That Doesn’t Seem Right
“I once had a patient complaining about and passing (we heard them drop in the bowl) bladder stones. She gets pills galore, of course. Those things hurt! We sent the stones for testing, and it turned out the joke was on us… they came back as gravel.
She’d sat hunched over on the toilet, making all the right noises and movements for it to look like she was in pain. Plus it’s easy to hide small stones in your hand when you’re doubled over. The pebbles were small, the right size and the lack of blood is common in some people. But even the lab said, ‘Not usually found in human anatomy.’ No more pills for you, lady!”
Mommy Will Be Right Back
“One time I had a patient fake a stroke to get pain meds. She did it during her 10-year-old’s birthday party, of all times. She perked up quite a bit when we mentioned pain meds, and requested a particular dosage (which was much higher than we were going to give her). Lady had negative CT, negative MRI, inconsistent symptoms on exam, and a history of pill seeking. She clearly had issues, but it made me sad for her kid.”
Gastro Disastro
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“I once had a young person fake a gastrointestinal bleed. They went to the ER with a picture of blood in a toilet saying they threw up a lot of blood. We immediately put two IVs in each inner elbow and started working them up.
They say they have to go to the bathroom and we allow them to walk in there because they still seem strong enough. They come back out and say they threw up again. Blood was everywhere.
They get whisked away to the ICU for immediate intervention due to the amount of blood that has been visualized. Then they have a unit of blood transfused without checking their blood count again to stay ahead of the gross loss of blood.
They throw up in the bathroom again with the same bloody show. Though they aren’t pale and are still strong, plus blood pressure is still good, so we figure that they’re young and can handle more before showing signs of deterioration.
Then they are sedated and intubated (to protect the airway if their bleeding is that bad) and an endoscopy is performed to find and stop the bleeding. It looks perfect. Nothing is seen, and we went down with the scope a second time just to be sure.
The gastro doctor says there seems to be no bleeding and doesn’t know what to make of it. Everyone’s confused. The nurse starts trying to figure out why and finds an empty, bloody syringe in the patient’s pocket while they are still out cold.
This person took a saline flush, emptied it, and used it to draw up blood from their IV, then proceeded to squirt it all over the bathroom to fake throwing up blood. Even squirted some in their mouth the second time to really sell it.
We removed both IVs before they woke up. Then we explained nothing was found and they are perfectly fine, but we did find the syringe. The patient gets angry and says they’re gonna leave. That’s fine, sign this form (your insurance might not pay now), and we’ll call you a cab and pay for it because you’re still recovering from being fully sedated and intubated for that endoscopy.
The patient denies a cab and walks home.”
She Couldn’t Believe Her Eyes When She Came Back In The Room
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“The patient was a man with a fistula (a hole from the skin to the organ) created by the man picking at an incision site. He had a controlled substance alert, was continuing to request his oxy every 4 hours on the dot (which I gave because abdominal wounds are painful), and also requesting IV Dilaudid.
When I told him that I wasn’t going to be giving him the IV Dilaudid, he was very upset and tried to manipulate me into changing my mind, but I didn’t cave. Later I enter the room to see him happily picking at and extruding his own bowels.
The ostomy bag that was catching the output was completed filled with blood. The first thing he requests when I enter was the IV Dilaudid. Probably one of the grossest things I’ve seen in the hospital.”
Don’t Try This At Home
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“A guy ended up in the operating room from the emergency department with a dislocated shoulder. We were going to reduce it (pop it back in) under sedation. He named both substances that the nurse anesthetist pushed through his IV.
He asked, ‘Is that Lidocaine? Is that Propofol?’ and he didn’t seem the type that worked in the medical field, what with the large swastika on his chest, which looked fairly fresh. We put him to sleep, moved his shoulder around under the x-ray, and wouldn’t you know, his shoulder was fine.
