In the ER at the trauma center, we see a lot of patients who are drug seeking. Because it's the ER we cannot turn patients away, we must trust that the patients who are being seen have valid complaints and we must treat them all. Most drug seekers come in complaining of chronic back pain. Chronic back pain is hard to find the cause of in the ER, so the docs do the usual lumbar spine x-rays, which come back with normal findings, give the patient a script for 10 vicodin or perocets (enough to get said patient through a weekend of partying) with a referral to see a primary care physician and send them on their way. Most of the drug seekers we see are recreational users. We may see them a couple of times a year, today with chronic back pain and in a few months with chronic shoulder pain and then a few months later with another chronic ailment until we circle back to the back pain again. These seekers typically are careful and don't use a particular ER facility too often. They often rotate between area hospitals in order to get what they want. There are those however who are seen just a little too often in our trauma center ER and are addicted. Our docs may give them what they want the first couple of times they come in but they then draw the line and tell them they can no longer "help" them. I have seen ER docs get in patients faces and tell them that they are no longer going to serve their habits and they will receive nothing more than Ibuprofen for their "pain" in our ER. As soon as these patients figure out that they are not going to get what they want they don't even sign themselves out; they just get up and leave. The amature seekers will come in with "hand pain", "wrist pain", "foot or ankle pain" and after the x-rays come back without positive findings and once upon examination by the ER doc the patient can move their appendage in all directions, they are told they will get nothing more than Tylenol or Ibuprofen for their pain. The amatures then storm out just like the seasoned pros without signing themselves out. This all leads me to yesterday...
I thought I had seen just about everything in the realm of drug seeking patients. The pros will even go as far as claiming "abdominal pain" (which is just as hard to diagnose as chronic back pain in the ED...although docs will go to more extensive testing i.e. CT's and ultrasounds as well as X-Rays to find the source of the problem)and will force themselves to throw up to prove how "sick" they are or to prove how much "pain" they are in. I've actually seen patients put things down their throats in order to make themselves vomit. Disgusting. So yesterday, I had a patient that I have X-Rayed on several occasions in the last 2 months (3 separate occasions to be exact). In fact, this patient and I are on a first name basis, I walk in the room and say, "Hi E***" and I get a "Hey Hiliary" back. He's here for his shoulder, again. This is his 3rd shoulder dislocation in 2 months. They have just re-located his shoulder and he has dislocated it again before even leaving the ED. This guy has been given some fairly heavy sedatives and 4 mg of morphine since coming in while they reduced his shoulder and he is able to get up off the ER bed and walk pretty soberly over to my room, although his eyes are glossed over like he's high...scary, huh? He knows the drill in the X-Ray room. I barely have to adjust his positions for my x-rays. The kicker...he volunteers to do an axillary view so they can see that his shoulder is dislocated posteriorly (his words, not mine). Listen, NO ONE with a shoulder fracture or dislocation EVER volunteers to do an axillary view because it HURTS...A LOT! But this guy does, amazing. I take his axillary view and send all his films and take him back to his ER room where he will wait for them to come in and give him another cocktail of drugs while they put is shoulder back in for the second time in one day. I distinctly remember the last time this guy was in the ER (about 3 weeks ago) and it was a different doc on. Dr. W got in this guys face and told him that he knew what he was doing. He told him, "E***, I am here to save people's lives. Any YOU are wasting my time. Someone who dislocates his shoulder this often is doing it to get high. You need a surgical consult and I can't help you with that here in the ER with a chronic problem. There ARE people her who need acute care for acute injuries and illnesses. STOP wasting my time." I love Dr. W...he's not afraid to give patients straight talk. So I find it interesting that there are people out there who are willing to purposely injure themselves to get high and who have such a drug tolerance that they are able to pretty soberly walk to the X-Ray room after being given enough medication to put any "normal" person down. Interesting probably isn't the right word...sickening, maybe closer to the right word. All I really have to say is WOW.
Dude, addiction sucks.
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