February 22, 2011

• Moron Compassion and Pain Scales

  Being an ER physician is very challenging.  On a daily basis I am reminded that many people out there have the intelligence ranging somewhere in between an eggplant and a dachshund… and I might be insulting wiener-dogs by saying this.

  So I go into the patients room, who is here for an assault.  I try to have great compassion for anyone who has been assaulted, regardless of the circumstances.  I once got punched in the face at a video arcade over tokens.  I didn’t know the price for NOT giving said tokens was a black eye or I possibly would have reconsidered.  However, considering at the time my near rapturous love for Galaga and pinball, I think I would still have rather had the black eye than give away my allowances worth of tokens.

  I walk into the room.  I find mom.  Here’s the conversation, which I am embellishing, but surprisingly little.

  Me (handsomely):  “Hi, I’m the doctor here to evalu-”
  Mom (sighing): “She’s in the shower.”
  Me (confused): “Excuse me?”
  Mom (smug):  “She’s in the shower”
  Patient (drunken shouting):  “I’M IN THE SHOWER!”
  Me (still confused) “Why is she in the shower, I’m here to evaluate her…”
  Mom (not sure) “I’m not sure
  Patient (drunken slurred speech) “I WAS COLD!”
  Mom “She was Cold”

  <I should pause here to explain there is only 1 room in the Emergency department with a shower, just in case patients need to rapidly be cleaned from chemical exposures, etc.  She did not have chemical exposure.  She had been exposed to chronic stupidity, but showers help this very little.>

  Me (a little frustrated) “But, she’s here to be seen, right”
  Mom (also frustrated) “The doctor’s here to see you!”
  Patient (drunken anger) “I’M TAKING A SHOWER, TELL HIM TO COME BACK LATER!”
  Mom (embarrassed) “Can you come back later”
  Me “I guess I’ll come back later”

  So I leave the room, still confused.  She continues to take her shower.

  I go on to my next patient, he is 16, and he has back pain, I’ll call him Jimbo, because typing ‘incompetent douchebag’ over and over takes too much space.

  ME (awesomely) “Hi there Jimbo, what brings you in,”
  Jimbo (Deeerp!)  “I gots me some back pain,”
  ME (still sweet)  “Ok, when did this start”
  Jimbo (Derrrr)   “I dunno”
  Me “…”
  Jimbo “maybe 3 weeks ago?”
  Me “Are you asking me?  Alright.  What did you do”
  Jimbo (slightly angry that I’m distracting him from watching TV) “I dunno.  Nothing.  My BACK hurts.”
  Me “Yes, I understand that.  Where does it hurt in your back.”
  Jimbo “It hurts IN my back.”
  Me  “Right.  WHERE in your back does it hurt?”
  Jimbo (while leaning forward, twisting all over, reaching down for the dropped remote, then twisting the other way, all without the slightest amount of difficulty or distress) “it hurts EVERYWHERE!”
  ME (Getting a little miffed) “I see.  It says here you have 10 out of 10 pain,”
  Jimbo (also getting miffed) “That’s wrong”
  Me (a little relieved)  “Oh?”
  Jimbo (while yawning and leaning over to the side to see the TV better) “Yeah, I told the nurse that it’s actually 20 out of 10 pain, but she only wrote down 10!”
  Me (turning off the TV) “I see, did you take anything for it?”
  Jimbo : “Yeah, my step dad gave me some Norco (which as you may know is stronger than vicodin) for it.  That helped, but it still hurts now.
  Me:  “ah”

  So I examine Jimbo and find nothing.  I then leave this room and order some muscle relaxer.  This annoyed him as well since he wanted IV narcotic pain medicine.  Did I mention he is 16 with no health problems?

  Back to the drunken princess, who has finished her shower

  Her “I have 10/10 pain”
  Me “But you just walked up to my desk, asking if you could go smoke, you don’t appear to have any pain.  At all”
  Her (drunkedly) “I have a high pain tolerance.  My pain tolerance is really high so I don’t ever complain.  Can I get something to eat, and gimme some Vicodin.”
  Me …(about to say something, but I am called out of the room)

  I do orderr some Xrays to be sure nothing is wrong (nothing is wrong (shocker))

  A child is brought in.  The kid has the exact same birthday as my daughter.  He is amazingly cute.  Unfortunately the beautiful child accidentally pulled boiling water onto himself.  The parents are frantic and the kid is wailing uncontrollably.  The child has 2nd degree burns over the face, chest, arms and legs.  Multiple layers of skin are sloughing off and other areas have very large blisters.  The nurses and I work quickly to start an IV, get pain medicine and attend to the badly burned child.  The 22 month old kid is an absolute trooper and mom and dad (all things considered) do amazing as the kiddo gets some pain relief with many small aliquots of morphine.  The kid’s pain gets under control and we get him ready to transfer to the burn unit. 

  My heart is racing, but we did a great job.

  Now back to the other patients.

  Me “Hey Jimbo, how’s your back pain?”
  Jimbo “My what?”
  Me “Your back pain, remember?  How do you feel?”
  Jimbo  “Oh, I guess it’s down to a 9/10 (while he eats cheetos and drinks his pop)”
  Me “9 out of 10, huh.  So it’s difficult to think of any pain worse than what you have right now?”
  Jimbo  “Yeah, I have really bad pain”
  Me (thinks about the 22month old covered in burns) Great.  Here’s a script for motrin and a muscle relaxer.”
  Jimbo “WHAT?!  You mean you’re not prescribin’ me Norcos?  Not even Vicodin?”
  Me “No.  I don’t prescribe healthy 16 year olds with no problems narcotic medicine.”
  Jimbo “Well, I’m just going to go to another hospital then”
  Me “You are welcome to do that, but I’m still not giving you Norco.”

  I leave, he’s discharged.  I visit the inebriated showering princess again, to tell her everything is normal.  She’s angry as well since she is VERY drunk and I won’t give her Vicodin right now for her pain.  She has a hard time telling me where, precisely, her pain is, but she wants narcotics for it doggonit!  Every Xray is negative and she is discharged.  Also quite angry at me.

  So maybe this is just me venting, but that’s a typical shift. For every 1 real patient, I see two retarded patients.  Well, that’s not true, since actually most of my actually mentally challenged patients are quite pleasant, I would not want to insult the retarded.  At least that day I was able to help someone who really needed help, so that’s good. 

  • 2:56 am
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