More Fun with Drug Seekers

Another busy night with the oh-so-wonderful Bobo was the usual  freak show.  We gave out 30 Percocet because certainly every single pain deserves to go home with at least four pills.  Right.  That was dental pain, chronic back pain, and various atraumatic aches and pains.  What a tool.  I had to get in his face and advocate for narcotics for a patient with a bad wrist fracture who really needed them; then she said she hated that stuff and wouldn't take anything stronger than ibuprofen unless she really, really couldn't stand it.  Sheesh.

I had to retrieve Drama Mama from the parking lot.  She had been hit by a car, having been standing in front of it when it accelerated. Three hours prior to arrival.  She arrived by private car without swelling, bruising or a mark on her.  "I can't stand up!"

 I won't go into the booooooooring detail here, but let's just say the mechanism of injury, while consistent with the degree of 20/10 pain the patient stated she was experiencing, was not evident in the exam.  In other words, she had pain everywhere but not so much as a ding.  And then there was the healing abcess on her forearm and that history of IV drug use that she denied and said it was from a fish hook.  She was so high on the last 2 visits that forgot her own story.

It seems the Dilaudid train had left the station without her.  She had been getting daily wound checks/packing/IV antibiotics (of COURSE she was not sent home with an IV, duh!) and multiple doses of narcotics at each visit because of her histrionics. Bobo, to his credit, was not convinced with Drama Mama's appallingly sub-standard over-the-top acting.  Apparently yelling about your pain (between cell phone calls to yell to yell to friends and family about life-threatening pain) is considered to be the ultimate test of veracity.

Bobo: Don't put an IV in her
Me: Duh
Bobo: Just go ahead and give her 1mg of Dilaudid IM

Drama Mama got her shot; moaning, sobbing,crying (without tears of course) she managed to very calmly ask me what side she should roll over to and then EFFORTLESSLY proceed to do so.

Eight minutes later she was on the call bell yelling hysterically: "It's not working!  I need more medicine!"
Me: "It will take a little longer than eight minutes to work.  But I'll tell the doctor"

Bobo was informed, at the 10 minute mark when he was done with...whatever he was doing, that I had given the shot exactly 10 minutes previously and she was refusing an x-ray until she gets more medicine.

He told her nothing more and that she needed to give it 30 minutes.

Ding!  On the call bell again (which, but the way, she had to get out of bed to retrieve because I failed to give it to her bad nurse that I am).  "As long as I have to wait a half hour I might as well have an x-ray"

Me: "Peachy!"

She managed to get another 1/2 mg Dilaudid out of Bobo before even he got tired of her and kicked her to the curb.  Drama Mama walked excruciatingly slowly with her enabler/handler/boyfriend twice her age to the doorway, yelling at him the whole time to "hold me up!", accompanied by much moaning, sighing, wailing and gnashing of teeth.

End of story?

Nope.

She was in the next day as I came to work, same complaint except this time she had embellished her story and added theft of her daughter's back pack and some oxycontin's, and that she had tried to stop them from taking the vicodin we had prescribed the night before by standing in front of the vehicle.  Not realizing the lie that she was hit by the car BEFORE she came to the ER.

And we didn't prescribe any vicodin.

Which proves that time travel IS NOT possible!

Fifty Shades of Drunk

Patients frequently walk unknowingly into the ambulance bay door instead of the main ER door even though it has a big-a$$ sign on it that says AMBULANCE on it.  This is right in the middle of the department work area so immediately all eyes are upon thee. It is like walking directly onto a brightly lit  stage.  Spotlight!

A couple walked in center stage, and the woman, realizing that she was on stage immediately put her hand to her head.  She had apparently passed out cold when she went outside to smoke a cigarette while out to dinner with spouse and friends.  She fell into a puddle as it was raining.

"I think it might be an allergic reaction"

She "didn't have much to drink...maybe it was the lobster mac and cheese.  My father is allergic to lobster".

"Not much to drink", it transpires, consisted of  6 beers and 2 margaritas over the course of the evening.

The woman asked if we would be testing her for lobster allergy.  Um, no.  You need an allergist for that, it's not an emergency.  She also continued to tell us that she doesn't drink much (not since they invented the funnel, ba-dum chhhhhh!), has a respectable job, children, responsibilities, etc, etc.  She was not an alcoholic.

And thus the middle aged couple continued to speculate, while the woman was rehydrated, that the cause of her syncopal episode was allergy (possibly), dehydration (quite likely), encephalitis, meningitis (improbable), or heart related (ruled out).

There was NO WAY it could be related to alcohol related since she just didn't have that much to drink.

Defying Gravity

I worried about this guy.  IV drug user; hugely swollen and red arm, an abscess gone completely haywire, and it looked like it had been going on for awhile.  He was promptly triaged and placed in a room, the dirty used ace bandage unwrapped.  The smell was horrible.  He looked sick.