Apparently pill seekers with a weak rotator cuff that can easily dislocate use this trick to get pills and have it ‘fixed’ in the emergency department. Little did he know the orthopedic surgeon on call decided to take him to surgery and do things the expensive way. He was uninsured, so I’m sure the medical bill was insane.”
Inconsiderate Imbecile
“I had a patient reporting a 10/10 migraine, demanding Dilaudid and her home dose of narcos. She had all the lights on in the room, TV on with volume up high, and was playing on her phone when I go in to assess.
I wasted 15 minutes of breath trying to explain why opioids are not a good treatment for migraines, and that I would not be giving them any narcotics for a migraine. We could try any of the options neurology had recommended, specifically for the intractable migraines, but we would not be using any medications not ordered by a neurologist.
I explained that opioids are not a good treatment for migraines, because they’re more than just pain in your head. It’s pain, nausea, sensitivity to light and sound, dizziness, and distorted vision. Similar to a broken arm, pain is a symptom, but not the root of the problem, or the only symptom. We want to treat the migraine, not just block the pain. Treating the migraine syndrome itself should remove the pain without opioids (and will also end the other symptoms). Opioids may relieve the pain temporarily, but the underlying migraine may outlast the opioids effects, and it can actually make your migraines worse in the long run.
Sadly, lots of healthcare staff will just give patients what they want because it’s easier than dealing with crazy people. I mean, I had 4 other patients that shift, who were actually sick and in need of my attention. The ordeal of denying her opioids took an hour or two out of my shift and took my attention away from patients who were riding the line of being medically stable. It’s a dangerous game to play.”
He Just Had One Very, Very Important Question To Ask
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“As a resident, I had a patient who had a blood clotting disorder, but who was also addicted to IV pain meds. He figured out how to get admitted for an extensive workup due to a possible blood clot in the lung, and wanted IV pain meds for his ‘chest pain.’
He came in all the time, but it was very difficult to block the admission because he actually did have a risk of this problem. He never took his blood thinner correctly, and his symptoms always bought him a couple of days at least while we ruled out a clot and got his blood levels where they are supposed to be.
But it meant he had accumulated over 30 high-resolution CT chest scans over his life, which is not good for you. I had one question I would ask people who tended to come in complaining of every serious sounding symptom they could think of, ‘Does it ever hurt behind your eyes when you pee?’
I was very salty at that point, this guy was a nightmare when he ended up in your service, and it really bothered me that he was admitting himself with a likely fake lung tumor just to get a day’s worth of IV pain meds and Benadryl.
With him, I started asking the ‘pain behind your eyes when you pee’ question like it was extremely important, and he quickly answered yes. I acted like it was an extremely serious condition that warranted evaluation
I consider it one of my greatest achievements in residency, that one day he showed up in the ER with ‘pain behind my eyes when I pee’ as his chief complaint. Then one day I overheard a colleague talking about this crazy dude who came in demanding to be admitted because he had excruciating urination-related eye pain. Made my day.”
Jacked Up Junkie
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“I once had a lady who’d maxed out her fentanyl scripts and other meds. She did have a legitimate issue, but she’d also become a full-blown prescription pill addict.
She agreed to be admitted to the hospital under the pain management team for a horse tranquilizer infusion, with supplemental morphine and diazepam to help with withdrawals (the horse tranquilizer is thought to ‘reset’ things so the patient can make do with less narcotics).
The only problem was, she had psychological issues as well, and was basically babied along for four weeks. The number of pills she was still on was spectacular. No one would take control, and nobody wanted to deal with it.
When I’d go in there, she would rate all her scores high and pretend to have the shakes. No lady, wiggling like a worm is not a withdrawal symptom.
Then she got another pain patient in with her, and despite me bringing my concern to light, they remained roomed together. Of course, they egged each other on, and things escalated.
The second day, before I got to work, the patient had gone on a walkabout with her horse tranquilizer drip. She claimed to not remember doing it, but after I got to work she told me she might do it again. The head nurse wanted her moved to close to the nurse’s desk so she could be observed.
