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.