Ambulance call goes out for a patient who is in “excruciating pain all over.” She has a history of fibromyalgia and ran out of her pain medications at home. Time of call: 18:35 on a Friday night. Being out of pain medications after office hours on a weekend is a red flag. When she arrives, she happens to just have moved into town this week. Another red flag. The emergency physician working at the time looks her up on the state database. She has received medications from 13 previous physicians. Red flag #3. She gets a shot of Toradol, is informed that we do not refill prescriptions for chronic pain medications in the emergency department, and is sent on her way.
About 2 hours later, another ambulance call goes out. A 36 year old woman fell while walking up steps, hit her forehead on the edge of a step, sustained a deep laceration, and passed out. Now she has an excruciating headache.
As the ambulance rolls in … it’s the same woman.
We remove the bandages and there is a scratch across her forehead. Said scratch looks very much like the patient took her fingernail and scraped herself across the forehead. Patient swears the “laceration” is from the impact. The laceration is too superficial to suture, so instead the patient gets some nice “Hello Kitty” band-aids applied to her wound. The defensive medicine clinically indicated CT scan of the head is normal. Because she was just discharged from our emergency department only a few hours ago, it is too soon for another dose of Toradol. Fortunately, there is some Tylenol … Number Three waiting at the desk along with her discharge papers.
About 6 hours later, a police call goes out on the scanner. On the main highway through town, there is an erratic driver. Two truck drivers saw a car swerving back and forth on the road. They assumed the driver was intoxicated, so they blocked the lanes of traffic with their rigs, slowed down, and forced the car to come to a stop. Then they called police.
The driver of the car told police that she was on her way back home from an out of town emergency department where she was seen for back pain and given an injection of narcotics. The patient was slurring her words, so police called an ambulance and the driver was transported to our ED.
You guessed it. Same patient.
Alcohol was not detected, but she did seem to respond nicely to naloxone.
Well, ma’am, given that you have been present in our emergency department more than the staff has been present in our emergency department over the past 24 hours, we have taken the liberty of completing a change of address form for you at the post office and we will start holding your mail in the doctor’s lounge so that you can pick it up on your subsequent visits.
Please remember the excellent service you received when filling out your patient satisfaction survey(s).