ER Stories - Shocking, Hilarious, Bizarre, and Sad Tales from the Emergency Room

ER Stories - Shocking, Hilarious, and Sad Tales of the ER

September 1st, 2008 at 7:51 am



There are some people in the blogosphere who have to chill. I have received a boat-load of vociferously angry comments on this site over the last two days - it appears that many of these commenters are either: A. Overly sensitive to any discussion of obesity that does not remove all blame from the patient. B. People who suffer from chronic pain conditions (legitimate or otherwise) and Cushing’s disease/syndrome and C: People who just don’t get what it is like to work in an ER.  Some are all of the above.

Thus, in this post,  I will address my view (and very likely others’ in the health care field - especially those who work in the ER) on obesity, chronic pain,  psychiatric illness, and what it is like to work in an ER. Take this into account when you read any future posts that concern these issues - and don’t immediately jump down my throat saying things like “You are not compassionate”, “You should be a garbage man, not a doctor” and “I would report you to the medical board if I knew who you were”. Please try to keep comments at least somewhat constructive or they will be deleted.

Any other health care providers please feel free to chime in.

A. Obesity. Everyone agree that it is an epidemic in this country now. Unfortunately it is getting worse and worse in our youth for a myriad of reasons. The other sad fact is that our obesity seems to be spreading across the oceans to other countries as well. Our country’s obsession with fast food apparently is being exported. Even in France all places, American-style fast food is making inroads, bringing obesity along with it. So, with that said, what to make of obese patients. First, any patient who is having an emergency will be treated appropriately with compassion in my ER. This of course includes those who are obese. However, the sad fact is that many people feel that obesity itself is not at all in any way even at least partially the fault of the obese patient. I do not believe this. Yes, there are a minority of patients who suffer from conditions where they are bound to be obese no matter what they do. Those who have adrenal diseases (like Cushing’s disease or syndrome), are severely disabled, have hypothyroidism, fat storage and metabolic diseases, etc really cannot do much to prevent themselves from becoming overweight unless they starved themselves. People who really have these conditions have truly been dealt a very bad deck. Many others are obese at least partially for psychiatric reasons. They eat because they are depressed - food is their drug of abuse. However, many, many people are obese because they simply eat too much unhealthy food and do not exercise enough. Many of these people live in subcultures within America where obesity is not only tolerated (mostly in women), but is praised, despite the well known health hazards. Obese patients are treated with respect in my ER - however, if they are disrespectful to the staff, demanding, and make a nuisance in my shop, they will get rebuked,just like any one else. Additionally, just like with smoking, I feel it is a doctor’s duty to reprimand patients for unhealthy behaviour - and this includes unhealthy eating and subsequent obesity.

B. Chronic Pain. Here is hot-button topic if ever there was one. Chronic pain is HORRIBLE. Chronic pain is debilitating. Chronic pain is sad. However, chronic pain is not to be managed in the ER! If truly have chronic pain, go to a pain management specialist! Often they can recommend many treatments besides narcotics to control it. I am sure there are millions of these sufferers who do indeed go to specialists and guess what - we never see them in the ER! Or, if they do come in, it is only once in a blue moon. The ones that come in day after day after day with diagnoses like “tooth ache”, “migraines”, “fibromyalgia”, “back pain ” (often with no documentation of getting any real work up for the cause their pain) , etc and claim to be “allergic” to everything except Demerol, alter our Rx’s, and overtly fake or exaggerate symptoms are a different breed. They are manipulators and often criminals. The should be arrested. They are lucky they just get thrown out with Naprosyn. They may be a minority of chronic pain sufferers but they drain our resources, waste our time, and cost the taxpayers money.

C. Psychiatric Conditions. Psychiatric disease is widespread. Many, many, many people have some form of it. In fact, I cannot recall the study but I remember reading one a while back where where the investigators went to a busy ER waiting room. The did not ask what the people sitting there were there for - they just asked them to fill out a professional questionnaire used by Mental Health providers to screen for anxiety disorders. About 40% of the people that responded there were determined to be suffering from some anxiety disorder! So, you can see how often we in the ER have to deal with it! Anyway, people who suffer from these disorders need help. In fact the ER is a great place to come when you are truly down to the point where you are suicidal or at your wits end. It is not a great place however if your symptoms are milder. We are simply not trained for and do not have the luxury of time to spend with each person who has a complicated psychiatric history. We have to juggle an ER with sometimes dozens of patients, some of whom are in danger of dying at any moment. We cannot do much for you except admit you or make a referral.