Of course, she didn’t like that and threw an epic tantrum. She was over 50, and some of the highlights included ripping her IV out and spraying blood all over her fresh white blanket, sitting on the ground, and smacking her head against the cupboard.
I honestly wasn’t fussed. It was all for show, but I took her sharps out of her bag for good measure. She did eventually settle down, and after a week was fully detoxed. I met her in another ward a few months later and she was a different lady, having a normal level of pain meds for the procedure she just had, and finding them effective. I don’t know if she remembered me or not, but we both acted like we just met each other.”
Pesky Patient Placebo
“A patient was asking for painkillers every 10 minutes. She claimed she had a headache, toothache, stomach ache, and all the aches in the world. We had examined her and there was nothing to worry about.
But after she wouldn’t stop complaining, I gave her a Tic-Tac and told her to swallow it. 5 minutes later, she comes back and tells me, ‘See? You didn’t give me any medication all day and I was in pain, but now after one pill all of my problems are gone!’ I was both dying laughing and ripping her to pieces inside my head, unreal!”
That’s Gotta Be Bad Karma
“A woman with a shaved head came in telling us she had leukemia and was in serious pain. She kept saying that she needed painkillers, but there were no records indicating she even had cancer, and when we did a complete blood count it showed that she was in fact healthy.
After that, we discharged her and notified police. A few weeks later, I saw her on my state’s most wanted list for carrying out ID fraud at pharmacies in 20 different counties. Oxy is truly something else.”
Stubbed Toe Emergency
“In my training to be a catheterization lab specialist, I went to pick up a patient in the emergency room for a foot x-ray. She literally came to the ER because she stubbed her toe. Here’s the thing: if you break any of your toes except for the hallux, there’s no treatment, no case, no surgery. So she’s getting an x-ray pretty much for no reason because it’s extremely difficult to break your first toe.
Anyway, as I approach her room, I can see her on her bed reading her phone quietly. When she sees me, she puts her phone down and starts to moan, whimper, and hold her foot. ‘I’m certain that it’s broke.’ I check her ID, introduce myself, and explain that I’m ready to wheel her back (yes wheel, she wouldn’t walk) for her x-rays.
‘Oh no, I’m not going anywhere until I get pills for this pain.’ For context, people seem to think that in a hospital, there are only doctors and nurses. I’m a woman in scrubs so she thinks I’m a nurse. Also, stubbed toes are very low on the triage list so she’d been in the emergency room for hours.
When she realized I couldn’t give her any pills, and that she’d have to wait longer for her x-rays, she suddenly decided that she could go after all. ‘I’ll just get the pills after.’ Guess what? Nothing was broken.”
Puke And Rally!
“I had a guy who would come in at least twice a week for gallbladder attacks. It became obvious in short time that he was pill seeking, as he refused everything but the strongest opiates, and would all of a sudden be in no pain and storm out when denied.
After a while, when we turned him down, he would vomit extremely loudly to show how serious this was. The only issue was, as he is holding the emesis bag to his mouth, you could see him bending his middle finger into his throat to stimulate his gag reflex.
He continued this for close to 2 months before he realized he had seen almost every provider, and none were going to prescribe him opiates of any kind.”
That’s Not How Detox Works
“I once had a detox patient with a history of seizures. She was on chronic anti-seizure meds but eating up the Ativan during detox. After she had been safely through the medical risks of detox (mainly seizures), we discontinued the Ativan.
The patient threw a fit when she found out. I educated her on the role of benzos during withdrawal (for example, seizures). Then she tried to start refusing her chronic seizure meds. Lady was purposely trying to give herself seizures to try and get Ativan back. The same patient was also eating up her pain meds the minute she could get them. So I told her that I wouldn’t give her anymore pain meds if she wouldn’t take her seizure meds, and that was that.”
Better Luck Next Time
“Back when I was an intern in a busy trauma emergency department, one day a guy walks up the ambulance bay and screams that he needs to be seen immediately. They take him back and he starts telling everyone he was in a car accident last night going ‘100+ mph’ on the interstate but did not go to the hospital because he was worried about his friend, the driver.
