There are a few times in emergency medicine when you know that a patient is either very sick or very injured.
When you see a car screech to a halt in the ambulance bay and then see people get out of the car and start running about haphazardly, it is generally a good bet that the person still in the car is in need of immediate medical assistance.
When a car drives by the emergency department entrance and pushes someone out of the passenger door, and takes off, leaving the person laying on the asphalt, it is generally a good bet that the patient needs urgent medical assistance and that the person providing the transport was either involved in some criminal malfeasance and has a warrant or, alternatively, the driver just no longer wanted to deal with the patient.
Yep, driveway dump patients are usually quite challenging. Many times, there is no ID. Most times they are either unconscious or near unconsciousness. Those face plants on the concrete welcome mat don’t help matters.
So there she sat in Room 7. The latest driveway dump. Ahhhh lucky Room 7. The room closest to the ambulance entrance. The room that housekeepers knew to keep stocked with extra towels and gowns and masks. Personal protective gear we used to protect ourselves from the blood, vomitus, and even the occasional excrement that would sometimes fly our way as we cared for our patients.
Walking in the room, there was a different smell, though. Not the typical “sanitizer residue” odor you get every time the room is cleaned. More of a stagnant “chili con queso” aroma. Quite pervasive, too.
In any event, the patient was quite inebriated, quite loud, and quite uncooperative. We removed her baggy jacket and wanted to get her undressed so we could put a gown on her. We couldn’t understand much of what she was saying in slurred Spanish, but from the tone of her voice, she didn’t want anything to do with taking off her t-shirt and army fatigues.
So I sat down to start an IV line on her. Naturally, I got it on the first stick, because I am just that good.
Then the patient looked at me and said “Morphine?”
I looked at her with a surprised look. “Morphine?” she repeated, pointing at her IV.
“Por que?” I asked. Yes, I know a few words in Spanish. Not sure why I asked her “why”, though. I knew that I wouldn’t understand what she described as her excuse.
I was right. I did pick out the word “dolor” a couple of times from the next few minutes of her description why she needed morphine.
“Espera el doctor” I told her. Hopefully she understood that I meant she needed to wait for the doctor to examine her.
She reached into the pocket of her army fatigues and pulled out three objects wrapped in tin foil. Then she held them out to me. An odor of refried beans and salsa just kicked up a couple of notches. I looked at the objects. They were flattened tacos. Refried beans were squeezing out of the sides of a couple of them and crumbs of hot sauce-covered taco shells were dropping all over the floor.
She raised her eyebrows and nodded her head as she extended her arm even further.
“You,” she said, pointing at the tin foil objects. “Me, morphine?”
No, ma’am, sorry. I don’t accept bribes of makeshift taco salad in exchange for controlled substances. It’s against my ethos. However … I could probably get you some Tylenol … Number Three.
And you can even keep the tacos.
This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.