ER Abuse

Scalpel has been talking about the pain scale and pain-seekers recently. Reading these entries got me thinking about a trip I had to an ER during med school and the lasting impression it left with me.

Between 1st and 2nd year I had a research project that fell through. Since this occurred late in the year I decided to just get a job and work over the summer. I don’t really like research anyways and my Orthopeadic frenzy had significantly subsided so I didn’t feel research was absolutely mandatory at that time.

I returned to work for the company I’d been with prior to med school and was given a job in the backroom where I would stock and pull items for the salesfloor. This entailed some heavy lifting which aggravated my back already damaged from poor weight lifting during high school. I began taking Aleve in the mornings before arriving to work in order to move better and decrease the stiffness I was appreciating in the morning. This seemed to be working well until 4 weeks into the job.

One Saturday morning I awoke with a great deal of pain. I found that I had a significant amount of trouble getting out of bed and walked bent over since straightening caused a great deal of discomfort. Some NSAIDs and attempts to stretch out my back resulted in little improvement. Deciding to rest my back, I laid down for a period of time, hoping for a “miraculous” improvement. Instead my decreased range of motion and pain only increased.

I found that I couldn’t stand up at all. In fact, trying to walk resulted in me crying out briefly a rather nasty curse and falling to the floor. Wife found me crawling on the floor, unable to get out of this position, heading to the living room to sit. She decided that there was something very wrong and that I needed to go the ER. I resisted, thinking it weak and pointless; after all this wasn’t an emergency – right?

She persisted and I finally caved. The ride to the ER was torture, with every bump knifing through my back. In order to decrease the pain I was in the fetal position the whole ride. On arrival I tried to get out of the car, only to fall on the sidewalk from the pain. Wife ran in and found a volunteer who brought out a wheelchair. Humiliated, I again resisted, but eventually had to sit and be wheeled into the ER. They wouldn't let me crawl.

The staff was courteous and quick (not very busy at that time of day), but I continue to feel that they thought me a druggie. I rated the pain a 5/10 since I didn’t want the stigma of being a “seeker” and tried to be as helpful as possible in relating my history, but when everyone who wants drugs mimics this kind of pain I just knew they were talking about the “drug seeker” with lower back pain in room 12. It was frustrating to know that I was in very serious pain, had fought seeking treatment, and just wanted to be able to walk without severe shooting pain, but that because of parasites in society I was most likely considered an addict.

After some x-rays, a perfunctory exam by an NP (I wasn’t even taken seriously enough for an MD to waste his time on), and a shot of narcotic in the ol’ butt, I was discharged to follow up with my doc.

The narcotic and muscle relaxants worked wonders, allowing me some increased motion, but I was unable to return to work. An MRI done later per my PCP showed osteoarthritis of the lumbar spine with small herniations. I was informed that the kind of work I was performing was out of the question with my back and physical therapy was eventually needed for me to regain my normal mobility.

Now, I tell this story not as a lesson to be learned for all ER docs. Rather it is the reason that I find so many of the patients I’ve seen - who claim 10/10 pain, want Lortab or Dilaudid since they have “allergies”, and abuse our system - completely abhorrent.

It is the reason I decided to opt out of Emergency Medicine. I was just too jaded. It is because of patients like these that those who truly need the services of the ER are often initially considered addicts. It's because of asshole patients, cyring wolf constantly, who abuse our system that ER's are practicing defensive medicine. It's the reason I think ER's should get a free pass for all frequent flyers who they don't believe who present with an actual problem. You weren't believed? Too fucking bad!