A Letter to a Cliché
Dear Mademoiselle:
I'm so sorry that your visit to our storm-ravaged ER was less than satisfactory to you. I must admit that working for 20 hours straight in a facility without air conditioning might have made me slightly less than optimally compassionate, therefore I was not inclined to repeat my explanation to you why you couldn't have a fifth round of intravenous narcotic for your "migraine."
A delicate migraineur like yourself obviously ravaged by pain to the point that you "almost threw up" once and bearing such a tortured expression when I would enter the room to interrupt your cell phone conversation obviously needed much stronger medication more frequently than I was willing or able to provide to you. Our nurses definitely got the message because you were hitting that call bell like an enthusiastic xylophonist. Well played!
Unfortunately mon cherie, as I explained to you already, your extensive list of allergies to non-narcotic medications made treating your condition rather challenging. You are living proof that narcotics are ineffective for treating migraines. Merci!
Complain about me then as you wish, my delicate little cheesepuff, but understand that welfare recipient drug seekers like yourself aren't entitled to unlimited narcotics any more than you are to unlimited recitations of my gentle GTFOOMER speech, and that on your next visit your reputation will precede you.
Oh, and that "bloating" in your abdomen? It's called fat. Might I suggest avoiding the crepes and that obviously uncomfortable thong?
Bonne chance,
Scalpel
I'm so sorry that your visit to our storm-ravaged ER was less than satisfactory to you. I must admit that working for 20 hours straight in a facility without air conditioning might have made me slightly less than optimally compassionate, therefore I was not inclined to repeat my explanation to you why you couldn't have a fifth round of intravenous narcotic for your "migraine."
A delicate migraineur like yourself obviously ravaged by pain to the point that you "almost threw up" once and bearing such a tortured expression when I would enter the room to interrupt your cell phone conversation obviously needed much stronger medication more frequently than I was willing or able to provide to you. Our nurses definitely got the message because you were hitting that call bell like an enthusiastic xylophonist. Well played!
Unfortunately mon cherie, as I explained to you already, your extensive list of allergies to non-narcotic medications made treating your condition rather challenging. You are living proof that narcotics are ineffective for treating migraines. Merci!
Complain about me then as you wish, my delicate little cheesepuff, but understand that welfare recipient drug seekers like yourself aren't entitled to unlimited narcotics any more than you are to unlimited recitations of my gentle GTFOOMER speech, and that on your next visit your reputation will precede you.
Oh, and that "bloating" in your abdomen? It's called fat. Might I suggest avoiding the crepes and that obviously uncomfortable thong?
Bonne chance,
Scalpel
Labels: drug-seeking scumbags, letters, migraineurs
posted by scalpel at 9:24 AM
22 Comments:
Scalpel, wanna post about your shifts during the hurricane? Any other crazy experiences? Did you work allot or werre you home with your family.
My family evacuated while I had to stay behind to work. During the storm itself there were zero patients for over 12 hours, towards the end we started getting a trickle of patients and the next couple of days were really busy. Mostly carbon monoxide poisoning, chainsaw injuries, people slipping in the water, getting splinters, and stepping on nails and such. Along with the usual stuff like this, of course. Lots of med refills too, but few pharmacies open.
GTFOOMER = GOMER?
I received House of God for my birthday this year (along with Mount Misery). Brilliant read. :)
Stay safe/sane down there, mmmkay?
Four rounds? Wow. You're nicer than I am.
And that's saying something, I think!
Enjoyed seeing all your regulars, you can have them back now though.
What 10 said.
Owwwwtch. Pity you can't say that.
Scalpel... Thanks.. You are preaching to the choir...
A recent call I placed.. Of course the names are changed to ensure confidentiality.
Doc... this is Nurse Disillusioned calling from the hospital regarding a pt of yours who is currently in my care. Mrs. PITA, a direct admit by you for abdominal pain not yet diagnosed.
"Yes.. She is insisting on a higher dose of narcotics for her "renal colic." It seems she has an exacerbation of pain when any nurse passes by or enters her room.
I have given her every scheduled med and PRN ordered for her. She rings the bell 15 minutes in advance of any drug order to allow me time to get it to her.
Yes...I collected a urine spec and there was frank blood observed in it. It dipped large for blood.. I will continue to strain her urine.
Her appetite? Hearty... She's a member in good standing of the clean plate club.
Allergies? Yes.. to all non-narcotics.
Ok let me read this back to you to confirm... More narcotics and benzos? .. Oh good.. She's hit pay dirt..
While your at it doc.. It seems her girth is outgrowing her arms so I'd like an order for a set of longer arms for her so she can wipe her own a**. By the way, She is on the call bell constantly. I have 5 other patients, 2 or whom are palliative. I'd like to provide some one on one care to them.
Hello doc?
