Sometimes you have a shift where patient after patient just suck the life out of you. Usually in these cases, the patient is not acutely ill but for one reason or another, they take up vast amounts of your time and in a painful way.
In some cases, the patient is a motor mouth and just won’t stop blabbering or take hints and cues that you are not interested in the details of tonsil surgery they had when they were 5 when their chief complaint today is right leg pain. Often but not always, these patients are anxious to the point of you wanting to just mist the air of the room with aerosolised Ativan before you go into to question them. In other cases, the patient’s complaints are so vague and discombobulated as to make exclusion of emergency nearly impossible to a high degree of certainly without ordering a billion dollars worth of expensive and probably unnecessary tests. You can forget about actually making a diagnosis.
And then there are the narc addicts. The straight forward scamming drug seekers are actually not so difficult to deal with. I just look up their Rx history on our state’s database, and confront them about it. The conversation usually ends with me telling them to hit the road unless they want to take the ketorolac I offered them. It raises my blood pressure though to get into arguments with these folks and it puts me in a bad mood for a good part of the shift. However, the ones that really drain all of your life force are the ones that are on chronic pain meds for something non-life threatening (usually Fibro, back pain, or migraines) and then come in with something that is actually concerning – theoretically. Like they have a new pain that is completely different from their chronic pain and thus require a workup. During the workup it’s a guarantee that they will demand huge doses of pain meds – and usually not for the new pain but for the chronic pain. The longer they stay, the more RN calls you get saying they need another blast of 2mg Dilaudid. This is in conjunction with the whining that always seems to be part of these patients’ personalities – even if ultimately they have some new, legitimate medical issue.
After a shift like this I was BEGGING for someone to be A). Normal, B). Not on chronic narcs, C). Not weird and overly anxious and the bonus would be they actually have a real emergency but I would take a bogus straightforward case!