet for repeat business for dental pain, migraineurs and various other narcotic seekers. It's quite a business.

Some of our docs and a couple of the nurses work at other ER's and see the same people from time to time. It's funny how they kind of just walk out when a nurse who took the same complaint (word for word) looks at the chart and says "Hmmm. I know you were give a 'script for Pen VK and Vicodin last Friday evening at Mt. Seaside. Are you not taking them?"

One girl claimed her backpack was stolen. Which contained her prescription for Percocet. One guy said he lost his prescription (at least his fifth for 20 Vicodin in the last 2 months). Another claimed her 3 year old threw her Percocet in the toilet. And the old standby "I knocked them into the sink".

How refreshing would it be to have someone come in and say, "Look, I'm addicted to painkillers" instead of devising these ridiculous fairy tales. A young guy I remembered from 2 or 3 months ago came in and told the exact same story about how he saw the dentist, he has an abcess and was told to come to the ER for antibiotics (and pain pills) and blah blah it will cost him $700 to pull his tooth and he doesn't have the money. Same story exactly, I looked it up because I remembered he had an unusual name. Funny that this time he had a different last name. He was invited never to return.

We have an unusual group of co-dependent migraineurs. A couple of them take turns driving each other (we don't let 'em drive after they get their fix for obvious reasons). One doc gave a migraineur VALIUM for cripes sake along with 100 mg out of the usual 150 mg of Demerol they normally receive. Now they all want it.

Speaking of driving under the influence of mind altering drugs, one of the chronic migraineurs got her meds, got on the phone for her ride, and said she would wait outside on the bench as he would be right along. OK. We were busy, but I was suspicious. I know what she drives, too, and I checked the parking lot. Nope, no van. No patient on the bench either.

I popped into my bosses office which has an expansive view of the back parking lot where we employees park. Oh, look.....there is my patient 15 feet below me starting her van and driving away.

Oh, doctor, guess who just lied and drove home?
Wanna talk liability?

That's it, he says. She's not getting another narcotic from me, and let the record show that she was observed driving after she said she had a ride.

Three days later she came back, parked her van in the back and got............NOTHING.

This is not to be mean or vindictive. Do you want to put your loved ones, both on and off the road at risk with this nutbag driving with a boatload of narcotics onboard? Didn't think so. I sure don't.

One of our newer docs refuses to give Demerol. At all, which is kind of interesting. She might order morphine, with a Vistaril chaser (which stings like a mad bastard when you inject it I might add). One of the co-dependents now claims morphine as an allergy.

I will say that some of the other docs are interested in coming up with unified plan. We are all feeling like pushers.

Come to find out, without fanfare and without warning the hospital pharmacy had decided to take Demerol out of the formulary as of June 1 (basically a list of meds the hospital carries....we aren't CVS, you know).

Apparently one of the migraneurs was forewarned, and must have thought it meant that we were no longer stocking Demerol in our satellite ER only, because low and behold, there she was on June the downtown main ER. Hmmmmmm.