But now he’s losing feeling in his legs and has severe back pain, so he needs to be seen. Of course, the story is super fishy, but we put him on a backboard/collar and get some x-rays of his chest and pelvis (our protocol for any severe trauma).
The radiologist who is stationed in the department flags me and asks when outpatient got a CT scan. He showed me his pelvis x-ray and his bladder is super bright’ it’s filled with the iodine contrast agent they inject in your veins when you get a CT, which is then excreted by the kidneys over the next few hours.
So we confront our patient about why he didn’t tell us about being seen at another hospital and getting a CT. He launches into a rambling explanation about concussions and amnesia. He has, of course, also exhibited several other pill-seeking behaviors in his short time with us. He decides to leave against medical advice, but not before asking the nurse directions to the nearest hospital, presumably to try the same trick.”
Try A Chill Pill
“My mother-in-law is a family doctor. I went to her practice to drive her home and was sitting in the waiting area. The place is emptying out and I’m there alone.
The receptionist goes downstairs to get a coffee because there’s one patient left and she just has to do paperwork when they come out. Then this haggard looking guy comes in in a wheelchair. While she’s gone, he wheels over beside me, giving coughs that sound and look like death.
Anyway, the last patient walks out before the receptionist is back. A few minutes later, out comes my mother-in-law and she spots this guy. She says immediately, ‘Mr. __, please leave.’ He starts on some crazy mumbling rant about how he’s in so much pain, how he can’t even walk anymore, and a bunch of other stuff.
So of course, she says something like, ‘If you do not leave I’m going to have to call the police.’ And this guy jumps out of the chair and runs at her. Now it wasn’t super fast by my standards at the time (I was a 25 year old in decent shape), but he was going to mess her up by what I could tell.
Thankfully I was able to get up and sort of semi-tackle him against a wall before he got to her, but he was surprisingly strong. I couldn’t actually believe what I was seeing. My mother-in-law had locked herself in the reception office that’s glassed in (apparently this kind of thing happens more than once, which is scary).
I let the guy go and he didn’t seem like he was gonna mess with me, but I in retrospect I probably should have kept him pinned in case he had a knife. I guess I thought I was invincible.
The guy swears at her for a while through the glass and starts banging on it. It was as if I wasn’t there. I thought he might come at me, or try to hit me, but nope, he was just boxing the glass in front of him.
The one funny part was when the secretary opened the door to come in, saw the guy, and ran away like the devil, spilling her coffee The look on her face was priceless, and lunatic man was oblivious.
Anyway, like 5 minutes later a couple of cops show up and weirdly the guy kinda calmed down. They cuffed him and took him away, and then we did reports. Nearly an hour later I was finally able to drive her home. My mother-in-law said the guy just wanted pills, which she saw a lot.”
Seems Excessive
“I got called out to a residence at 2 am (because of course, it’s always 2 am). The guy says he’s having 10/10 finger pain and gingerly holding his hand in the air. He says there was no trauma, it just started suddenly and it’s unbearable.
So we load him up and take him the 25 minutes the hospital. The entire time he’s holding his hand in the air. But we had a full conversation about football, and never once did he complain about pain.
We wheel him into the ER, and literally, the second we walk through the door, this guy starts writhing in pain. He says he can’t sit still because the pain is unbearable, so he stood up, screaming at the nurse to help.
Then he turned to the nurse and said, ‘I had this same issue at a different hospital 2 weeks ago. They couldn’t tell what was wrong, so they gave me morphine, but that didn’t work so they gave me Dilaudid. That worked! So maybe you should just start with Dilaudid tonight.’ And then he went back to moaning in pain.
The nurse and I just looked at each other, put him in a bed, and I drove all the way back to the station. I highly doubt he was given any painkillers that night, it was just a colossal waste of everyone’s time.”