Sunday, April 27, 2008
Ethics be damned, I finally did it. I worked the overnight recently and one of our executive class frequent flier patients showed up in the waiting room at 2am. Dr. Deborah Peel (the patient) was, evidently, prepared for the fact that our ER cocktail lounge had been closed for a bit so she tanked up prior to arriving. Her chief complaint was that she was "really going to do it this time", as in, she was really, honest to goodness, no kidding and no reversies, going to off herself.
All she had done toward that end was polish off the better part of a fifth of Old Grandad with some valium as a chaser and yank out stitches one of my colleagues had placed in her wrist (very superficial wound) the week earlier. Apparently not happy with how quickly she had been brought back to a bed she 'fainted' out in triage and when I was called to see her in the room she had the "I've just seen a ghost" stare and was very good at it. Just as an aside I could well have said that it appeared that she had just had an encounter with the 'numinous', which is my favorite new word, but let me go ahead and tell the rest.
After I jammed a Q-tip most of the way past her turbinate (nasal passage) and she persisted with the stare I gave her narcan and she woke up a bit. Turns out narcan does occasionally have an effect on severe alcohol intoxication and this woman did not have opiates on board so that was interesting. It took about two minutes to figure out that she wasn't going to die within the next 5 hours so I felt a lot better. I ordered tests and meds and went to the next patient.
The next patient had his face mangled by a big dog. The patient and his girlfriend were extremely nice and I really enjoyed helping them out. The repair took me about 45 minutes and I had big flaps of facial skin to realign and the lip to put back together in two places.
As I was actually doing something worthwhile with the dog bite guy the aforementioned woman kept yelling that no one was doing anything for her pain. Debbie (as I call her now) denied being in pain when she 'woke up' so that, along with the fact that she was as drunk as Cooter Brown made it inadvisable to giver her pain meds. She would not leave her nurse alone though. Finally the nurse had to act so she came to me and I nodded conspiratorialy before she said anything.
ME (within earshot of drunk lady): "Wow, it sure sounds like she's hurting, better give her something strong... Why not try 650mg of paracetamol, but tell her not to take it unless she wants to sleep because it's so strong (wink, wink)".
NURSE: "Oh doctor! Are you sure???"
ME: "I think it will work and I think she needs it".
Paracetamol is tylenol (as the Brits call it). The patient asked what the pills were, she was told they were paracetamol and would make her sleepy etc... and like a good patient she swallowed the tylenol and promptly went to sleep.
Ethicists would probably say I abused my authority and engaged in deception. I don't agree as tylenol is a pain medicine and I would argue that I was setting the patient's mind up for successful treatment. In fact, I would argue that I was using CAM and that it worked like a charm.
The dog bite guy did well and he and his wife winked at me knowingly when the snores started from the adjoining room. CAM rocks!