D. Life in the ER. Simply put, if you have not spent any significant time either working or volunteering in an ER, you really don’t know what it is like.  People are at their WORST in the ER.  Sometimes it is because they are sick or a loved one is sick. Sometimes it is just their true colours coming out.  If many of you extremely touchy-feely types actually had to work a shift in the ER you would probably want to kill someone.  Why?  Because you don’t realise it but much of the population is either nasty, manipulative, violent, malingering, antisocial, and or disrespectful.  Of course the majority of people we treat are not, but I guarantee if you have to deal with even 4-5 out of the 20-30 you might see on a given shift, you will re-think things.  Imagine getting threatened by people who you are trying to help.  Getting spit on. Getting told what do by people who don’t know anything about the practise of medicine except what they read on blogs or in newspapers.  Witnessing the gross indifference people have for sick loved ones.  Witnessing child abuse regularly. Dealing with intoxicated persons who want to kill you. Listening to people bullshit you about their medical conditions so they can either get out of work, get disability, or get narcotics (often for resale).   Imagine getting zero respect from people for the years of training you have.  Our oath forces us to deal with and treat people the rest of you in the outside world would just walk away from, ignore, or call the police about.  I signed up for this so I know I have to do it so don’t accuse us of whining.  This is whining.   And on top of all this, you have to treat the TRULY sick people - ie people have to be intubated, recussitated, cardioverted, sutured, and transfused.  Those 4-5 “bad” patients severely inhibit you from what you are trained to do - take care of the sickies.  They waste your time, sap your energy, and burn your resources.  How do we cope?  We develop morbid senses of humour. We develop tough exteriors.  We tell those off who need to be told off. Nowadays we vent on the internet. (this blog partially serves this purpose for me)  You won’t last a month if you don’t develop these survival skills. That said, I would not change my job for anything. Why? Because there are also always some people per shift who really do appreciate what you do for them (even if it just telling them they are OK and they have nothing to worry about).  There are people you bring back from the dead who look back at you in thanks. There are people that make you laugh.  There are people who help restore your hope for humanity. That and the fact that you never get bored working in the ER -which I consider worse than dealing with drunks!  And finally, we don’t get rich working in the ER. We do all right and I am grateful for the living I earn, but don’t lump us in with high profile surgeons like Dr 90210.

All that said, it really comes down to respect. If you are not in true extremis (ie about to code, severely short of breath, just got shot, or have a bad fracture in which case I will of course forgive you), then I will do almost anything for you when you come to my ER as long as you can show some respect and thanks to me and my staff. I have gone on the internet to help people figure out their insurance and find them a provider that takes it, I have called 10 relatives all over the patch to keep them informed as to a patient’s condition, I have spent hours arranging a transfer for people not out of medical necessity, but for their personal preference. I have given people money to get home on the bus. I write generous work notes.  I have spent eons explaining a diagnosis to patient while the whole ER backs up. I will give you 25 percocets just because I don’t want you to run out over the weekend. I have spent 30 minutes with families who just lost a loved one.

Don’t say I am not compassionate

However,  if you try to pull a fast one on me by lying, faking illness,exaggerating symptoms, or making threats, or you are just plain disrespectful and nasty, don’t let the door smack you on the ass on your way out. (Cushingoid, or not)

  • 1

    If an obese patient with chronic pain and a psychiatric condition goes to the ER because they want to stop smoking you can say “go see your family physician.”
    Oh no, that’s me!

    Dr. R at Medical Jokes on September 1st, 2008
  • 2

    Don’t worry about the haters…and for the record I am obese and though at times slightly stung when I read about obesity stuff on er blogs, I completely understand.

    I’m a teacher in a poor city district and when I’ve blogged about stuff or talked about the say to day struggles I have I get the same comments as you do from people who simply do not get that although we ARE compassionate public servants, we encounter a whole lot of irresponsible, ridiculous crap every day, and calling it what it is isn’t “insensitive”.

