Giving false identifying information may seem like a good idea when you get brought in by ambulance after getting your ass beat in a bar brawl that you started.

After all, there’s no way to track you down if you don’t have any ID, right? Free stitches. Free x-rays. Free pain medications. And all of those dimwits in the ED are required by law to treat you. Dudette, you’re golden.

Unfortunately, there would be a little problem if the ED doc was having a bad day. Let’s just say that he missed a fracture on your neck x-rays … an unstable fracture. One that could pith you if you twist your neck the wrong way. You need further care.

Then let’s assume that the radiologist’s note about the missed fracture got put in front of me with your disconnected “phone number” and your fake address. I would have no way of contacting you to let you know to come back.

Some might call it Darwinism at work.

Then …

When someone lives in a town 40 miles away and just happens to come to your ED for the worst back pain they’ve had in a long time and they just happen to be allergic to NSAIDs, Ultram, and Flexeril, it tends to set off little bells in the back of an ED physician’s head.

But there were no previous visits to our hospital and we called the hospital from the town where the patient lives. No history of any ED visits there, either. I check the online state database for controlled substance prescriptions and there’s no history of any narcotics being prescribed to him.

Those ED nurses have pretty good memories, though. So when one of the ED nurses sees you walking to the bathroom and says “I haven’t seen HIM around here for about a year,” you’re busted. “Oh yeah, that’s Johnny So-and-So. Let me guess – back pain?”

Registering under a fake name. We pull up his real name on the state database and there are pages of narcotics prescriptions from hospitals all over the area.

Looks like you’re getting Tylenol … number three for your back.

I’ve decided that I’m taking pictures of any patients who don’t provide picture identification when they register and including those pictures on the chart.

I’ve also decided that I’m going to get a stamp that goes on every prescription: “NOT TO BE FILLED without state-issued picture identification.”

$9.50 well spent.

While an abscess probably isn’t an “emergency” within the strict definition of the term, it is still something that needs to be lanced and drained so that it can heal.

As a side note, many abscesses, once drained, do not require antibiotic treatment. They get better on their own with the drainage. See sample articles here and here.

Women are predisposed to a certain type of abscess called a Bartholin abscess (link contains graphic pictures) which occurs, as SeaSpray would say, in Bajingoland.

Draining an abscess is painful. Draining an abscess in Bajingoland is more painful. That’s why we inject lidocaine into the area to numb things up before we proceed.

So the nurse gets the patients into stirrups and I start to examine the abscess. I lightly palpate the area to see the extent of the abscess.

“OK, you’re going to feel me press gently on the area to see how big the abscess is.”
“Stop, stop. I don’t want to do this.”
“Without examining you, I’m not going to be able to help you very much.”
“OK. Go ahead.”

I gently press on the area for a second.
“Ow. Ow. No. Stop! That hurts.”

“I understand it is painful. I’m trying to be as gentle as I can, but I need to see how big the abscess is before I can help you.”
“OK. I can take it. Go ahead.”

I grab a syringe with lidocaine in it. “I’m going to shoot a little medicine into the area to numb it up so it doesn’t hurt so much.”
“Ow. Ow. Ow. I don’t want to do this any more. Take the needle out NOW!”

That was it. I could just see her going to the hospital administrators or to the police and saying that I was inappropriately touching her down there without her permission. Fortunately, the nurse was watching everything, but it was still a hassle I no longer wanted to deal with.
So I told her “I’m going to refer you to a gynecologist to drain this. I don’t feel comfortable doing it.”
“But it HURTS!”
“I understand that. I told you that I was going to numb it up, but you told me to take the needle out. And now you’ve told me not to touch you three different times.”
“OK, go ahead. Let’s get it over with.”
“I think it’s better that you see a gynecologist to do this for you.”
“So you’re going to leave me in pain?”
“Not at all. I’ll give you some pain medication to take until your appointment.”

Then the bombshell …
“Why are you refusing to take care of me?”

I wish I had a tape recorder in the room. This is just one of those situations that can be twisted to make you look bad no matter what you do.
There’s no way I’ll come out of this encounter looking good.

We’ve had a run on suicidal patients engaging in self-destructive behavior, lately.

First there was the man whose consumption of alcohol had in turn consumed him. He came in a shell of his former self, upset that he had no home, no job, no money, and no wife – all a result of his relationship with the bottle. He had nothing to live for but his bottle and even the bottle was starting to fail him. He truly wanted to die.

Then, just as we had whisked one suicidal person off to the psychiatry floor, another one came to take his place. A young woman with two infant children and 7 months pregnant with a third was upset because her two current children had been taken away from her by the state. She drank some alcohol, then took a “bottle” of her friend’s Wellbutrin (which later ended up being “a few pills”) in a suicide attempt. She also had plenty of drug paraphernalia in her purse. The track marks on her right arm showed that she was a lefty and the insulin syringes in her pocket contained material much too dark and viscous to be used for diabetes.
She was in a rage yelling at everyone one minute and then sobbing uncontrollably the next.
When asked about the last time she used cocaine, she indignantly screamed that she did not use cocaine. I held up a crack pipe that came out of her jacket pocket.

“It’s a meth pipe, duh.”

She bawled as she told us how she had recently become addicted to crystal meth. I sat there with a blank stare on my face thinking for a second how her pretty white teeth probably won’t remain that way.
She refused to drink charcoal recommended by the poison control center, so we inserted an NG tube into her stomach to get the charcoal into her system.
Then she began bawling again, demanding to know whether the charcoal or the NG tube would hurt her unborn baby.
The irony in her question really made me sad. From her age, it probably wasn’t too long ago that she was getting dressed up for her high school prom and her parents were proudly fussing over her hair, taking pictures, and staying up worrying about whether she’d be safe that night. Now she too was a shell of her former self.

“Your baby’s going to be fine. Don’t worry about her. Get some rest, now” I calmly told her as the nurse gave her a sedative.

Treating all those “shells” has a way of getting you down sometimes.