“Careful, he’s been in here like six times in the past month and a half. Always looking for his narcs. Check the state database.” That was the report I got from the triage nurse as I picked up the chart.
I humored her and checked the state database. She was right. The patient had received prescriptions for opiates from 6 different physicians in the past two months — two from the hospital across town and the rest from our hospital emergency department. Each time they were only for a handful of pills – usually 10 or 12.
I went into the room with a skeptical eye.
He was moaning in pain. Couldn’t tell if he was acting or not. If he was, he was doing a pretty good job at it.
I examined his hip briefly and was horrified to feel his hip joint grind under my hands and watch his leg flop back and forth. Damn. He’s got a broken hip. I ordered an x-ray.
Then I heard his story.
He was driving to work a couple of years ago and he was broadsided by a drunk driver. Heavy vehicle damage. Suffered a broken hip and an acetabular fracture. He was taken to a trauma center and surgeons fixed his injuries. Unfortunately, the surgical site got infected. They had to remove all the hardware and inserted an antibiotic implant. Later, they planned to go back in and revise the surgery.
In the interim, the patient lost his job and his insurance. He had state minimum auto insurance that didn’t cover his medical bills. The person who hit him was uninsured and undocumented. His wife left him six months ago. He lost his house and had to move several hundred miles away to live with his son a couple of months ago.
After losing his job and his insurance, he applied for and received state insurance – Medicaid. Fortunately, he was insured.
With his insurance change, though, he had to wait almost six months for an orthopedist appointment. He even kept the appointment slip. The orthopedist evaluated him and scheduled him for surgery the following week. When he tried to find a doctor to do a pre-op physical exam, the only doctors/clinics that would take his insurance gave him an appointment three months in the future. So the surgery had to be canceled.
I hate being lied to, so I called the number on the appointment slip and checked his story out. He wasn’t lying.
When he called doctors and clinics in the area, no one in a 45 mile radius would take him as a patient because of his insurance. He’d been to several emergency departments to try to get orthopedic treatment and the orthopedists all referred him back to the original orthopedist who did his trauma surgery.
When I called our orthopedist, he looked at the x-rays and declined the case as well. High incidence of complications given the delay in treatment. Not likely that even the original surgeon will fix this now. The patient would most likely end up using crutches the rest of his life.
I felt sorry for this guy, especially seeing how well his insurance was helping him with his problems. The only assistance he received was a pair of crutches.
So I ended up doing something I’ve never done before. I gave a patient a month’s worth of Norco from the emergency department.
Any of us could be a stop light and skid mark from being in his exact same position.
What would you do?
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.