WhiteCoat

I Made A Drug Seeker Cry Today

I made a chronic back pain patient who was out of his pain medications cry in my emergency department today.

Actually, he was already crying when he came in. The nurse said that he hobbled in from the waiting room bent over like an old man and using his wife’s shoulder for support. He couldn’t stand upright because of his severe pain.

I was finishing up with the patient in the room next to his when I heard him get put into the room. He was moaning and moaning. As I discussed the discharge instructions with the current patient, the moans sometimes overshadowed what I was saying.

Before going to see the patient, I looked up his old records on the computer.

He was 41 years old. According to his old chart, he had wrenched his back while fixing the tire on his car more than a month ago. Ever since then, he had been having pain in his lower back. His primary care physician gave him a couple of weeks of Percocets and some Valium. Those medications helped him somewhat, but he still had pain. When he ran out of the meds, he got one week’s refill and was referred to physical therapy. He went to physical therapy twice and it caused the pain to get so bad that he stopped going. He called his doctor back and his doctor ordered MRI of his back. I pulled the MRI report which showed multiple minor disk bulges but no other problems – definitely nothing that would cause his back pain. So his doctor set him up with a pain clinic. No appointments were available for more than a week and his doctor had cut him off from narcotic pain medications after the relatively normal MRI. This was his third ED visit in the week.

When I walked in the room, he was in a fetal position on the bed and he was crying.

“I’m Doctor WhiteCoat. How can I help you today?”
“My back, doc. It’s killing me.”

He described the whole story. I already knew most of it from notes in the computer. I also saw the several doctors from whom he had received pain medications.

He wouldn’t lay flat on the bed because he said it made his back worse. His position of comfort was laying in a fetal position or laying on his back with his knees flexed.

Back in medical school, I worked part time in a back pain clinic for a year or so (long story). After a normal neurologic exam, I thought he probably had a psoas muscle spasm. Pretty common cause of non-traumatic back pain.

So I gave him some Toradol and Valium. I told him that I thought I knew what was causing his pain and that if he trusted me, I could probably make him feel better. Fortunately, the ED wasn’t too busy that day, so I could spend a little extra time with him.

I got him to lay on his back with his legs flat. I went to see another patient.
I came back and had him roll on his stomach. I went to see another patient.
I came back and used the stretcher to extend his back a little. I went to see another patient.
I came back and used the stretcher to extend his back a little more. He moaned in pain. I went to see another patient.
After the third incremental extension, I let the bed back down. I showed him how to get out of a bed without putting a strain on his back. Then he stood upright.

No pain.

A win!

I showed him a few stretching exercises he could do to hopefully help keep the pain from developing again.

I left the room to finish discharge instructions, printed out some examples of stretches he could do and came back to hand the printouts to him. When I came in the room, he was crying again.

“I thought that your pain was gone,” I said hesitantly.
“It is. I was just telling my wife that you’re the first doctor through this ordeal that has actually sat down and listened to me and who tried to fix my pain without pumping me full of drugs. I don’t even think I’ll need the pain prescription. My back feels that good right now.”

I smiled. He reached out and gave me a firm handshake. Then he pulled me in and gave me a hug.

A little surprised by that whole man hug thing, but I was glad that I was able to help him.

I was working in the charting room (which is out of the patient’s view) when I heard him walk up to the desk and say “Tell Dr. WhiteCoat thank you again. He is an excellent doctor. And thank you for all your help.”

After he left, I had to rub it in. I walked out and said to the nurse “I heard you have a message for me?”
“What?”
“A message for me from a patient?”
“Nooo.”
“Something about being an excellent doctor. Come on now. You can say it. Ehhhhhhxellent … Ehhhhhhxcellent.”
Then the secretary chimed in.
I heard him say that you were a dork. Dorrrrrrk. Dorrrrrrk.”

The insubordination that all of us excellent physicians have to put up with some times …

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

23 Responses to “I Made A Drug Seeker Cry Today”

  1. DefendUSA says:

    Nice! I talked my stubborn spouse into PT because he was a miserable, grumbling bear about back pain. Luckily, the PT was former Army LTC (apparently a comfort to him) and she spent an hour with him. Now, he has been pain free for three months because of the stretching he does before getting out of bed!!

  2. Tanja says:

    Totally not the story I was expecting after that headline :)

  3. Susan says:

    Great Story! My DH has dealt with back pain his entire life (overweight, even as a kid, scoliosis too…) – we’ve been working out with the same trainer for 3 years now, she’s peeled back his low back pain to psoas, iliacus, and gluteal imbalances… in addition to regular workouts, stretching every day, and his inversion teeter. His back aches aren’t totally gone, but they’re SO much better than they were before.

