Arrggh. So I get a patient the night before last, 18 year old, comes in on the ambulance, in his words, in a sickle cell crisis. Chest and joint pain, 10/10. Huge kid. Like, 350, 6'3. Immediately starts asking me for pain medicine, but in a very desperate, sweet sort of way- "Oh please, miss, I'm hurting so bad." I tell the doctor the story and get him some Tylenol, since we can give some per protocol. I tell him very sweetly and sympathetically that I can't do anything until the doctor sees him but that his chart is second in line and he should be in soon. I go to take care of my other patients. I'm in a room for 15 minutes- when I come out, he's called me three times asking for pain meds. Same story- sorry dude, I don't have MD behind my name, I can't give you Dilaudid yet.
I reach a lull and tell him that I can at least start an IV so that when I do get orders, he'll be ready to go. Kid has absolute garbage for veins, naturally- I call one of our medics but he's tied up doing other things, so he can't help for a little while. In the meantime, the patient falls asleep- the doc gives me orders- as soon as the kid wakes up, he is all over me again asking for pain meds, water, blankets, crackers, juice. My medic finally gets a line and I go to medicate him- first red flag- he asks me how many milligrams he's getting. I can see this in some cases, but it always makes me a little suspicious. Two. He's already pissed about that. Twenty minutes later, he calls me in asking for more pain meds. I tell the doctor, who rightfully says no- he demands to talk to the doctor. He calls me about 8 times about it, starting to yell at this point. The doctor tells him no in person- he calls me every hour on the hour after that, arguing with me about the number of minutes that have passed.
At this point, I talk to the lab, who helpfully point out that no sickled cells were present on his CBC. Hmm. I very delicately inform the doctor, who orders two more of Dilaudid anyway(!)
Naturally, he immediately wants more, along with more juice, and lets us know by yelling at us out the door all night long. Finally, it becomes time for his third dose- I'm stuck in a room dealing with a demented patient who is trying to fight the breathing treatment she needs. He is calling the secretary constantly at this point, since apparently the doctor had told him he would get another dose, probably since the patient starting pulling shit saying that he couldn't go home and needed to be admitted, but he hadn't written an order yet. I try to explain this to him- that I can't give narcotics based on his word alone- and he starts screaming at me about how I'm not listening to him, that he wants the doctor and the charge nurse, that I don't care, etc. I finally get the order his last dose- he tells the charge nurse that he has a ride home.
We wait a while and I discharge him- he's clearly drugged out of his mind at this point, so we keep him in the room for a while to let him sleep it off while he waits for his ride. It's right about shift change at this point, and his hulking ass keeps trying to get out of bed and run out of the room. We tell him repeatedly that he has to have a ride at the bedside before he can leave- he responds to this by pointing at random nurses while everyone is taking report and screaming that his ride is here. When that doesn't work, he screams at me that he wants food, that we've kept him her all night without feeding him. I tell him no repeatedly, that he's discharged and his ride can pull through McDonalds. We finally have to call the police- I decide this is probably a good time to go home.
When I got back to work last night, the nurse who took report tells me he was here until noon that day- apparently he lied about having a ride and spent the whole morning yelling at the nurses for breakfast tray. During that time, one of the family practice doctors walked by and recognized him (he's been here 20 times this year for the same thing) and let us know that apparently, he's not even sickle cell- he just has the sickle call trait. Awesome. I can't wait for the night that he comes in next. Someone's going to have some explaining to do.