Tonight I took care of one of the most difficult patients I've seen yet.
Typically drug-seekers are a straightforward bunch. ER docs have very fine noses for seekers; I like to think I can spot them within 30 seconds of entering a room. A confirmatory exam of the medical record usually reveals multiple visits in the past for "knee pain" or "back pain", always with the same story.
"Well, you see, I have chronic back pain, but I'm VERY CAREFUL to stick to the pain contract I have with my primary physician, you see, but today my doctor was out of town, and it's the day I'm supposed to renew my vicodin, and so I called but they told me I had to come to the ER, so now I'm here and in pain and all I need is a 3 day supply and then I can get to my doctor's office on Monday, you see..."
Drug seekers always speak in run-on sentences. The nice thing is that once they've been called out, they're usually pretty good about going home. Or, at least, to the next ER in their rotation.
This woman was different, though; she was mentally retarded.
I've never actually seen an intellectually challenged drug seeker before. The problem was, no matter how many times I told her she wasn't getting pain meds, she just kept asking. Our conversation went something like this:
"I want vicodins for my tummy pains."
"Ma'am, you're constipated, which is what is causing the pain, and if I give you vicodin it will make it worse."
"But it huuuuuuurts!"
"I know, you need a laxative."
"It huuuuuurts and I need viiiiiiicodins!"
"No, you need a laxative."
"I need viiiicodins, you don't even knoooooow!"
"I do know, because I am your doctor, and I am telling you what you need is a laxative."
"No I need viiiiiiicodins!"
"We're getting nowhere, are we..."
I felt awful, because I honestly didn't know what else to say. The worst part was, her narcotics addiction truly was causing her constipation - and therefore her pain - and I could not make her understand.
In the end I had to call security to escort her out; there was no other way to get her to physically leave the room. It left a horrible, sour taste in my mouth. I've kicked drug seekers out before and felt a slight twinge of Schadenfreude, but never have I needed security to boot someone out who doesn't understand why.