    If they can’t handle the truth, that’s on them

    CP on September 1st, 2008
  • 3

    Whining can be healthy if done in a productive manner that is not conducive to
    reducing patients to a simple label and by making rude remarks…even on a blog. For example, your writing above is much better a representation of who you are than any single post on your blog. You still show your true colors of being overly judgemental of others, but perhaps you could actually improve your style and ways to learn to vent in a constructive manner that shows more tolerance for those with conditions of all kinds. When an ER refuses to provide a patient with a psych. consult upon severe depression, or sends a patient who was severely dehydrated out the door when they can barely walk and their legs are buckling, or a family physician yells at a patient for wasting government money by going to the hospital for breathing difficulty and gets mad because a patient needs an electrolyte workup due to past history of hypokalemia, then it becomes obvious that good doctors seem to be out of reach for many. I have seen a top notch teaching hospital almost let my sister die because the staff kept ignoring the signs of embolism in both her arms and legs and because I had formerly worked with a client who had blood clots and I am not a doctor or nurse…I had to point this out. Another hospital didn’t want to deal with her because she had autoimmune pancreatitis and was pregnant. She got passed from one ER to the other. She lost her first child, and didn’t find out until over a year later that it was because she had sepsis during her first stay that they did not treat right away. If you have compassion, then all your writings should show it. Each and every single post you put on a blog, should consist of showing respectfullness even towards the most awful and difficult of patients. Political correctness really is important in creating a good atmosphere on your blog. If you really took the time and went through and saw the posts you and others have made you would realize that they show a huge lack of thought. There is nothing wrong with getting things out in the open. But, as with everything else in life, there is a place and a time for those things. If you wrote about ER experiences in a more colorful yet less vulgar way, including depth and human kindness, you really could shine.

    HumblyTruthful on September 1st, 2008
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    You must not have read all of the sensitive, judgmental, more holy than thou, more ethical than thou, more honest (and allegedly truthful) than thou, more intelligent than thou, more special than thou - gosh they really are more special and should be handled with kid gloves, even though they should not be in the emergency department. Oh my. They weren’t in the emergency department. That doesn’t stop them from imagining what you do there, what you think there, how you torture people there. I guess they called the Psychic Frauds Network.

    Elsewhere, they will find another imaginary “outrage” and move on to demonstrate their ability to diagnose people they have never met. They will probably include their histrionic hyperventilation troll dance.

    How horrible to have been so rude to someone and mistreated her - even though you were not the one who was treating her and may not have talked to her. Reading comprehension is apparently not a troll talent. A free form interpretation, taking liberties to create drama, pulling on heart strings, . . . .

    In the meantime, they will be as mean as they can in demanding respect for system abusers.

    rogue medic on September 1st, 2008
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    Don’t agree.I love your blogs!

    Heidi on September 1st, 2008
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    RogueMedic, could you please clarify yourself in such a manner that makes sense so one can appropriately respont to your post.

    HumblyTruthful on September 1st, 2008
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    I don’t think excessive political correctness makes for good reading. That is in Time Magazine. And regardless of the sad misdiagnosis your sister had, that does not mean that every patient who comes in crying wolf actually has some life threatening condition. In fact most people that act like a drug seeker are drug seekers. You can smell ‘em a mile away. Also, as I mentioned above, my problem with patients is when they are nasty, rude, disrespectful, and manipulative. Unless your life is ebbing away in front of me, please be nice and courteous to the staff and understand what we go through to help you.

