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Tylenol, Anyone?

A patient comes into the emergency department holding his jaw.

He has had a chronic toothache for the past two weeks. We looked up his old records and he had been coming to the emergency department with toothaches and back pain for the past four years.

He has a dentist appointment scheduled at an out of town clinic for a week from Monday. He just needs enough pain medicine to hold him over until that time. After all, he’s been “popping Tylenols like candy” and they haven’t helped him one bit.
“Exactly how much Tylenol are you taking?”
“I’ve gone through 3 or 4 hundred in the past week. I’ve probably taken 50 or so in the past day or so.”
“You mean ‘fifteen’, as in 1-5?”
“No, fifty … like 5-0.”
“OK, well, we’re going to need to check your liver enzymes and get a Tylenol level on you to make sure that you don’t need a liver transplant. Taking that much Tylenol can be potentially deadly.”
“OK, whatever. Can I at least get some medicine for my pain?”

I then took out a needle, drew up some Marcaine, and performed a mandibular block on him.
The pain was gone, but he didn’t seem happy.

About 45 minutes later, his Tylenol level and liver enzymes came back.
Anyone want to guess what they were?

Zero?!?!! I was shocked. Normal!?!?! Thank goodness.

“Well, your Tylenol level is zero, so there’s no Tylenol in your body.”
“Yeah, well they were generic.”
“Generic Tylenol still has Tylenol in it.”
“Yeah, not as much as the real stuff, though. Can I get something stronger for the pain?”
“Since you have already stated that you were overdosing on medications, I am hesitant to give you anything stronger for your pain. I can make a call and try to get you into the County Dental Clinic in a couple of days, though.”
“This is bull****. I’m going to sue you and this damn hospital for not treating my pain.”
“You already told me that the pain was gone after the shot I gave you.”
“You’re NOT giving me anything to TAKE HOME!”
“I’m sorry, I’m just not comfortable prescribing you additional medication, especially when all these doctors are being charged with crimes when their patients overdose.”

He stormed out of the emergency department cursing at all of us.

The nurse came up to me afterwards and said “You could have at least written him a prescription for some Tylenol.”


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.


  1. We’ve had several of these this week !
    What’s up ?
    Is it “Press-Gainey enabling” ?

    • What a jerk! I’m sorry that stuff happens so much to medical staff everywhere.

      My uncle once had a backache so bad ..that he said he could hardly get out of bed. (Not the norm for him) Turned out ..he had a tooth abscess that gave him such an infection it caused back pain.

      I read a heart wrenching story a few years back in another emergency blog, in which the ED nurse recounts her experience on losing a young patient because she OD’d on Tylenol and it was a horrible night for staff and just frightening what happens inside the body because of Tylenol OD.

  2. Anti-abortion;) Had one today that came in with debilitating abd pain s/p “abortion at pp in Boston” yesterday. States she was 22wks and “they did’nt say it would hurt this much. Long/short quant needed re-draw, couldn’t pee. Transvag US refused; Trans Abd non gravid, normal uterus. Score; Dilaudid 1mg and $$$ wasted time and services. Lessons learned; trust in human nature is misguided.

  3. OOPS! I meant my longer comment for you and was going to tell Hueydoc that “Press-Gainey enabling”

    was funny. :)

  4. You should have told him you were going to write for acetominophen – or as they say in the UK, paracetamol.

  5. I always love the patients who are “allergic to Tylenol”. Ironically, they are not allergic to Percocet (which contains Tylenol). When I ask them about it, they say they’re only allergic to plain Tylenol, but their body can handle it when mixed with a narcotic. Um, yeah whatever dude.

  6. Wow. I’m surprised he even let you do the block – most of the seekers are “afraid of needles” and won’t let you go there.

  7. I love- love- love the way you treated this fellow. Especially since you “treated his pain”. If you are that good with the mandibular blocks, can I come visit when my dentist isn’t available? I always get the danged dental pain at night or on the weekends. Of course, I usually put an ice pack on it and watch late nite tv until the office opens. But then, I’m not a drug seeker.

  8. Just a simple local block of the tooth works great too!

    You should have written him a script for Zofran ;)

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