drug seekers

Since the cool thing to do seems to talk about those who use the ER to get their pain med fixes, and people are telling their, you will never believe what happened stories, I, being the little follower puppet I am, am going to share with yall the patient that pushed me from the naive little nurse I was to the jaded veteran I am (haha). It was a relatively slow night in our er. At about 1130, a patient comes via ems "fully packaged", i.e. cervical collar, backboard, the whole enchilada. I am getting report as we are putting this patient on the bed and the EMT tells me that they picked this patient up, who was with a sibling, because a door had come off of its hinges and hit this patient in the head. Ummm, ok, why fully packaged? The sibling demanded it. The sibling comes in with the patient in one of those soft cervical neck collars that looks like a sock full of rice. Mind you, I could have fit my neck in with his neck, the thing was so loose. The sibling starts talking about the reason he made them keep the patient on a backboard is because he has a bad neck problem and he knows the damage that could be done to his siblings neck permanently. The sibling keeps going on and on about his "disability".

I turn to assess my real patient and the first thing I notice is that there is a hospital emergency id band on the right wrist, from the hospital not even 2 miles up the road. I ask the patient about it, and the patient tells me that the hospital staff was mean and rude to them, even talked bad about their shoes! I get the rest of this patient's history, chronic fatigue, appendectomy, spleenectomy, migraines, degenerative disc disease, and, I kid you not, pancreaectomy(did I spell that right?) This patient is also allergic to everything under the sun and tells me that due to not having a pancreas, they can not take any PO meds, it makes them way too nauseous. This patient wanted me to believe that there is no longer a pancreas in their body! That is just to give you a taste of how crazy this patient is. I just happen to know a coupla nurses that work over at the other hospital's er, being a semi small town, the nurses sometimes work at both places, and I decide to give them a call.

Before I call I read the ambulance report and almost cry trying to keep from laughing. Apparently the patient was picked up two blocks from the other hospital at a gas station in the back of the taxicab. So, our medic had to get the patient from a seated position onto a backboard and secure c-spine....hmmmm. So once I recover i call one of my colleagues at the other hospital. They tell me, unofficially of course, that the same story was given to them, they did ct and xrays, everything was clear. They were about to give PO pain meds when the patient started going on and on about how because of the pancreas being removed, they are unable to take PO pain meds, they need a shot. Well that hospital has more balls than ours, they held their ground, and apparently, the patient ripped off the c-collar, and stomped out with the sibling trailing behind. The nurse also throws in the bonus that they have both been trespassed in the past at their hospital. If I can get the patient to sign a release, they would be more than happy to fax us their copies, bonus is that our radiologists are the ones that read that hospitals ct and xrays overnight.

So my mission was to get this patient to sign a medical release form, which I knew from prior experiences was not going to be easy. What did I do? I merely told the patient that high doses of radiation can be harmful, especially with as many medical problems as the patient has, so instead of repeating the studies that were completed at the other hospital if you sign this, we can just get their studies and not have to expose you to more radiation, which could cause your leukemias to act up. The patient replied "you know what, you are absolutely right." So I got the signature and faxed it to the other hospital.

I give the doctor the heads up about what is going on, and let the doc know that the fax was coming back. While awaiting the fax, my patient's sibling has disappeared. My house supervisor calls me laughing so hard he can barely talk and tells me to look at our security cameras. I look in the lobby and lo and behold, but who do I see, the sibling sitting out there, rolling his head back and forth in that ragged soft collar, it really did look ridiculous. Then I stop laughing because I see that the sibling has signed himself in for neck pain. Ohhh, boy.

About then, our night got bad, real bad. One of our own comes in unresponsive with a huge lac to the back of the head and no one knows what happened. Ends up having a huge subdural with a shift and must go to have an emergency craniotomy. So that takes up a long time. When I leave that room, I see my patient up in the room walking around (the doctor has not had a chance to see them yet), going to the side of the bed and grabbing the c collar off of the floor. I ask what was going on. apparently my patient got tired of lying on the back board and getting told that the doctor must see them before any meds could be given and the backboard got flung across the room. Our lovely tech just went in and set it up against the wall, told the patient there was a trauma and the doc would be in as soon as possible, all calm like. Apparently next, the patient ripped off the c collar and flung it too, this was largely ignored by all involved. So I was coming out of the trauma and witness my patient walk over to the side of the bed, pick the c collar off of the ground and out it back on, upside down and sideways.

I nonchalantly walk into the room and apologise about the wait, tell the patient that they are next to be seen. The patient then proceeds to tell me that the neck brace isn't feeling quite right, could I fix it? Keeping a straight face and playing the game, I put the collar back on right, though my nurses notes clearly show the real picture.

I feel I have done my civic duty by giving our doc all they need to treat and street this person. But to my utter dismay, we repeat all the studies and we have ordered 1mg of dilaudid! i am so mad I can spit. I go in there and am about to start the IV when the patient informs me that they have a port a cath. I ask the patient why they have a port. This patient proceeds to tell me that their family practice doc knows what small veins they have and if they are ever in a wreck or anything and needs an emergency transfusion, they need something that can be accessed. I am standing there utterly flabbergasted. I want this docs name to yank his license. I have never heard such bull in my life! That is what central lines are for, we would never resuscitate someone with a port anyways, the gauge is too small.

End of the story, patient got dilaudid and phenergan, everything was stone cold normal. C/O 8\10 pain on discharge, doc ordered a Lortab which the patient took without regards to the missing pancreas, didn't even bring it up and was surprisingly spry springing out the door with sibling who was not as lucky and got the a doc that does not believe in handing out candy to keep the pilgrims happy, his motto? If you feed them, they will come.....