drug seeking....

every morning we get to the hospital at 6am and whoever is there first prints out copies of the current patient list. then, we sit down and divide out the new patients admitted overnight and keep the remaining ones we have already. today, we had 5 new patients so we all kept the patients we had been seeing and then picked new ones to see, write progress notes on, and follow up on. today, i picked a 37yo F named Brandi [not real name but similar]. i thought her case looked interesting because her CC was abdominal pain and hematemesis [vomiting blood]. i thought it would be a change in the cases i had seen in the past so i said i would take her. after us 3 students divided up the patients, one of our interns [Dez] walked in and we went over who was covering each patient. amongst our conversation went:

 “who is taking Brandi?” -Dez

“i am” -me

“hahaha, well good luck because apparently she is a complete handful and is pretty much just drug seeking. i didnt want to take her because i can’t say no so im making A [other intern] take care of her” -Dez

“wonderful” -me

I went up and read the patients chart and the nurses were already talking about this her. she was requesting specific amounts of medication and was very attentive to when she was getting her next dose. she was also making demands of how much and what else to give her because ‘she knew what worked for her pain.’ granted, she has had a couple different spinal surgeries because of accidents and had nasopharyngeal cancer, so shes not completely pain free, but everyone knew the story was a little seedy. especially because she had been vomiting blood “for 3 days, and vomited twice in the ER” but no one has actually witness this...

My other intern [we’ll call him ‘young persian doctor from brooklyn who is obviously from brooklyn’] was my intern on the case. he knew exactly what this lady was up to and knew exactly how to get her on his side and sweet talk her. his mission= get her out of the hospital as fast as we can to free up a bed for a real patient. i tried to give this lady some credit and since i am a medical student and not completely jaded yet, i went in with an open mind and tried to listen as though she really had a problem.

 i went into the room and spoke with her and immediately she started crying. she was not rude at all, just very talkative. she was very ‘opioid educated’ as she called herself, since she had been on pain killers for at least a decade. we [all the docs] were sure she was just constipated from opiod use and her abdominal pain was due to a ‘back-up’ and she just didnt want to hear this. she really thought something was wrong. and when i looked at her stomach, i agreed that this could be something more. her stomach looked very distended and firm,like she was pregnant [and she was not an obese lady]. so, i asked her a plethora of questions and decided she may have some kind of ulcer, colon inflammation, etc. She insisted on getting a GI consult and i actually agreed. 

when i told the intern he laughed at me. he had already called for a GI consult, mostly to cover his ass because you cant ignore this even though she may be making it up. he laughed because he thought i believed her, which i could of did. so, we discussed it with our attending and we got a GI consult. i was hoping they would order an EGD and sure enough, later that afternoon we heard the consult ordered a abd CT and an EGD. 

the abd CT was done in the afternoon and it was clear. “no acute changes or pathology.”  “you still think there is something actually wrong with this patient?” -brooklyn asked

“maybe.....” -me

i went up to tell her the results and she just cried more because now she had no idea why she had this pain. then she asked me for a neuro consult for her headaches and a pain management specialist for her pain. at this point, i stopped feeling sorry for this lady. while she talked, i had to force myself to not blow her off and be rude because there was a chance there really was something wrong. but it was very hard to take her seriously when in between questions, she kept saying how much she needs her dilaudid, ativan and benadryl cocktail. 

i am keeping faith that she may really been in a lot of pain and that tomorrow the EGD shows something. but, i wont be suprised if it doesnt. she admits that she had a pain pill addiction but says that she ‘doesnt abuse pills because she really needs them.’ partially, this is our [healthcare’s] fault because during all her post op and chemo we pumped her so full of drugs that she probably got addicted, but then again, not all of us constantly pop pills for the pain we feel. everyone has some sort of pain somewhere, it may be chronic or acute, but not all of us need a norco or vicodin everyday to deal with it. 

i really hope im wrong on this one.