  4. Jeff says:

    Great story. Do you have a good source/reference that I could look at to see how to do the stretches?

    Thanks

  5. MeganLee says:

    I appreciate your line about teaching the pt how to get out of bed. I am a sonographer -I scan pregnant bellies. It is incredible the number of women who start to sit straight up when I tell them they are finished. If I catch them in time, I make them roll onto their side, swing their legs over the stretcher, and push up with their arms.
    Almost to a woman – they say – “that is easier”, and, “my doctor never showed me that”
    It must take me all of 30 seconds – and I hope it will save them back pain when they get another 10 weeks along.

  6. Hello Pit Bull says:

    Thank you for sharing this! My husband has suffered from chronic back problems for years (DDD). He HATES the way the pain pills make him feel and says he refuses to live his life in a haze of narcotics. However, he too has had trouble finding a medical provider that wants to do something other than shove a script at him. He did finally manage to get a referral to a pain clinic and has had some excellent results in reducing his pain WITHOUT drugs.

    Not all “drug seekers” are looking for drugs… some of them just want relief from the pain and would prefer that it not come in the form of a pill. How nice it would be if all medical professionals would take the extra moment you did to work with the person and not make assumptions.

  7. Zachary says:

    From an ED intern —– Awesome. Im not a DO but am still a fan of manipulations that can help patients out without “pumping them full of drugs”. Do you have any links to this specific maneuver?

  8. Raf says:

    Great job, doc.

    I was freed from 10 years of severe back pain the day that lateral thoracic supports were fitted to the backrest of my wheelchair.

    Not many things make me angrier than getting stuck with a healthcare provider trying to solve a mechanical problem with pharmacology.

  9. Genoz says:

    Can I have his pain meds? Just kidding, nice job helping the poor guy! I had the same experience. I bent over to pick something up and I heard a pop. After about a month someone showed me how to take care of my back and voila, I am happy again.

  10. Bloodshot says:

    After reading the story, he doesn’t seem to be a Drug Seeker but a “Exellent Doctor” Seeker. He didn’t mind that he didn’t get any drugs.

  11. ER made my elderly father cry last night says:

    So many so-called “drug seekers” are in actuality “pain-relief seekers”.

    The “us against them” “GOTCHA!” mentality against anyone seeking relief from pain from the ONLY PEOPLE our government has licensed to be allowed to relieve their pain disturbs me — it is a common, “fun” theme on so many medical blogs but I don’t understand what you “win” when you play this game.

    Doctors are in a position of incredible, State-bestowed power when it comes to pain relief, and it’s hard not to get the idea from some blogs that they exercise their power to deny mere mortals relief “just because they can”.

    I don’t know whether some of you understand what bullies you sound like.

    Signed, a daughter who just spent hours in an ER department with her 75 year old father who was suffering EXTREME pain from an abscess where two teeth have just been removed, and who got demeaned and embarrassed so that you could win some kind of “HAHAHA, turned ANOTHER one away!!!!!” points.

    Y’all made a formerly proud old man cry in front of his daughter. I hope you’re happy.

    • Marni says:

      Uh, did you actually read the post????

      • Ruthie H says:

        Ditto to Marnie….in case you did not read it, they were tears of joy and appreciation. I honestly do not think WC was saying “look at me…look at me”. I think he was actually bringing attention to the fact that sometimes we actually need to take the extra few minutes (if at all possible) to listen to the patient, go the extra mile. Just put the anger away for a minute and actually read the post. I’m sure you would have a different outcome in your thinking of this post.

  12. liz says:

    beautiful story! great work, doc.

  13. JJ says:

    WC,

    Bad news. Due to a computer glitch the address of this patient was lost. Consequently, no Press-Gainey will be sent. No soup for you.

  14. Tarl says:

    I suspect your patient felt something like this:

    http://chuckleaduck.com/comic/tell-me-when-it-hurts/

  15. Larry Sheldon says:

    You have no idea what it is like to find somebody who listens and attacks the problem.

    I put up with pains (not usually debilitating) in my upper back, my arms, my wrists.

    In addition I had a condition I don’t know how to express but it did its worst when I tried to relax to go to sleep.

    Here is the best I can do–I have a drill I learned years ago of identifying then conciously relaxing muscles–wiggle right toes–relax all of those, left toes….,fight calf…..

    But when I got to my upper body, it sometimes felt like there was a relaxation in arm muscles, say, from what I thought was already relaxed. Like a loss of tone. or a flinch from a pain I was not aware of and didn’t “feel”–a subliminal pain?

