Thursday, April 17, 2008
What does the name Emergency Department mean to you? A place to go for help when you are sick or injured? How about a place to go for breakfast? As it turns out, that's really all one of my recent patients was looking for.
She was a hand-off patient, meaning that another person initially saw her, and transfered her to me at shift change. The story was that she had just been discharged from the hospital the day before and was back with more pain. It was her typical sickle cell pain. No chest pain, no difficulty breathing, no fever. So the other resident treated her pain, gave her some IV fluids, etc. Sick sicklers we work up with labs and imaging, those with pain crises we treat and if we're unsuccessful at controlling their pain, they get admitted to the pain service for PCA pumps, and other meds we're not willing to administer willy-nilly in the ED.
So, I was a good little resident and immediately re-assessed the patient after signout. Her pain was a little better, but she said that she usually gets better pain relief when the morphine is pushed, rather than run in with fluids in a drip. Fine, second dose: IV push, followed by another liter of fluid.
In the meantime, the breakfast cart arrived in the department. Breakfast trays had been ordered for all of the overnight psych patients and nursing home guests that for whatever reason couldn't be moved out of the department overnight due to placement issues. Typically, we don't feed our patients as oftentimes they are not around for more than a few hours, are potential surgical candidates, or are in acute distress and can't actually swallow anything safely.
It is not "three hots and a cot", people.
So the sickler requests breakfast. Fine. Since the cafeteria was actually up and running by this point, a nice, hot breakfast arrived at her stretcher in less than 30 minutes. That's pretty damn good. During that 30 minutes, she pressed her call button no less than three times to demand fruit punch, more fruit punch WITH ICE, etc. from her poor nurse who was also managing an overdose-patient, a cardiac patient, and I think an asthmatic, all with multiple orders and monitoring tasks to keep up with.
Finally, the tray arrives. The call bell for Room 19 immediately starts beeping. Soon afterwards, the charge nurse comes up to me, and said that the patient was upset that there wasn't any meat on her breakfast tray.
She said, "This ain't no breakfast-- there's no meat in here! I've gotta have bacon or sausage, or I'm just going to go home."
That was the best news I had heard yet.
So, I go back to the room and tell the patient that I hear she's feeling better and ready to go home. She says "Yeah, my pain's all better, I just want to finish my breakfast." So we discuss follow-up plans with her hematologist to discuss chronic pain management.
The unsatisfactory breakfast? Steaming-hot cheese omlet, 2 pancakes with maple syrup, and hot coffee with cream and sugar. (I think I'd crammed a pre-smashed protein bar into my pie-hole that morning on the drive in, so I was seriously eyeballing her breakfast.)
Patients like this always frustrate me. I think her nurse should have set out a tip jar. They stroll in and out of the department frequently, and have been in so many times that they come with all sorts of crazy demands and expectations. Occasionally, they present really sick, but like the boy who cried, "Wolf", when you see someone multiple times every month it's hard to take their complaints seriously.
Often, it seems to be the patients who aren't paying for our services with co-pays or insurance premiums that try to glean as much out of the hospital as they can. I wonder how this works with countries with socialized medicine. Surely they still have the frequent-fliers, mainly drug-seekers, but do they have patients that are just as demanding, or do people abuse socialized medicine less?