Tuesday, June 15, 2010

Behavior Modification

Kurt Killgore was riding his bicycle across a busy street at three in the morning. He swerved to avoid a truck, fell of the bike, and landed on his right side. The paramedic crew thought he might have a broken collarbone, and rightly put him in a sling. His pain was severe. It was so severe, in fact, that the only way to kill the pain was with sleep. Which he did all the way here during his ambulance ride.

The EMS crew woke him up to move him onto the bed. He opened his eyes and looked straight at me, standing at the foot of the bed. “Hey, man I need something for pain. The damn paramedic wouldn’t give me anything.”

I shrugged. ”Seems to me you were sleeping pretty good.”

“Oh yeah? Well, f…k you. I love you too, man.”

According to the paramedics, he was one of those guys who was full of love for his fellow man. Apparently this duality…carnal lust and romantic affection…was his usual response to anything that was asked of him. Nice to see someone with true joy in his heart. Gives me faith in the human condition. Also good to find that once again my gender identity has been reinforced.

I shook my head and stepped out of the room while the staff got him over to the exam bed, the effort accompanied by much moaning and groaning and use of creative language. The nurses did their part, trying to get some kind of story from him, and trying to start an IV just in case we needed it to do things like, well, treat pain. However, he decided it was much more important to swear at the nurses an occasionally reach out and grab at them instead of allowing us to care for his stated complaint. Finally, it was my turn.

“I’m Dr. Rodenberg. What happened to you?”

“I’m in pain, man. Pain. I need something for pain. And why are these f…..g nurses sticking me for an IV? I need something for my f…..g pain.”

“Can’t give you anything for pain ‘till I figure out what’s going on.”

“What’s your f…..g problem? I’m in pain. I don’t want those b…..s touching me. You better give me something now, man, if you know what’s good for you.”

I took a deep breath, about to begin one of those well-rehearsed speeches I’ve built up over twenty years in the ED. There’s a whole catalog of these speeches. There’s the reassuring, “I don’t know what’s going on but it doesn’t look like anything serious so you can go home,” talk. There’s the hopeful, “Do you think maybe talking to one of our psychiatric staff might help?” conversation. There’s the very sad, “Your loved one is in very critical condition, and while we always hope for the best we plan for the worst” discussion. But the, “You’re being a jerk and I’m not going to put up with this anymore” lecture is one of my favorites.

“Okay, here’s how this works. You know where you are and what’s going on, so you’re in full control of your senses. So you can choose to stop this behavior. If you don’t, and you continue to be abusive to my staff (I get very possessive in these moments; I don’t know why), I’m going to assume that you’re refusing care and I’ll have security escort you out the door. And if you grab at someone again that’s called assault, and the cops will be here to drag you to jail quicker than spit. Are we clear?”

“Man, you don’t…”

“Are we clear on this?

He grunted in a non-threatening way. Care proceeded as it should; x-rays of everything on the taxpayer’s dime, some pain medication to put him out of our misery, and nice dressings over abrasions on his elbow and knee that will soon resemble his socks, adhering to him for the next several years until the breakdown of nuclear forces between the gauze atoms causes them to disintegrate. He was discharged back into the real world with a sling on his right arm for his broken collarbone and admonitions to (chose one or all) get a bike helmet, put ice on your shoulder, use Tylenol for pain, call the local detox center or Alcoholics Anonymous for help with your drinking problem, follow-up with an orthopedic surgeon in 4-5 days for recheck, and go in peace, all of which will remain unheeded.

I don’t know why, but this kind of interaction gives me great satisfaction. While it can’t really contribute to the care of the patient, I can at least make my work family feel protected and supported. Not sure it’s in my job description. Just think of it as a value-added service.

1 comment:

  1. Excellent story. I once worked for a man that protected his staff always in light of an abusive customer. It was my favorite job ever. Customers come first, but not if they abuse the staff!