He left without being seen, scampering unnoticed out of the department after about 10 minutes on the premise of using the rest room.  Home number disconnected.  Police well-being check turned up an abandoned house.

Some people don't merely fall through the cracks: they plummet.  Perpetual free-fall.

It's the Most Wonderful Time of the Year

School is about to start, so it's time to have all those rashes, bug bites and aches and pains checked that kids have had all summer.  It is also the time of year for requests for school and sports physicals, and immunizations to be updated which we do NOT do; lack of planning on the part of the parents does NOT constitute an emergency.  This is just laziness because I know the local school nurses send updates in the spring notifying each grade level to start making their summer pediatric appointments promptly because they book up three or four months in advance.  It is pretty hard to get an appointment once June rolls around, and by the end of August you are just crap out of luck and your kid won't be playing sports without that physical form.  So just do it already.  Some people will try to parlay a bogus injury into a comprehensive physical exam, but we are wise to that and won't sign the forms.

During the school year we see WAAAAAAYYYY too many school-age kids at 9:00 or 10:00 PM with injury sustained during the day.  It is one thing to try common sense remedies such as RICE (Rest, Ice, Compression, Elevate) for hours and then bring the kid in because it is very painful.  Most often the complaints of knee, foot, ankle pain are reported near bed time without any intervention.  After a full day of school, sports, playing and jumping on the trampoline for an hour the kid reports the injury as "not better" and the parents race to the ER for an x-ray, walking without difficulty.

So I am going to go out on a limb here and suggest, as a public service, that this school year a little common sense be deployed when it comes to breaking land speed records getting to the ER for a negative X-ray.  See RICE, above.

Also, crutches are really not fun after about an hour.

I'm So Dizzy, My Head is Spinning

A 63 year old man walked in with dizziness.  Dizziness is always so vague; it is a gateway symptom to something else that's going on usually.  In this guy's case, there was also a bunch of other stuff, including leg swelling for months, and oh, yeah, this numbness in my face.  He hemmed and hawed and thought out loud about each and every question which just makes triage so much more difficult.

Dizzy Guy was accompanied by a female friend; close friend from the looks of it and the way she tried to answer every question.  Or contradict every response he made.  Or point out another symptom.  Or correct a time frame.  Or rat out yet another symptom.  Or embellish and speculate on every triage question.

Me:  Are you diabetic?

Dizzy Guy: Well, I haven't seen my doctor in about a year, so I could be...

Dizzy Girlfriend: He has to be...

Me: To be clear, you have never been diagnosed with diabetes or pre-diabetes and are taking no medication?

Dizzy Guy: Um, no, but sometimes my blood pressure is up.  I have some back pain, and I.....

Dizzy Girlfriend: He has been under a lot of stress at work; I want you to write that down.

Dizzy Guy: I'm FINE.  I'm NOT having a heart attack.

Dizzy Girlfriend: I want them to know everything and you don't tell them everything....

Dizzy Guy: I have been having some leg swelling, but I think I've been walking around a lot..

Dizzy Girlfriend: I think he's been trying to cover up the fact that he's been short of breath when he walks

Dizzy Guy: Not really, it was hot yesterday and I was...

Dizzy Girlfriend: Yes, I really think he was!  And he didn't eat as much as he usually does, and...

Me: Time out!  Let me just talk to Dizzy Guy for a minute, mmmmkay?

Dizzy Girlfriend: OK, I'll shut up.  Did he tell you about these little dots on his legs?  And why does it look like they are 2 different colors...

Me: Why don't you have a seat over there for a minute?

Dizzy Guy: She will drive you nuts.

Dizzy Girlfriend: I'm just looking out for you

This exchange was rapid-fire, neither one could focus.  And they kept interrupting each other AND me.  I became frustrated being unable to get a word in edgewise so I kinda lost it.

Me: OK, nobody talk but me, then I want the Reader's Digest abridged version unless I ask.  Got it?

Things deteriorated when the doc told them Dizzy Guy might be having a TIA.

Dizzy Girlfriend: (yelling into the phone) He could be having a TSA!  He has to go for a CAT scan!
Dizzy Guy: Is she driving you crazy yet?

Me: (banging head against desk) TIA!  TIA!  TIA!  TSA is at the airport!
Partner in crime: Well, at least they won't need the complimentary strip search.

I pulled a 7th grade Vocabulary Workshop word out of my a** and pronounced them garrulous.

As he was wheeled away, the paramedics offered him a blanket.

Dizzy Guy: Well, I don't know, I could.  I really don't need it, but I suppose I could take one and....
Me: Just take it!  It's a blanket, not an investment decision!

They were nice people, but exhausting.