Friday, January 13, 2012

"I Know My Body"

As Promised.
Oh, the statement that strikes fear into the heart of doctors and nurses everywhere.
Look, at face value this seems like a relatively innocuous statement. People with chronic illnesses are in tune with when something bad is on the horizon before it's immediately evident to everyone else. I know when my asthma is getting bad before I start to wheeze. One of my fellow nurses who suffers from lupus can feel when she's about to have a flare. It comes with the territory of having a chronic problem.

That being said, people like this are not the ones who utter "I know my body" to ER staff. But who does? Hold on, let me go get my graph:

Obviously this is now the time that every butthurt person who has been un- or mis-diagnosed since medicine was invented is going to come out of the woodwork and tell me what an asshole I'm being, but listen. There is a whole other world of people that those who don't work in crazy town everyday do not even know about. And I can say this as someone who used to not work in crazy town- I had no idea these people were out there before I started working in the ER.
I'm talking about the people who come into the ER on a semi regular basis with the same vague complaint who receive a negative workup each time. Sometimes they get pain medicine, but every time they get pissed off because we can't find anything. We refer them to specialists, who they sometimes see; other times, they just keep coming back to us and getting angry when the same limited tests we can show the same thing (nothing). You know you're really screwed when these folks visit the specialist we referred them to, only to be told nothing is wrong, and then they come back to us for answers.
You can explain the tests results and the necessity for follow up until you are blue in the face, but there's always the one comeback that you can't address- "I know my body! Somethings going on and you guys are missing it!" Sometimes, people want to be admitted to the hospital for "I know my body", because somehow sleeping on the hospital grounds will somehow lead to answers that the extensive tests run today did not reveal.
It frustrates me not to know what the problem is, too. The fact is, there are several illness for which there is no positive test. There is also not a positive test for attention seeking, narcotic seeking, hypochondria or straight up craziness. Unfortunately, regardless of the true cause, this means a referral and further investigation is in order. Dramatically throwing your discharge papers on the ground and shaking your head while screaming "but I know my body" does not change this fact.


  1. o lordy I so needed to read this today.Sometimes I question my assessment skills because people are so insistent there is a big dark illness I am just not seeing.

  2. There needs to be an ICD9 code for "I know my body; crazy"

  3. I see, on all kinds of blogs relating to all kinds of jobs dealing with the public, a lot of skepticism in the comments. "You expect us to believe that? Nobody's that crazy."

    Except then there are always other comments from people who've worked with the public for a long time, and they say "Yeah, I can believe it. See, this one time..."

    Either you are all in league with each other -- across lines of age, location, profession, culture, and politics -- to put one over on the rest of us, or some people are actually crazy. And if you'd rather believe the former, well, you may just be living in a suburb of crazy town yourself.

  4. I hear the "I know my body" BS the most when someone tries to convince me that their dry cough, scratchy eyes, and/or stuffy nose are somehow magically going to turn into pneumonia and they absolutely unequivocally need antibiotics OR ELSE THEY WILL F'IN DROP DEAD RIGHT IN THE LOBBY.

    It should be noted that the last time someone said that to me, however, it was a patient 2 days post-MVA who nearly passed out in her bathroom who had a belly full of blood. She was (1) pale/ill-appearing and (2) not a loser, however, which was the major difference.

  5. "No of course I haven' t seen the specialist you referred me to 20 times this year. I know my body and it needs Percocet!"

  6. EXACTLY! Also, I think my body said that I need 4 of Dilau-da IM before I go. IT'S MY BODY DON'T QUESTION IT

  7. "I know my body", promptly followed by "I am NOT crazy, you know, I assure you I'm fine psychologically. I mean, it's not like I LIKE going to see doctors, I really don't, but there's just something WRONG with me", on their 25th visit to various specialists in the past three months or so, none of which managed to find any real disease. "And really, I have a PhD/masters/any sort of advanced education, so it's not like I don't KNOW things!" Yes, sir, that's right. While I'm busy treating you, I'll also provide legal, financial and plumbing advice, cause, you know, I have that MD, so I MUST be an expert on anything and everything, just like your MBA makes you an expert on cancer.

  8. Generally I follow those "I know my body" statements with "do you what I know? how to assess that body"
    Most of the time, they're wrong, but like Nurse K, one of the last times someone said that to me, he had a PE.

  9. I have never met you, but I thought of you today. I had a postop patient with all the alarm bells ringing- chronic pain, fired by multiple pain management docs, we were the only hospital who understood her and I was the best nurse ever because I was smart/kind enough to not judge her. Allergic to NSAIDs and requested a particular dose and brand of pain meds before she walked in the door. Hmmmm. Her surgery is generally uncomfortable but not that bad- outpatient deal. Her usual morphine equivilent dose is 8 mg/day. (Ordered, anyway...) I gave her the equivilent of 86 mg of morphine in a couple hours, plus a bunch of benzos and some non-narc tricks. She screeched "I knnnnnnnooooowwws my boddyyyy!!!" too. Never dropped her O2 sat or BP, not even a little. Got her snoozing a bit, stated pain never less than 11/10. My general take on narc abuse is "I'm not gonna fix it in the hour I'm with this patient and they just had surgery..." so if they can handle it and say they need it, so be it. Today, even my patience was sorely tested. Thanks for the mental giggle that made it tolerable.