Bad to worse

Some of these stories just write themselves. I sometimes have to think about how to turn a patient encounter into a blog post. But sometimes, like last night, I get a vision as it's happening.

At 10PM, a call came in for a victim of an 8m (25 ft) fall. The call itself was nothing unusual. What was unusual, however, was everything else about this case.

The 48 year-old female patient arrived a few minutes later, and I asked her what happened today. "Nothing today."

Uh, what? "Then when did you fall, ma'am?"

"Oh, 2 days ago. But my back started hurting and I started peeing blood today. So I called for an ambulance." The red flags were already going up.

She refused to tell us her last name, asking us to call her Betty (not her real name). After her workup (including CT scans from head to toe) revealed absolutely nothing wrong with her (including crystal clear urine), she continued complaining of severe back pain, so bad that she couldn't move.

Riiiight. This didn't add up at all. "But you've been walking around for the past two days, right?" I asked her, not believing a word of it.

"Well, I'll be honest with you," she started. "I've been taking oxycodone and Valium, and that's the only thing that's allowed me to move around."

I glanced at her blood work - her blood alcohol level was 0.391, several times the legal limit.

"So you've been self-medicating with narcotics, benzos, and a hell of a lot of alcohol?"

She looked at me like I was crazy. "Well, I was supposed to be in court yesterday for my DWI from last year, but they couldn't proceed with the trial. But my back is killing me, so what prescription are you going to give me?"

THIS is her game? She got out of her DWI trial, so she got hammered on booze and narcotics? And now she's trying to score more from me?

"Not today, madam" is what I said to her, but "OH HELL FUCKING NO!" is what I was thinking. You were unlucky enough to get the doctor who doesn't give a fuck if you lodge a complaint against me. You will NOT get your fix from me.