    Over the years doctors would give me Naproxen Sodium (which I think makes me angry) Tramadol (which I think maybe a placebo that doesn’t work).

    Some times I’d get sent to a physical therapist who got me to do much needed exercise, and sometimes used manipulation and traction or Buck Rogers LASERs and ultrasound, and often made me feel better.

    Many suggested surgery of one kind or another (Carpal Tunnel was all the rage for a while but the PT at the time convinced me that while we didn’t know what it was, he was sure carpal tunnel it wasn’t. A back surgeon said he couldn’t find anything to fix.

    Then a couple of years ago my right shoulder hurt so bad that “debilitating” is probably a useable descriptor. That got me to a PT that did the hand-held traction things (and also made some headway on lymph edema in my legs which no doctor could or would address). But when the shoulder pain was eased the payers of funds said that was good enough.

    The a year or so the left shoulder went off and that was debilitating. A daughter who sees a chiropractor for injuries she got playing football hammered on me to see a chiropractor here that hers recommended. I was raised to not trust Chiropractors, but when the choices are limited to one…

    He diagnosed my problem as “brachial neuralgia” which set off all the alarms–I an very suspicious of doctors he think that by naming something they have solved the problem, and I get really suspicious when they translate my complaint (“arm nerve hurts”) into Latin.

    But the first guy I saw in the practice did his manipulations and the relief was profound.

    And short lived. Then next guy (actually, the one recommended and the owner of the practice) seeing me in pretty severe agony said it was a shame in a way that I had gotten early relief, because it was going to take a while. But over several weeks he did his thing (and I listen to his nonsense about flu shots and store-bought food) and I feel healed.

    the twitch feeling that I can not describe came back the other day but after seeing them for “adjustments” it is gone for the moment.

    He listened, he took in all that I tried to describe, he explained what he thought was wrong and what he was going to do about it and he did it and it worked. And I can afford it.

  16. Janice says:

    God bless you. I want you to know you made me cry too. Thank you.

  17. Ella says:

    From someone who has experienced debilitating pain that noone could diagnose, I know sometimes doctors can’t fix the problem. But there were a few doctors who clearly listened to me, and tried to figure it out. There were also some who tried to shove pills at me. Thank you so much for being the former with this patient. You may have given this man his life back.

  18. NotADrugSeeker says:

    hope you see this since it’s been so long – I stumbled across this looking for examples of how medical professionals treat people they think are drug seekers, trying to explain to a friend what I mean, why it’s so frustrating, and why I won’t go to the ER unless I’m bleeding out the eyes.

    I’ve had cluster headaches for about 15 years and it took about a year to diagnose. A horribly painfully condition (many doctors feel it’s the most painful condition) that doesn’t show up on any tests so you can’t prove you have it? Naturally many docs and nurses treated me like an addict looking to score.

    I’ve even seen medical professionals say, on forums like this, that ANYONE who comes into the ER with a headache or backache is a drug seeker. And, they, particularly ER workers, seem to feel it’s their job to punish suspected drug seekers, with pain (“let’s be incompetent when we place that IV and stab her 8 times”) or humiliation (I was once injected in my bare ass with what they claimed was Demerol (thought I believed it was saline as it did nothing for me) in a room full of people) or just upset and frightened (I was once left restrained to a gurney for an entire night, which was a scary, upsetting experience, was aggravating for my PTSD, and just in general made me feel just horrible)

    So, I was expecting a vastly different story when I clicked this link. You ARE an excellent doctor, and something even more rare, a doctor who listens. Most people who come in with pain AREN’T after pain meds, they are after pain RELIEF. They may think pain meds is the only thing that will relieve their pain, but it’s really pain relief they want, and a doctor who listens is worth way more than their weight in gold. I’ve only met one in my life, and I’ll never let him go :) But listening and diagnosing, rather than just shoving pills down our throats, that’s really what we want. Thanks

  19. Barb says:

    After several years of badly needing narcotic pain meds for extensive osteoarthritis, I finally found a doctor who took time to listen to me. She ruled out any cause for pain except the arthritis pain, and gave me an adequate narcotic.
    Before her, I had been given small doses which were never enough, driving me to take dangerous amounts of ibuprofen and acetaminophen. Pharmacists treat me like a drug seeker. My existence was one ruled by pain.
    Doctors who actually listen, observe, and treat their patients are precious. Just remember that the result is not always removing narcotics from the patient’s life, but sometimes supplying those that actually make a difference and believing what the patient says. We’re not all lying to get drugs.

Leave a Reply


− 2 = four

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM