John Doe is a 25 year old male presents with left sided facial/anterior neck swelling, left shoulder soreness and pain/parestheisas over the left buttock/thigh. He was skin popping heroin the night before last and woke up yesterday morning with these symptoms and presented to the ED…Febrile to 102 in the ED…cough, hoarse voice, a couple ulcers over his chest…CXR shows scattered infiltrate, cultures and some labs are cooking but he's got a white count and a CK>16,000. Yadda yadda yadda. This is a good case, why don't you cover him Bostonian??I hate those words..."this is a good case" usually means that the patient will have a mildly interesting work-up but is such a pain in the ass that the residents didn't want to deal with him...
My prediction was right...he's cursed and swore through the H&P that morning. He kept telling us that he just woke up that way and was in alot of pain. He was even courteous enough to remind us that he has a tolerance to opiates. So my attending decided to throw me under the bus: "Alrighty, well we'll do our best to make your pain more tolerable and then Bostonian will be back in to talk a little later on". Thanks doc...I can't wait to work with this little ray of sunshine for the next 2 weeks.
So I come back later in the day and he's passed out, snoring away with a half finished breakfast tray in front of him...guess that extra dilaudid helped with the pain. I woke him up and got the whole story from his side of what happened. He ended up being a pretty nice guy underneath the gruff exterior and the pain was controlled. He had gone to a decent college was trying to keep his own business afloat, but he got mixed up with the wrong crowd and started using the hard stuff. I ended up having to do the patient education since I was covering him.
John: So this was pretty serious huh? I could have died from this, right?
Bostonian: Yep, if you had waited to come in, you might have been much worse off.
John: Hey, how old are you man??
John: That sucks. We're the same age and you're here being a doctor and I could have died from heroin. That's scary man!
Bostonian: Yeah, we've had different lives. My parents were on my ass for the first 20 years of my life and your dad was an alcoholic who and won't even visit you 3 miles from home in the hospital. But the good thing is that you're young and still have your health and a business and a talent. You can change your life before the drugs kill you...alot of people don't get the wake-up call until it's too late.
John: You know I've been thinking about going back to school once I get clean. You've inspired me man, I want to do something with my life. I mean seeing you here making a difference, it's amazing. I don't want to waste my life any more.
Bostonian: I'm glad, I'll have the case manager give you some numbers for rehab programs.
Getting over your cynical preconceived notions of someone is a good thing sometimes. It gave me one of the more rewarding patient interactions in my career, but I'll always wonder how much of that was him blowing smoke up my ass to get his dilaudid and how much was genuine. I'm hoping that he's clean and back in school!
I guess you gotta wear the rose-colored glasses sometimes to hope for the best, because reality sucks sometimes.