When the first two sentences out of the patient’s mouth to the triage nurse are “I need something for pain – it’s 10 out of 10” and “Also, I’m allergic to Toradol, tramadol, codeine, morphine, and I can’t take NSAIDs because I have an ulcer” then it raises my eyebrows even more.
The injury wasn’t a 10 out of 10 injury. The patient was reportedly moving a couch while wearing flip flops. She caught her foot and hit the outer part of her great toe on the edge of the couch. In the process, she ripped the callus off the side of her great toe, leaving a raw area about an inch in diameter and a scrape to her instep. This injury caused her to have 10 of 10 pain.
As the nurse started to clean her wound, the patient howled. Literally.
“Aren’t you going to give me anything for this pain?”
“How about we start with some Tylenol.”
“You’re allergic to all of these other medications and your wound certainly doesn’t look bad enough for something like Norco. So I think we’ll start with some Tylenol.”
She looked at her boyfriend who had accompanied her to the emergency department.
“You know, it’s FAKERS like you who make it so that people in legitimate pain like me don’t get proper pain medicine.”
He had a shocked look on his face. I didn’t know the boyfriend, but I kind of agreed with the patient’s sentiments. Drug seeking patients do tend to ruin things for patients who really are in pain. This woman appeared to be overacting from the pain she was having from her injury, but who knows? It wasn’t too busy in the ED at the time, so I went and looked the patient up on the state controlled substances database.
Surprisingly, the patient only had 88 prescriptions for controlled substances from 18 different prescribers in the past 12 months. Only four prescriptions for Norco in the past 10 days.
I went back in the room and handed her the printout from the state database.
She scowled at her boyfriend. “This is all YOUR fault.”
Then she got up and stomped out of the emergency department before the nurse had a chance to bandage her wound or to provide her with Tylenol for her 10 out of 10 pain.
Funny how information can have such a dramatic effect on relieving pain.