Of Chance and Drugs

This is my 100th post! And I worked a double shift- out of the last 32 hours, I worked 24 of them...  It doesn't feel so bad, but looking at it that way makes it look that much worse! Luckily, most of these past 16 hours in a row were  not on my feet, as I was in Urgent Care and had a lot of paperwork to do.

And little did I know, I missed the memo that declared today the unofficial Drug-Seeker Day!
It's the holiday where opiate addicts of all ages, shapes, sizes, and intelligence levels come to the ER to feed their gambling vice.  Will they score? Will they score big? And on our tab? (That would be the jackpot) Or will they get escorted out by security and blacklisted? Take a roll of the dice- somewhere along the way, many have apparently found reward in this terrible game.

Naturally, this game of opiate-collecting is equally one of chance and skill.  As far as chance goes, they might meet one of our new providers that doesn't know them by name/face/habit.  Perhaps they might come when we are tired/distracted/discontented and hope we might not notice how regularly they visit every 30 days to get that magical prescription. Maybe they might have a legitimate (self-inflicted) injury.  Or perhaps they might be skilled players and alternate between different pharmacies and providers every few days. Maybe they developed incredible powers to break down the will of providers or just the gift of gab and persuasive power.

In any event, I was working with a well-seasoned veteran APRN who knows the numbers to local pharmacies, certain pharmacies outside state borders, the websites to trace narcotic prescriptions for certain individuals, and  has an exceptional sensitivity for people.  His sarcastic pen broke many dreams and wrote many prescriptions for motrin and tylenol today. Becoming rather seasoned myself, I made sure security was already awaiting our problem clients on their escorted walk back outside.

There were quite a few seekers from out of state that were found on our databases to have been flagged in multiple states. They were very surprised to be found out so quickly, but I am sure they will find other places and other ways to gain these prescriptions lawfully.  Or they will come back tomorrow for another roll at the dice in urgent care.

S

Prescription Parables

Once upon a time, there was a young woman who came to Urgent Care and said she fell. She proclaimed to have a lot of pain. Upon the doctor's asking, she revealed that she fell over a month ago. X-rays revealed nothing out of place, but when the doctor prescribed her Motrin, she protested she needed something stronger. However, her record showed she was allergic to all narcotics, which she contested with all her might. This all was to no avail, however, as she was prescribed Tramadol, which she incorrectly identified as an anti-inflammatory. The brash young witch then argued with and threw a pen at the doctor, angry that she could not get a narcotic prescription, revealing that she stopped coming to our hospital because we wouldn't give her anything in the past either, at which point, security escorted her out, amidst a volley of curses very unbecoming for any young lady.

Moral: Be a lady, leave with dignity. Contesting the competency of the doctor will get you red-flagged, not the Rx you want to sell. Threatening to go to patient-services is also futile.

Corollary A:

Once upon a time, there was another young woman who claimed to have fallen. Pathetically lethargic in a wheelchair, she said she couldn't move. Upon entering the room, I asked her to hop onto the bed, which she did with lightness and grace that one expects from a young lady. She proclaimed not to remember when she fell, where she fell, nor why she didn't remember she fell. As her x-rays came back normal, and interviews with her proved futile as she was high as a kite, we concluded she was in need of nothing stronger than Motrin. Of course, she protested this decision, naming Percocet as her drug of choice. When she realized she could not budge the doctor, she threw out her prescription in our pail, laughed in our faces, saying, thanks but no thanks, *****. Threatening to go to patient-relations, she was too high to notice our stone-cold faces as we calmly called security to escort her out.

S

I'm Tellin' duh Troof

Mr. First-timer:

S: So it says on your triage note that you came in for back pain that you've been having for a month. Did you fall or lift heavy objects? How did your pain start?

Mr. First-timer: Well, when I was a kid, a car hit me.

S: That's when it started??

Mr. First-timer: Then, last year, I slipped and fell on some ice, y'know. Like, it was slippery.

S: Ok... anything happen recently? What made you come in today?

Mr. First-timer: Well, I went to the dentist last week, to get a toof pulled (points), and I got some percocets. And when I took them, I noticed, my back pain went away too... (expectant eyes)

S: ... I think I see. I'll let the doctor know.

This rookie obviously has not trolled for pain-killers before- that or he's just really honest.

S

A Good Day in Urgent Care

Yesterday evening was the perfect follow-up shift to a few days in the drunk tank. I was stationed in a separate little urgent care clinic where people come in for less medically serious reasons- small lacerations, broken fingers, muscle strain injuries, small abscesses, rabies shots, prescription refills, etc. The technician can help clean wounds, dress wounds, splint injuries, apply ace-wraps, knee immobilizers, sling and swaths, ice bags etc to an orthopedic injury, as well as a lot of the computer work.

Besides one aberration patient, the day flowed very smoothly and I got to hang out with some of my favorite nurse practitioners ever.

The drama-king came in screaming, my wrist, my wrist! he had it bent backwards with an ice-bag filled with hot water. For some reason, he was in a wheelchair. APRN took one look at him and said, take him to x-ray (and don't bring him back). "I need meds!," he yelled, "I'm in so much pain. Get the doctor here right now, I can't go without pain meds!" There was alcohol and who knows what else on his breath. I got him an ice pack, and he went off without meds to x-ray. He had 2 visitors come in soon after, a disheveled girl and a man with a gold grill in his teeth. I have never seen anything like it... it's like

But with this:

Why in the world would anybody do that? But anyway- there was something strange about this situation. When they heard he might be coming back to this clinic, the girl angrily said "I'm not playin' these games. He better get the meds over there. Let's go."

They're obviously still young and green in the drug-seeking game. Better luck next time...

Urgent care can be really hard to work in when there are a lot of patients sent to us, all of whom need x-rays or stitches, or abscesses lanced or a consult from orthopedics/podiatry/plastics/etc. There are just so many procedures and tasks to do for each patient.

It's hard on the physicians assistants/APRN's for different reasons; they were talking about the ones who couldn't take it anymore- the ones who had quit. A woman came in for thoracic back pain and was sent home with a followup appointment and pain meds; the next time she came in was for a massive pulmonary embolism, dead. The PA who treated her quit soon after.

You also get really weird/funny/stupid cases, like the cop who came in for a human bite.

Where did you get bitten, sir?

Here on my arm. Is it gonna get infected?

It looks like it didn't break skin. That means you're ok.

But there was saliva!

It didn't break skin, sir. It's ok.

Even with saliva?

Yup.

Or the guy who came in for "genitourinary problems" who ended up with just a blackhead/ingrown hair on his pubis. It wasn't even remotely red or swollen. He made sure to call his wife a few times and leave messages to assure her he was ok, but that he was in the emergency room, not telling her what it was for and scaring her half to death.

Or the kid who had a giant abscess on his butt cheek who grunted the whole time we were lancing it. Just grunted- no yells of pain, per se.

I walked by the drunk tank to take a look; it was even worse than the night before. THANK GOODNESS I wasn't in there last night. If anything, being there every day is what is going to make me burn out.

S