July 30, 2006, 5:03 am

Don’t Think Twice, It’s Alright

nursebook

Trapped by the Golden Gate Bridge!

By….a blonde? What does she want? Advice about her rash? An Advil?

And what on earth is the nurse doing climbing rocks in full uniform?

Why on earth would she expose her cap to the elements like that?

Has she no respect for the symbol of her profession?

The biggest question of all, though, is…

Will the nurse lose the cap precariously perched on her head just above the rushing waves of the San Francisco Bay?

And just who is that guy in black hanging off the rocks to the left?

********************************

Oh, you were good.

The best I’ve ever seen.

You had me, a PA and a MD all absolutely convinced.

Pale and diaphoretic, you made it to the ER within sixty seconds of your sudden onset of excruciating abdominal pain.

That’s fast…..were you just outside the doors when it started?

******************************

You were much younger than you looked.

In fact, you looked you ran a string of methamphetamine labs and sampled from each one.

You looked like you had had a rough life up to that point.

The number of pregnancies you gave me would have meant that you had been pregnant every month beginning at age eight.

You were in your thirties.

******************************

I know a ruptured ovarian cyst when I see it.

I’ve had one.

For all intents and purposes, you looked like you had one, you acted like you had one and your were treated emergently for your pain.

I figured you would be going to OR. I even pulled out the surgery packet.

We were extremely worried about you.

We scrambled to find an IV.

(A lot of scarring for someone who has never used drugs. But even drug abusers have serious illnesses, we suspected, but we continued to worry.)

When you mentioned you had three tubal pregnancies but also had your tubes tied something inside my subconscious registered “does not compute”, but we were too busy trying to find the source of your pain.

No matter, we started the line and we hydrated you and we gave you the very best in narcotics that we had to offer and we gave them liberally to get your pain down to a tolerable level.

Your scans and ultrasounds showed nothing. You didn’t even have an ovary on the affected side.

But your pain was better.

And when you left, you didn’t even want to know what your tests showed.

Because you knew.

It was nothing.

But you had gotten your fix.

We had put our energy into and given much undivided attention to you because you presented as seriously ill.

But, as Bob Dylan sang so perfectly:

You just sorta wasted my precious time….

But don’t think twice, it’s alright.

9 Comments


  • Intelinurse2b

    July 30, 2006 at 6:43 am

    I have always wanted to ask a seasoned ED nurse this question, “How do you prevent yourself from becoming calloused towards people in pain seeking pain relief and not begin to suspect everyone is a seeker when their complaints and past medical histories and even their current stories don’t gel?”



  • TC

    July 30, 2006 at 12:55 pm

    It’s hard not to become calloused, especially when you see the same ones return. I try to remember that addiction/alcoholism is a disease and that although you try your best, you’re probably not going to cure anyone of their addiction in an ER visit. You just have to act with integrity and compassion. And it’s not just the addicts who try to pull the wool over your eyes, either.



  • d

    July 30, 2006 at 2:18 pm

    What I want to know is, so you slip up and accidently believe a drug seeker and give her the fix she’s looking for … aside from the pain of being wrong and being lied to, who is hurt? The drug seeker? I don’t think so. She’s good for a few hours or a day or whatever (I have no idea how often people who use drugs want them; I’ve never met one), and that’s one hit she’s not getting from a used needle or that’s cut with Drano. Or is it just that she’s tying up a bed that could be used for someone else? I’m not endorsing drug seekers or saying they should head to their local ED. I’m not saying medical people shouldn’t be on the lookout for people who are seeking drugs. I’m just saying that when I read blogs where nurses and doctors are beating themselves up over this, they shouldn’t be. They erred on the side of compassion, and I really don’t think there’s anything wrong with that.

    A little rambly there. Oops.



  • Dawn

    July 30, 2006 at 7:10 pm

    Kim, does your ED have a list of known drug-seekers posted anywhere? I had been told during one of my clinicals that one listing such as this existed in the Twin Cities at one time, since the same drug seekers tended to go from ED to ED looking for their fix.

    Just wondering. Great post as usual. I learn something new from each one!



  • Kim

    July 31, 2006 at 5:20 am

    Intelinurse2b: You don’t get calloused (or just mildly so) because you take everyone at their word. They say they have pain, they have pain. This was just such an unbelievable scenario. People in severe pain are not often able to answer questions appropriately or even think straight. That’s what was happening here, I thought.

    d: I am the Queen of Ramble, so no prob! LOL! The seeker gets their fix, but they never pay for their treatment. So, they have ripped off the doctor and the facility. And in this case, the night was hellacious and a great deal of time, energy and expense was utilitzed by this patient for no reason. The scary part was that it was such a convincing scenario. And you are right, erring on the side of compassion, or in this case good medical care, is always the right road to take. Still, you can’t help going “How did I not SEE that?” after it’s over.

    Dawn: We aren’t allowed to have drug-seeker lists. I have caught patients who didn’t know that one facility and another facility were actually a joint venture and we saw the visit an hour before on our computer. And you have to remember, even those who seek drugs will actually be sick sometimes, you can never write anyone off. I guess it’s better to have medicated when you didn’t have to than to not medicate or under medicate when you should have. The sad part is when chronic pain sufferers have to come into the ER, it’s people like this patient who make it harder for them to be perceived as needing relief.



  • Dawn

    July 31, 2006 at 6:23 am

    The reason I asked was that when I was doing a psych rotation during my LPN training, one of the nurses there mentioned that some of the drug-seekers can become so well known that some of the EDs in Minneapolis/St. Paul had lists of known users and their names. Could be an urban myth, but it wouldn’t surprise me. Pain is pain, and as you posted, it’s better to treat than not treat.

    And yes, unfortunately they ruin it for those who truly do suffer from chronic pain.



  • marachne

    July 31, 2006 at 6:42 pm

    The other thing about pain and those with chemical dependency is that they probably have a lower pain tolerance–the way I look at it, they’ve been self medicating for pain for years–might be psychic pain rather than physical pain but…

    I used to work in an Adult Foster Care home for PWHIV-AIDS. Everyone there was at least dual, mostly triple diagnosis (physical health issues, chemical dependency and mental health). The house was “chem-free” well, except for the proscribed opiates and medical marijuana (we called it “green medicine”). I *lived* with these people, understood the behavior patterns of people with addictions, and they still were able to pull suff over on me related to using. Didn’t make me feel good, felt like my trust had been abused, etc., but also kept me humble about my ability to “read” them.

    It’s a hard balance, trying to provide care, allow pain to be “what the patient says it is,” and keep healthy skeptisim.



  • marachne

    July 31, 2006 at 6:44 pm

    Oh, about the book cover — it’s a lesbian send-up of the Cherry Aims/Nancy Drew books. Very funny. An absurd cover is very in keeping with the humor.



  • Undiagnosed

    November 29, 2008 at 11:06 pm

    Look it’s hard unless your suffer yourself. Drug addiction or a life with chronic pain?? either are not appealing…


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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