Dec 052010

CC = TNTM = Too numerous to mention

22F 6am, My first pt of the day

HPI –The triage nurse wrote TNTM as the CC which is a bad sign. There is an inverse relationship between the number of complaints and the severity of the pts illness.

Me- “Good morning Ms TNTM, what brings you in today?”

TNTM = She starts out at a mile a minute “I have a headache and my hips hurt and I have fibromyalgia and I can’t sleep and I went to such and such ER and they gave me a script for 10mg oxycodone and I take 15mg so it’s not working for me.” She is blubbering and rambling rapidly. She has a folder full of papers and she throws a script at me written several hrs ago from a nearby ER for 10mg Percocet.  Quite a generous script actually.

I listen to her rapid speech for about 3 minutes before just flat out interrupting. I decide her CC is going to be headache. I try to focus her.
Me = “How long have you had the headache?”

TNTM = “Well it all started when I found out my boyfriend was making snuff films of me” She then bursts into tears and actually stops speaking for a moment.

I pause and look at her with curiosity.  She is alive and if not completely well then at least breathing which casts doubt on her statement that her boyfriend made her a snuff film star. How would one “find out” that someone made a snuff film of her? Wouldn’t she be dead?

Me = Ignoring her last statement I cut to the chase.  “I’m not going to give you any narcotic medications or any narcotic medication scripts.  However I’m happy to help you with non-narcotic treatments.  Does that interest you?”

She begins arguing adamantly and I calmly begin my PE interrupting her intermittently with commands. “Open your mouth. Smile really big. Squeeze my hands. Now hold your hands out like this.” After I finish my PE and reassure myself that there is absolutely nothing organic wrong with this pt I head for the door.  As I’m walking out of the room she starts screaming after me telling me about how she has a “straining order” out against her son who was hitting her. My step falters briefly as I contemplate that one. She couldn’t physically have a son more than what, 8 years old?

ROS – positive for every question asked

PE – A blubbering girl, speaking rapidly with running mascara in NAD, normal VS and with all her carrying on couldn’t possibly have a bad headache.  Neuro intact.

I pull up her chart and start perusing her past visits. She has been in for pain at least 12 times this year.  I happen upon a note added to her chart several months earlier.

“Phone call received from Walgreen Pharmacy. Pt filled script written by this ER for 10 percocet and was found in the Walgreen’s bathroom attempting to crush and inject said Percocet several minutes after filling the script.”
Wow. Couldn’t you at least wait until you LEFT the pharmacy?

Dx – Drug seeking behavior

Tx – Pt offered counseling and help with drug addiction but denies she has a problem.  Script given for ibuprofen.  #20.  I didn’t even trust her with the ibuprofen to be honest.  I hope she doesn’t try to inject that.  Good morning Dr T.

Pt on state health plan, visit paid for by taxpayers.

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