Monday 6 April 2015

Bad drivers

I'm a good driver.  I don't drive too fast, I signal before I change lanes, I follow at a safe distance, and I don't distract myself by fiddling with my phone.  That said, I think I'm the only person in my entire area (other than Mrs. Bastard) who follows these very simple rules.  It seems that no one else within a 100km radius of me can drive for shit.  Some drivers are so bad or so reckless that there are two things I wish I had: 1) the power to revoke a driving licence on site, and 2) a giant roof-mounted laser to blast the most egregious offenders into oblivion.  Mostly I would probably end up using these on BMW drivers.  Assholes.

Under normal circumstances everyone around me can't seem to drive safely, but some of these idiots actually do various things to erode their already piss-poor driving skills even further.  A few ordinary idiots drink and drive.  Some slightly more creative idiots text and drive.  Every now and then some really special idiots do their makeup and read the newspaper while driving.

And then you have the rare mind-numbing, slap-yourself-in-the-face, what-the-fuck-are-you-thinking idiots like Nina (not her real name©).

Nina was brought to me one fine morning after she ran her car into a ditch.  As she was wheeled in, she was screaming, "OH MY FOOT!  OH MY GOD, MY FOOT!  OOOOOH MY FOOT MY FOOT MY FOOT!!"

Hm, it seemed her foot was hurting.  Ok, so she has a broken foot, I suppose.  Simple, I have an orthopaedic surgeon on call who can fix that.

We transferred her from the gurney to our stretcher, and the first thing I noticed was the surgical shoe she was wearing on her left foot.

Hm.  That was unexpected.

I asked her which foot hurt.  "THE LEFT!"

Well that solves that mystery.  But she wasn't done.


Well that explains that.  The next question was perhaps the most obvious - was it hurting more compared to before the accident.


If that doesn't make much sense to you, you're not alone.  It didn't make sense to me or anyone else in the room at the time either.  While shaking my head, I completed my workup which revealed no other injuries.  X-rays of her foot were entirely negative, of course.

Several minutes (and several nurses encouraging her to breathe) later, she calmed down enough to explain what the hell was going on, since none of us had been able to figure it out.  You see, she had run out of her prescription pain medicine after her surgery, and she was on her way back to the pharmacy to get more.

Ooh, that makes sen. . . wait . . .

But, I thought, it's only been 3 days since the surgery.  So how had she run out of her pills so soon?  Had she misplaced them?  Had her surgeon just not given her enough of them?  Did her dog flush them down the toilet?

Hahahahaha no, how embarrassingly nve of me to even consider a normal explanation.  No, apparently it was because she had been taking 2-3 times the normal dose, including SIX of them that morning just before getting in the car and driving.

And just when I thought the stupidity had ended, she had one more surprise in store for me in her urine tox screen: she was also high on PCP.

Maybe she thought the PCP would let her fly to the pharmacy instead of having to walk on her recently-operated-on foot. Who knows.  I didn't ask her before I perfunctorily discharged her.

If you're wondering, no I did not give her a new prescription for pain medicine.  I only give those to people who A) need them, and B) I am reasonably convinced will not abuse the shit out of them.


  1. One of the rules we got told about A&E (or ER) medicine: the loudest, most obnoxious and annoying patients are the least of your worries. The quiet ones are the ones with real problems...

  2. "I signal before I change lanes"

    That makes you a unicorn.

    1. around here the norm is to signal after you change lanes or make a turn.

  3. until the PCP report, I was willing to give the benefit of the doubt as being a sissy who was trying to medicate to zero pain. now I'm questioning whether the surgery was necessary or an extreme measure to gain access to more pain medication.

    one of the things I notice is that the "pain on a scale of 10" measure is dreadfully inaccurate.

    1. Pain is subjective! And some people get really dramatic about pain or they act like it hurts less than it really does.

  4. Doc I'm curious. What is the protocol at this particular hospital for discharging someone high on such a potent drug as PCP? Tie them to the bed until they're sober? Give them an antidote for the drug?

    Just curious.

    1. There's no antidote for PCP (or any drug). From what I've heard from people you just sort of get restrained until it wears off.

      Actually, I'm shocked that woman even felt any pain on PCP. Usually people don't and end up seriously injuring themselves without even realizing it.

    2. there are opiate blockers, out there (Norco) and there is another drug blocker my local ER has (I forget which non opiate it is used for) alcohol poisoning is often treated by the simple expedient of adding saline to the bloodstream to dilute the alcohol.
      so no antidote as far as I am aware, but there may be drugs that counteract the effects.

    3. It completely depends how crazy the patient is acting. If they are completely wild and out of control, I will sedate and intubate them to prevent them from hurting themselves and others (and to complete my workup). If not, there's no reason to keep them any longer than they need to be there.

  5. Couple of typos, doc. Several nurses encouraging her to breath instead of breathe. And need a "been" as in she had been taking 2-3 times the normal dose. Or I suppose it could be, "she had taken 2-3 times...."

    Anyway, absolutely love the blog!! Always entertaining! I've learned a lot reading your work and my respect for good doctors has only increased! Keep it coming!

  6. Turning without a signal was my worst pet peeve as a driver until I witnessed someone turn right from a left turn lane, across three lanes of traffic and during rush hour. Two days later, I saw someone else turn left from a right turn lane, again during rush hour; many of my friends have witnessed similar acts of insanity recently. I think I'll learn to fly.


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