Its 5:30am, almost at the end of another 12 hour shift and on the board pops up, Laceration to leg with side, comment knife still in leg. As a former trauma nurse, I am excited about this, not because of the trauma thats boring, I want to know how it got there, usually its always a good story. So I run out to check and see if the patient needs immediate attention. The patient is a 6 ft. plus guy sitting in one of the wheelchairs crying while his wife answers the registrars questions. So I ask him how it happened and he tell me he was sitting down in the chair cleaning his knives and the cat jumped in his lap and a knife fell and got stuck in his leg.
The cut is to actively bleeding so after they finish I wheel him to the room and make him get in the bed. I take a look at the wound, it’s a little tiny 2 inch blade in the back of his calf muscle. Any knife in a leg would hurt but it’s barely in his leg and he had the nerve to have a “tourniquet” wrapped above it like it was a serious debilitating cut. One of the other nurses ask him if it bleed a lot and he brags saying, “Oh no, I was in the marines for 4 years. I put a tourniquet on it immediately like they taught me.” Well if this is the toughness that you got in the marines I’m happy you were not with any group of marines I have met in my travels because they would have put him to shame.
I take a better look at the cord he used as a “tourniquet”, it’s like a mini bungie cord. I almost laughed in his face, it was not holding pressure on anything, just clinging to his leg. Hospital administrators always claims everyone deserves our finest care so I go and bring gauze and pad the knife pretending like it needs to be stabilised.
I call the doctor over so he can see this foolishness. He takes one look and says, “Oh yea take it out and irrigate the cut afterwards.” The guy immediately starts complaining, “Oh no, I needs pain medicine before you take it out and you need to numb my leg.” The doctor says, “Sir, it’s not that deep and you do not need pain medicine for this.” I barely touch the knife and it falls out. Afterwards, I try to irrigate the little cut and the guy yells, ” Stop, I need pain medicine so it doesn’t hurt otherwise I might punch you from the pain.” I don’t take kindly to threats so I calmly remind him not to punch me and that the knife barely cut him so it’s not hurting as much as he makes it seem. He finally shuts up and I finish irritating quickly and go talk to the doctor.
After I leave the room the doctor pulls me to the side and gives me an interesting hypothesis. “I bet that he did it to himself to get pain meds,” the doctor states. I never thought about it that way, but after I stop for a moment to ponder the idea it makes perfect sense. The guy has a puncture wound to the back side of his calf, how does that happen if you are sitting down? Would it not hit the front and not the back of your leg? But hey what do i know, I’m just a nurse.
The guy complains of pain again so the doctor gives him Tramadol (pain medication) in addition to the Keflex (antibiotic). As soon as I mention Tramdol he started complaining, “WHAT? Is that all you are giving me? I have a knife stuck in my leg and you are not even treating my pain.” Its amazing how drug seekers know all the non narcotics they should go to school and be pharmacists because they memorize all the medications.
I attempt to hand him discharge papers and his wife grabs them out of my hand. “Well he gave you 20 Keflex pill and only 10 Tramadol pills. Thats only 4 days of pain medicine and 7 days of antibiotics,” she states to her husband. How is it that your first thought is to count how many days you can take pain medicine? She told me her unsolicited history earlier so I should have expected it. She is in her mid 30s and is “disabled.” She told me she is disabled because she has fibromyalgia. This woman walks and talks just fine or better than you or me. I’m sure she could find a job doing something.
He tries for pain medicine one last time, asking me to call his pain management doctor for permission to give him an injection for pain. Man get the heck out of here, for a little nick that barely bleed you want narcotics, not on my watch. So I promptly tell him no and make him get in the wheelchair and out he goes. Pain management is a slippery slope. Most people we see in the ER are lazy wastes of space but there are a select few who really do need it. I have found it best to just have to hear them out you never know what crazy story you might hear.
How would you have handled this case? Would you have done anything different? How do you feel about the problem of drug addiction?