Monday, August 9, 2010

Well, What DID you think was gonna happen?

Jay Leno had a rather amusing segment called "What Did You Think Was Going to Happen?". There was a video clip with a young man straddled between the front bumpers of two facing cars, with his, er, um...junk.... stationed directly over a lit bottle rocket. Predictably, the bottle rocket lodges in his jeans at Ground Zero; hilarious hijinks ensue. What Did You Think Was Going to Happen indeed.

I silently ask the same question of many of our ER patients. There is a great dearth of common sense out there. A vast wasteland devoid of both common sense and, frankly, any sense at all. Of course, the patient's own agenda frequently defies any kind of sense or even native intelligence. Many simply have no brains at all.

It never ceases to amaze me how frequently ignorance is eclipsed by galactic stupidity.

There is no cure for the common cold. Only bonedheads and the uninsured/free care/I'm never gonna pay my bill crowd anyway show up at the ER for antibiotics to cure said cold. Two nights in a row. One guy was seen twice in 24 hours because his pneumonia wasn't better after 1 dose of antibiotics; he wasn't worse, just not miraculously better. Dumbass.

As you know from previous posts, many days I feel like the Narcotics Elf who works with Dr. Santa Claus. We see the same people over and over and over. Sometimes they hit the right doc, sometimes they leave with nothing but their pud in their hands. These are the "Pitch 'til You Win" repeat offenders. One of our more routinely presenting frequent drug-seeking flyers has apparently pushed even Dr. Santa Claus over the edge.

She had been seen by Gil earlier in the day for her really bad (yawn) migraine. He went off the board and gave her Fioricet, which is an OK drug for migraines but which does absolutely nothing at all for someone who just wants their vicodin or percocet. "Vikes or perky Percs" as my colleague Kerry calls them.

Anyway, she sent in one of her frequent flier co-dependents to scout out which doc was working and was busted by Sheila, the secretary. "Oh", she said, "I just wanted to see if Dr. Santa Claus was here tonight; I thought I would just say hi". Sheila kicked her out and told her that she was trespassing unless she wanted to see the doctor. Riiiiight. Way to go Sheila, booting her out, quite rightly. Well, what did you think was going to happen?

Play along with me now as we delve into the world of
"What Did You THINK Was Gonna Happen?"

You may vote for the most stellar example.

1. For three months in a row, the same idiot has come to the ER requesting refills of his extensive list of psychiatric medicines. For three months in a row, we have refused. He couldn't seem to understand why the result was not different for month four.

2. One woman has refused to take her antihypertensives or antidiabetic meds in six months. She is five foot nothing and weighs over 300 pounds. She smokes about 2 packs of cigarettes a day; everytime she comes in she has grande mocha Frappucino and a charming new tatoo to show us. Is anybody shocked and appalled that her BP is Patent Pending/130? I certainly am not. She routinely refuses admission (and yes, we have had a psych eval done) and claims that with all of her other expenses she can't afford her meds. Maybe holding off on the tatoos and Frappucino's would help, but I doubt it.

3. One young man came in with back pain; I often look up the previous visits when the story doesn't quite match the way the patient behaves in triage. For example, they might whine about how tight the blood pressure cuff is when they are texting with 10/10 pain. Or, not realizing that we have a camera in several areas of the building, we often watch patients exit their vehicle and walk normally across the parking lot, only to turn on the drama once they hit the door. I never say anything though I often will comment to the doc that I had observed a normal gait before entering the department. Hence the "look up".

This particular young man has not been seen in about 10 months; prior to that he had been seen at least 8 times in two months with various pain related complaints. On the final visit, he was give a script for 15 Percocet by Dr. Santa Claus. The pharmacist called, concerned that the "1" had been changed to a "4", so it looked like Santa Claus had written him for 45 Percocet; it's just not done. Nor do we give out narcitic 'scripts with refills. With a different colored pen. The phamacist was instructed to tear the 'script up and advise the patient that tampering with prescriptions was against the law. Dr. Santa Claus was kind enough to document this fact in the patient's chart for future reference. He is lucky he was not arrested. You can imagine that the kid was pretty pissed that he did not get any narcotics this visit.

4. Here's one from the lazy EMS from my own town, who called on the land line to say that they were bringing a 23 year old who had taken an overdose of Zyprexa (used to treat schizophrenia and bipolar disorders). He had stable vital signs and seemed "OK". That was the report. Are you fucking kidding?

Um, no, you won't. For one thing, any overdose is presumed to be a suicidal attempt until proven otherwise, regardless if it was accidental, ESPECIALLY with a history of psychiatric issues. That means that the patient must be watched continuously to assure his safety until he is determinied to be safe. Or shipped off to inpatient treatment. That means a security watch, which we emphatically do not have. We also do not have any social workers available at our facility to do an evaluation. The physician instructed them to take the patient to the Mother Ship. Lazy, like I said, to presume to do otherwise.

5. We actually had a teenager come in with testicular pain, brought in by his father. This occurred after the teen had some physical contact with his girlfriend; apparently not enough. He was diagnosed with blue balls; Dr. Cripes said he had to give a little birds and bees lecture to the mortified teen. I thought the father should be the one who was mortified. Cripes was at a loss as to how to come up with a medical diagnosis for blue balls; Google to the rescue. It is called vasocongestion. Don't try this at home.