    ERP on September 1st, 2008
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    My husband used to work in a major metropolitan ER as an officer and dealt with patients who had drug and alcohol problems.
    Just so you know, I am fully aware of the dangers posed by some patients. He got injured by an unruly person who was drunk and his arm was wrenched out of socket needing surgery. No, not every patient that comes into an ER has a life threatening condition. I never said they did. I feel that the physician has a responsibility to be nice to the patient as well. Unfortunately, there are many sick, depressed, or even patients with psychosis that enter the ER. Let me clarify that it was not the ER doctors who misdiagnosed my sister. It was the high risk prenatal team who were afraid to handle her due to multiple medical issues. All in all, just as doctors have gripes about patients…patients have gripes about doctors. If you choose not to go the politically correct route, that is your choice. It would be wrong in my opinion for a patient to post rude and derogatory statements about their physicians on a blog as well. I am no angel. I say things I should not say in my private life, but I always feel badly about it later. That is just how I am. Just as you want and need your patients to understand you and want them to be courteous, the opposite is true as well. I was the patient admitted to the ER for dehydration and sent home with my legs buckling. I was the patient who became delirious and was begging for someone to talk to because I had lost so much fluid and was not ok. I was not dying, but it was an emergency as far as the dehydration part went. I did not yell, or argue, or swear. I waited. And they refused to even send someone for me to even speak with. After 3 bags of fluids, I was much better and able to go home. These incidents happened at two separate ERs. My grandmother was the woman who after having RA her whole life was treated like she had to be dying with a pain level of 10 and that she could not possibly hurt so bad. She looks like she was in a concentration camp. She did not ask for pain medication. Just like you have beef with certain patients, I have a beef with certain medical professionals. Drug seeking behaviours still need to be addressed and carefully evaluated so as not to mistakingly label a patient as a drug seeker if they are not. This world is not always in black and white. And just as you may be hasty in making judgements, I am guilty at times of doing the same thing. On a recent visit to the ER for uncontrollable spike in BP, I heard a male patient cursing and threatening the ER staff, particularly a young female physician. She was upset understandably, and told him he had no right to talk to her in such a way as to curse at her. He got mad and left. At least no one got hurt. I cannot put myself in your shoes and you cannot put yourself in mine. But trying to figure out what that might be like, could perhaps improve things between patients and doctors.

    HumblyTruthful on September 1st, 2008
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    “Each and every single post you put on a blog, should consist of showing respectfullness [sic] even towards the most awful and difficult of patients. Political correctness really is important in creating a good atmosphere on your blog.”

    Absolutely not. This is ERP’s blog. He only writes for himself, and with that honesty, he attracts a certain group of people who work in emergency medicine. We understand the trials and tribulations this job brings, and we commiserate with him through this blog.

    I don’t understand this dogma that many chronic paineurs troll out on medical blogs: we all should be kissing their ass and being “sympathetic” towards them. Did the internet all of a sudden mandate laws against hurting people’s feelings? I’m not at work when I read and write on these blogs, and I can say and believe whatever I want, as can ERP. Maybe it “hurts” because it’s true.

    If you don’t like what ERP writes, DON’T READ. Save your delicate sensibilities and selfish histrionics for your own blog; I’m sure you’ll attract your own very special reader population. I, however, read THIS blog everyday, as do many other medical professionals. We won’t miss you.

    ERP, please keep up the awesome work and ignore this irrational BS.

    Nocturnia on September 1st, 2008
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    None of the patients who have responded to this blog are the so called “chronic panieurs” that you are assuming. They have cushings or adrenal disorders. They have jobs, and family members, and are perfectly sane. Since when do you think public blogs are only for medical professionals to read?
    People have come upon blogs to read them only to find rude and disturbing comments or statements. When patients see doctors writing things out in the open like this on their blogs, it is far more serious than you imagine. Histrionics have nothing to do with it. It is about being able to trust the medical community to uphold their oath and to respect confidentiality.
    Every blogsite has terms of agreement that posters are supposed to follow for possibility of libel and defamation of character. Doctors are public figures and become even moreso when they post very sensitive information about a patient or incident even without a name. You don’t have to give any heed to anything I say, but eventually a patient will be online one day and see a story that is all about them. Who knows, maybe it has already happened.

    HumblyTruthful on September 1st, 2008
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    ERP, I for one understand how hectic it can be in emergency rooms. I also understand that there are many, many people who use the ER for purposes that are not life threatening, mainly because they have no health insurance and can. I have to be pretty darn sick to go to the ER and pay 3 fold what my PCP can do for me without having to sit around for hours waiting for care.
    What upset me the most was the fact that you made a point to discuss openly the size of her dress which could double as a tent. Drug seeker, obese, whatever, society holds Doctors in high regard. You are treated with respect simply because you have a MD or DO after you name in most cases. Given that fact, you should act appropriately and be held to a high standard as well. Your comments in regard to this person was rude and unprofessional as well as your tag for the post.
    Also the chicken or the egg theory about her being cushingoid is really just ignorance on your part. Although, I don’t expect you to be a cushing specialist. Your a ER DR, you really don’t specialize in anything.
    But as I mentioned before (just so you know for the future) Cushing’s disease and Cushings syndrome ie psuedo-cushings has the same clinical and bio-chemical manifestations. It doesn’t matter that it is induced by long term high dosages of steroids. She will feel act and test exactly like a cushing disease sufferer. Shame on the doctor who prescribed that dosage to begin with. We should be blogging about how incompetent her PCP or Doctor who initially started treating her with highly addictive pain meds that turned her into a drug addict, and dosages of steroids that has given her a syndrome that causes bone loss, muscle wasting, heart disease, fatty liver, and diabetes. I think the whole thing is tragic and sadly it happens everyday.