Too bad mercy killing isn't an option. Putting her out of her (and your) misery is the only way to get her to go away.
You're a terrible person man.
I hope I never encounter fuckbags like your self.
Regards,
A medical student.
Hey medical student. Just wait. You're day is coming. Come back and revisit your comment in a few years after you start practicing medicine. You'll understand Scalpel's frustration.
MJ
Shine my shoes, errand boy.
Give me a break, medical student. I've worked in the ER for just over two months, and even I've seen enough to realize that scalpel's cynicism is justified. Wait until you've actually spent some time in the ER before you pass judgment on those serving in an incredibly difficult environment.
Kudos scalpel, the post was entertaining.
Ahh yes the med student who still does not know his head from his ass. You will excel in your studies I can see it now.
BTW: when any one of us wants your opinion, we will give it to you.
Scalpel, great post....an instant classic. GTFOOMER (Get the f*** out of my emergency room) had me rolling. FYI, make med refills easy for yourself. The Texas State Board of Pharmacy has allowed pharmacists to refill medications for 30 days without MD authorization b/c of Ike (that extends to CIII thru V as well). I would think most if not all pharmacists would do diligence in refilling ROUTINE medications (including narcotics) if they are ON SCHEDULE. (The exception is CIIs). So, if pts are clogging up the waiting room trying, send em back to their pharmacist. (Well, it adds some more work to us, but not a problem for the vast majority).
Ding, ding, ding...I need some more fentanyl please!!!! What a treat those people must be.
Why not just send the patient indicating possible drug seeking behavior through rigorous and thorough diagnostics at her and/or her insurance's expense. Several blood draws, CT, MRI, etc. and 7 hours later and she might not associate her next visit to the ER with a 4 day supply of norco and a couple IV doses of hydromorphone but rather several hours of uncomfortable and expensive diagnostic tests. Of course, if she's on medicare/medicaid the expense is unfortunately shouldered by the tax payer but eventually repeated abuses of this nature should warrant legislative review of the enabling policy (one would hope). I understand it's often easier to give the drugs and get the patient out of there and make room for those who are actually sick and understaffed/overcrowded ERs are certainly a symptom of an overall failing healthcare approach (ie, not enough insurance coverage, lack of appropriate primary care, etc), I don't know, I guess the more blogs I read from ER staff who seem to so frequently deal with this type of drug seeking behavior then my question is what is a reasonable solution to this problem? I know from a hospital administrative approach I've seen it's very difficult to deal with this problem, especially in an urban medical center. How do medical staff feel about drug addiction and what can be done to alleviate the strain on emergency rooms when addicts can't find their fix anywhere else? (Or when it becomes easier for an addict to get their high from an ER versus a drug dealer)
@Cynic: Awesome response, I don't remember anyone asking Medical Student for their opinion
It's usually either that old chestnut or the renal colic story that half of them can't even be bothered to learn properly.
Honestly, you think they'd do their homework.
Oh, or the 'letter' from their conveniently uncontactable doctor about their opioid anagesic requirements....
J
Ah, I wondered what happened to that old ex-friend of mine. She ended up in your ER. Sorry.
When she came to visit for a week, she insisted on a backstage tour of three of our lovely hospitals. Her behavior was incredibly embarrassing, and I got to witness the frustration of the ER personnel firsthand. I sympathize with y'all.
Incidentally, don't tryptans work for migraines anymore? When I get one I just pop a Zomig and go to bed.
That lady would have lasted five minutes in my ER before I threw her out. Done deal. I have established a reputation amongst our seekers I am proud to say that I don't usually give in to them. I love it when they call to ask if I am on and then DON'T show up.
Scalpel, I <3 you!! (I haven't visited your blog in a while, so am catching up now.) As for anonymous medical student, we all are unanimous in that you will eat your words in a few years, that's for damned sure... and you'll be thrilled to shine scalpel's shoes while you're at it!!
I have to ask, how badly is your judgement clouded when someone who is genuinely suffering from an intractible migraine of >72hrs comes into the ER?
Of course, for the the very few times I have ever going into the ER for migraine, I sure as hell ain't talking on my cellphone, eating is the last thing from my mind, and the only thing I am ringing the nurse's bell for is for a clean tray to throw up in again.
There have been times when I have gone in for >72hr migraines where I don't throw up (though the rest of the symptoms are certainly evident). In my case, a course of DHE45 and 2 of IV Morphine or Dilauded tend to do the trick to break the cycle. Would I be treated that way as a visitor to your ER? Keep in mind I am not a frequent flyer, probably in ER 1 time every 2 years.
It can't help but create a bit of cloud on your POV, and if it does, these drug seeking pieces of trash need to rectally examined (or any other cheap, yet humiliating and possibly painful test) each time they further chip away at your ability to provide healthcare to those that actually need it.
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