I made a chronic back pain patient who was out of his pain medications cry in my emergency department today.
Actually, he was already crying when he came in. The nurse said that he hobbled in from the waiting room bent over like an old man and using his wife’s shoulder for support. He couldn’t stand upright because of his severe pain.
I was finishing up with the patient in the room next to his when I heard him get put into the room. He was moaning and moaning. As I discussed the discharge instructions with the current patient, the moans sometimes overshadowed what I was saying.
Before going to see the patient, I looked up his old records on the computer.
He was 41 years old. According to his old chart, he had wrenched his back while fixing the tire on his car more than a month ago. Ever since then, he had been having pain in his lower back. His primary care physician gave him a couple of weeks of Percocets and some Valium. Those medications helped him somewhat, but he still had pain. When he ran out of the meds, he got one week’s refill and was referred to physical therapy. He went to physical therapy twice and it caused the pain to get so bad that he stopped going. He called his doctor back and his doctor ordered MRI of his back. I pulled the MRI report which showed multiple minor disk bulges but no other problems – definitely nothing that would cause his back pain. So his doctor set him up with a pain clinic. No appointments were available for more than a week and his doctor had cut him off from narcotic pain medications after the relatively normal MRI. This was his third ED visit in the week.
When I walked in the room, he was in a fetal position on the bed and he was crying.
“I’m Doctor WhiteCoat. How can I help you today?”
“My back, doc. It’s killing me.”
He described the whole story. I already knew most of it from notes in the computer. I also saw the several doctors from whom he had received pain medications.
He wouldn’t lay flat on the bed because he said it made his back worse. His position of comfort was laying in a fetal position or laying on his back with his knees flexed.
Back in medical school, I worked part time in a back pain clinic for a year or so (long story). After a normal neurologic exam, I thought he probably had a psoas muscle spasm. Pretty common cause of non-traumatic back pain.
So I gave him some Toradol and Valium. I told him that I thought I knew what was causing his pain and that if he trusted me, I could probably make him feel better. Fortunately, the ED wasn’t too busy that day, so I could spend a little extra time with him.
I got him to lay on his back with his legs flat. I went to see another patient.
I came back and had him roll on his stomach. I went to see another patient.
I came back and used the stretcher to extend his back a little. I went to see another patient.
I came back and used the stretcher to extend his back a little more. He moaned in pain. I went to see another patient.
After the third incremental extension, I let the bed back down. I showed him how to get out of a bed without putting a strain on his back. Then he stood upright.
I showed him a few stretching exercises he could do to hopefully help keep the pain from developing again.
I left the room to finish discharge instructions, printed out some examples of stretches he could do and came back to hand the printouts to him. When I came in the room, he was crying again.
“I thought that your pain was gone,” I said hesitantly.
“It is. I was just telling my wife that you’re the first doctor through this ordeal that has actually sat down and listened to me and who tried to fix my pain without pumping me full of drugs. I don’t even think I’ll need the pain prescription. My back feels that good right now.”
I smiled. He reached out and gave me a firm handshake. Then he pulled me in and gave me a hug.
A little surprised by that whole man hug thing, but I was glad that I was able to help him.
I was working in the charting room (which is out of the patient’s view) when I heard him walk up to the desk and say “Tell Dr. WhiteCoat thank you again. He is an excellent doctor. And thank you for all your help.”
After he left, I had to rub it in. I walked out and said to the nurse “I heard you have a message for me?”
“A message for me from a patient?”
“Something about being an excellent doctor. Come on now. You can say it. Ehhhhhhxellent … Ehhhhhhxcellent.”
Then the secretary chimed in.
“I heard him say that you were a dork. Dorrrrrrk. Dorrrrrrk.”
The insubordination that all of us excellent physicians have to put up with some times …
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.