Now i'm no Albert Einstein, BUT.......

This post is not completely about drug seekers, it's more about people who take advantage of the pain medicine that is handed out in the ER like condoms at your high schools nurses office.  Now I realize that pain is subjective, but when you enter a patients room and they are snoring at 1000 decibels, tucked comfortably into their heated blankets, making you call their name three times and give them a sternal rub or two to wake them up....this is not the best time to tell me that you are having 9 out of 10 pain.  It is also not wise to tell me that you cannot take tylenol and can ONLY take oxycodone because you THINK that only one kidney is functioning and Tylenol is cleared by the kidneys.  Heres why:

Number one... I will STRONGLY take into consideration that you are sound asleep breathing 8 breaths per minute with a pulse ox of 88% because you PRE MEDICATED yourself in the waiting room with "your" narcotic pain medication that was not prescribed to you...before you came to the ED

Number two... When you are slurring your words worse than someone who has had half their tongue cut off, and make me add STROKE to my list of differential diagnosis... I will fail you on a swallow screen and make you NPO because i don't feel comfortable that you can control your oral secretions... and you will by no means get that TASTY turkey sandwich you have hit your call bell 15 times for. 

Number three... You will severely piss me off, and I will find a way to professionally make you reconsider playing me for a fool, without neglect.

Thank you for your time :)

So thats what I'm dealing with...

Just a typical day in the ER....

The Fast Life: WHAT THE HELL DID YOU JUST SAY?!

The Fast Life: WHAT THE HELL DID YOU JUST SAY?!: "Every ER nurse, tech, doctor, etc. has at least one or two moments during every shift, that they have the intense urge to calmly verbalize t..."

The Fast Life: WHAT THE HELL DID YOU JUST SAY?!

The Fast Life: WHAT THE HELL DID YOU JUST SAY?!: "Every ER nurse, tech, doctor, etc. has at least one or two moments during every shift, that they have the intense urge to calmly verbalize t..."

WHAT THE HELL DID YOU JUST SAY?!

Every ER nurse, tech, doctor, etc. has at least one or two moments during every shift, that they have the intense urge to calmly verbalize the following phrase, "WHAT THE F*** DID YOU JUST SAY?!"  If I compiled every single piece of ebonics, slang, attempted phrase, or mispronounced medical condition/medication that i've had to stop and think 20 times about what i've just heard, and/or think 20 times about how i'm going to ask this person what in the hell they just said, without coming across as an utterly inconsiderate prick, I would have enough information to write a multi-volume encyclopedia.  I'll give a few examples --> with my response:

1.  "Yo i think i gotz dat screamin catty hooch" -->  Sounds painful... let me google that right quick

2.  "Boff mah headz is hurtin"  -->  No more questions asked

3.  "Dis toof been pain painin me all week long" -->  You don't deserve to have teef

4.  "I been had dis burnin fo a minute" -->  I for some reason believe that we have have a       misunderstanding of the definition of a "minute"

5.  "I gotz dis thang dats you know... DANGLIN.... right in between mah crack.. you know... mah butt crack" -->  My differentials included: Dingleberry/Hemorrhoid/Anal beeds stuck in rectum

Everyone is welcome to contribute to the list!... lets hear some more...:)

A Note to Drug Seekers

A funny note circulating in the ED... gotta love it!


OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don't have your vicodin, me because I've seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker. 

The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like shit because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot. 

The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your ass. I also don't want to miss the poor bastard who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier. 

The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.) 

The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me the fuck off. Pissing off the guy who writes the rx you want does not work to your advantage. 

The fifth rule is don't assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won't necessarily mean you don't get any pain medicine. Hell, the fucktards who list and allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.) 

The sixth and final rule is wait your fucking turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER. 

So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don't really give a shit if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says 'I am a drug seeker' and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier. 

Sincerely, 
Your friendly neighborhood ER doctor

Funny Discharge Instructions

Pt. comes to the ED complaining of dental pain, headache, and ran out of blood pressure medications 3 days ago, and isn't able to fill the Rx until tomorrow.  Blood pressure 200/100.  Pt wakes up every morning at 3am, smokes one cigarette and states he then smokes weed "all day long."  He also has been taking ExLax every single day to "help clean me out."

Treatment:  P.O. HCTZ, Penicillin, and Percocet... than discharge

Discharge instructions per MD: "Please take blood pressure medication as prescribed to you", and "STOP SMOKIN THAT WEED."

HAHAHAHAHA..  I read the discharge instructions exactly as written...kept a straight face the entire time.  God I love the docs I work with.