12 January 2011

The True Definition of Pain

It's been a slow shift. I have spent the last ninety minutes tossing pencils at the ceiling to see if I could get them to stick. There are fifteen minutes left until I get to leave. I am hoping my replacement won't be late.

I have three patients in the department:

  • An old guy with a broken hip, admitted and waiting for a bed. 
  • A psychotic dude with bizarre behavior. Off his bipolar meds and paranoid, disoriented and weird as hell. WBC up a bit but medically clear and waiting for his psych eval.
  • A dehydrated lady with gastro finishing up her IV fluids.

As I wander over the the nursing station to graze off of the candy in the dish, the nurse for the psych dude approaches me, timidly, and informs me that the patient felt hot so she checked his temperature.

I said a bad word.

She told me the temperature.

I said a series of increasingly bad words.

The fever meant he was no longer medically clear. With the elevated white blood cell count and the disorientation it now meant that he was going to need a spinal tap to rule out meningitis. I was pretty sure he did not have it, but it's medically inarguable and as a practical matter no psych facility would accept him without it.  (Rightly so.)  So instead of walking out right on time after a painfully slow shift, I would get to enjoy staying late to perform an aggravating procedure on an uncooperative patient.

As so many times before I prayed for the Rapture to come now and end my suffering.

It could have been worse. I hectored and harassed everybody and got the patient sedated and tapped in what seemed like record time. My partner was very gracious in agreeing to review the CSF and ensure an appropriate dispo. I left the ED less than an hour after the end of the shift. So I can't actually complain. 

But I left annoyed, with my sense of well-being completely shattered. (I'm getting annoyed again just remembering as I write these words.)

Fortunately, I had podcasts of Car Talk on my iPod and I listened to one of those on the way home. It's impossible to listen to those guys cackle and stay in a bad mood.


  1. Well, a rather good day, huh? A shift without cancer dx.

    Hang tough Shadow.


  2. I listen to 'wait wait don't tell me' podcasts on the way home from shifts. Maybe I'll try the car talk guys next time. Their sunny dispositions are infectious.

  3. I had a paranoid and psychotic guy recently who kept yelling at me 'I'M SHITTING OUT YOUR BLOOD". He was real crazy and intense, and there was a broad consensus to throw him in the seclusion room after a big dose of loxapine. I upset everyone by getting bloodwork, and doing a physical.
    He was psychotic so as expected he was totally wrong about the diagnosis, it was his own blood coming from his rectum, not mine.

  4. One wonders why the nurse TIMIDLY explained the change in the patient's condition? Although irritating and fruitless in this case they are probably others where thoroughness has saved a life.

  5. She was timid or hesitant because she knew I was going home and that she had just handed me a huge pile of work on my way out the door. She was genuinely sorry to have to tell me that I was now in a world of pain.

    Possibly, she was also hesitant because she knew I was going to say bad words and rant. Which I did. But I also made it a point to go back later and thank her for being conscientious. And she thanked me for listening to her. So we are good.


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