ER BFF and I were having a deep philosophical discussion the other day about which complaint is the absolute worst. For me, it's a toss up between vaginal bleeding vs. elderly constipation. Not always, but vaginal bleeding usually has at least somewhat of a dramatic spin that requires hostage negotiator level de-escalating skills. Plus it's a guaranteed pelvic set up, which is a pain in the ass, and at my facility you're guaranteed to wait at least 10 years for a transvaginal ultrasound to get done, so, yeah, you better hope the patient is nice. Elderly constipation really doesn't require an explanation I hope. Once you've done a fleets enema on one old person with unsteady gait and then had to watch them on the bedside commode for half an hour so they don't take a monster dump all over the floor and then fall in it while the room fills with the smell of 5 days worth of angry hardened turds, you understand.
I figured at least the last one was universal, but her answer surprised me: toothaches. Her explanation was that the situation pretty much always turns into drama. The patients that come to our ER with dental pain generally tend to think it is a life threatening emergency. Most have Lortab at their disposal at home, so when they aren't offered anything more than that once they've waited 6 hours to be seen, they are PISSED. I get her point, but I would still rather talk down 10 angry toothache patients than administer one fleets enema to just about anyone, so I guess it's just a personal preference.
So. What say you, internets? What chief complaint gives you the most nightmares?