Monday, March 22, 2010

Only in the Country: Drugs Don't Lie



Being an ER resident in an inner city county hospital, it is a great experience to moonlight in a small rural hospital. Leaving the hustle and bustle and sounds of gunshots is worth the hour and a half drive to small town America.

Today I was called out for a "trauma" patient outside the ER. They needed help getting the patient out of his truck because the vehicle was so tall. The patient was in the passenger seat, with his girlfriend driving. The truck was huge, and attached to it was a trailer with a John Deer tractor.

The patient was a thin white male in his 30s, screaming that his leg was hanging in pieces and wanting to know if I was going to charge him since the accident wasn't his fault. The 2nd part decreased my suspicion for something serious going on.

His story was so long and drawn out I can't remember all the details. He was talking a mile a minute, obviously on drugs. He said that 2 weeks ago he got into it with a "kid" for firing a gun around his house. He had been plotting for the last 2 weeks how to get the gun from that kid (the kid was 24). Long story short, his plan didn't work. After punching out the kids car window, the kid chased him down and ran his ass over, breaking his tibia. It was a very stable fracture that didn't require admission or emergent surgery.

This guy never stopped talking, and was obsessed with what pain medicines I was going to send him home on. As I slid off his boot, a crack pipe and a stash of weed, cocaine, and meth fell out. He was so high he didn't even notice. The nurse put it in his belongings bag and we kept with our treatment.

I gave him some pain meds to take the edge off. Of course, he was "allergic" to everything but Dilaudid. And I better not dare prescribe him anything less than the 10 mg Vicodin. He swore he only does weed and only had taken 1 Vicodin in his life, but he knew that 5mg Vicodins didn't work, that he needed more codeine in the pill and less tylenol b/c the Tylenol is bad for his liver, that morphine causes a flushing and anxious reaction (releases histamine), that Demerol is pretty good but Dilaudid is great.

The patient called the police to report the accident b/c he said he wanted to "sue the shit out of that kid." Well....the nurse told the police officer about his drugs. The patient quickly sobered up and said only the pipe was his. He didn't know where the drugs came from, and threw his girlfriend under the bus. The girlfriend had a better defense. She said the drugs couldn't be hers b/c she had just snorted all of her drugs.

In the end, I splinted the patient's leg and the nurse pushed him out in his wheelchair....to the police officers car. Once he got close to the car, he purposely fell out of the wheelchair to try and delay his transfer to jail.

Oh yeah, he also offered to sell weed to our registration clerk. But the drugs weren't his remember.

-ER Doc

If you liked this post, check out the our original "Rural Medicine" post

7 comments:

Da Blog said...

Ah yes- and people say the country is dull! I work on the trauma floor at my hospital. I'd say half the patients are transfers from outlying villages. Always something going on out there.

CheapbyChoice said...

Just when I think I have heard it all, there is one more story. I am not sure why this surprises me. I work with teenagers, who tell me all the time "weed is legal if you don't get caught."
I enjoy your stories, keep sharing them.

Smocha said...

That was pretty rich. I should go hang out at the ER when I'm bored :)

Anonymous said...

I came back to the city for a weekend with friends from residency last week - I'm a small town doc and they are all in city/office based practices. I'm always the life of the party with stories ;) and keep them laughing as they can't believe what we see on a fairly regular basis! I just wish all those docs I shipped people to remembered any rural rotations/moonlighting and knew what we had to work with and didn't assume I was an idiot :)

StorytellERdoc said...

Ugggghhh! You handled it well, though. I pictured this guy quite easily from your post. Well done.

Whitecoat said...

I enjoy moonlighting in the country hospitals for just this reason.
Gotta love the stories.

Burger Doodle Chicks said...

Now you're just teasing, what happened with the squirrel attack post? Enquiring minds also from the wild countryside would like to know! We've only got, "When Llamas go bad" out here, not nearly as exciting.