    CAM on September 1st, 2008
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    And did you say you worked in a teaching hospital in the northeast? Sounds to me, like she could have been a perfect patient for interns.

    CAM on September 1st, 2008
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    Yes, I will admit the dress sized like a tent crack was meant to a bit funny and illustrative of the patient’s size. Just because you make a little joke about someone’s appearance does not in itself mean that you find them revolting. What was revolting was her behaviour. And yes, we are a teaching hospital but do not have ER residents or regular medical residents rotating through the ER. Besides, I would never assign a patient like that to an intern - he or she would probably blow off the rest of their subsequent shifts!

    ERP on September 1st, 2008
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    Why would a resident blow off the rest of their shifts because of a patient like that?
    There are no ER residents in your hospital? I’m confused aren’t you a teaching hospital? Or are you a Trauma hospital. I would imagine you see a lot worse then this lady if you are practicing in a city in the Northeast.

    CAM on September 1st, 2008
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    When I read your rant about obesity, it reminded me that I hadn’t had breakfast yet, so I jumped in the car to run over to Burger King. It was hot, so I had the top down, but the wind brought back my migraines, so the voices in my head told me to get care right away. I would have gone to my doctor but I’m in the process of suing him because he wont treat my pain. Anyway, I pulled out my cell phone and told the ER that I was coming over and they should get me straight back because the pain was so bad. The doctor was a total jerk and wouldn’t even believe me when I told him that my sister had accidentally taken my prescription in her suitcase when she went on her month-long vacation. Then he tried to prescribe Ultram! I’m allergic to Ultram! I told him that, but he wasn’t even listening. The only thing that works for me is that Dilatim or whatever it is called. And I couldn’t believe that everyone out at the nurses’ station was laughing. They were probably laughing at me. Don’t they realize that there are really sick people in the ER? They need to learn to be more serious. Anyway, what really takes the cake is that they wouldn’t let me plug in my adaptor for my Game Boy Advance, and the battery was low, so I just had to sit there for 3 hours. That’s right! THREE HOURS! And when he finally did come with a prescription, it seemed like he was being disrespectful of my severe anxiety, because he just turned the light on, mumbled something about a patient next door who couldn’t breathe or something, and gave me the prescription and said I should see a doctor. What, he isn’t a doctor? I told him that I couldn’t afford this medication, and he had the guts to suggest that I cut my smoking down to only 1 pack per day to free up some money. I can’t believe how insensitive some people can be. Maybe I’ll find a lawyer.

    Braden on September 1st, 2008
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    I don’t think the intern would do well with a very nasty and demanding patient. They need to start out with more straight forward cases. In our hospital we only have an internal medical residency - not ER, not OB, etc. They rotate down to the ER for one month during their three years. I try to make it more interesting for them instead of frustrating.

    ERP on September 1st, 2008
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    Braden, are you just trying to get readers for your blog? ERP is posting intelligent responses and your fictitious collage truly shows your lack of such. Do you really need to post your story on two blogs?

    HumblyTruthful on September 1st, 2008
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    Braden, I think you are blatantly disgusting. I pray that you are not a Doctor and just a latent person with nothing better to do with your time. Your insinuations are just horrific. People can be obese without eating extra calories, and people do suffer from painful migraines. Not everyone is a supersizing, pill seeker. Gross!

    CAM on September 1st, 2008
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    You don’t know what it is like to gain over 40lbs in a year and a half, and become a shell of the person you once were. Reducing your caloric intake to only 1200 a day and still look 6 months pregnant. I hate how I look, and I hate how I feel. I know that there is NOTHING I can do about it until I am able to have surgery and even then it is only a 60% chance that I will have a cure. I cringe when I have to run into someone that I haven’t seen in awhile knowing fully that they will judge me and talk about how I am letting myself go. Do you know what it is like to go on NUtri-System with your BFF and have her loose 14lbs and you only loose 2 1/2? Or to go to a restaurant with your hormonally healthy friend and she eats a burger and fries while I order a grilled chicken salad. I want a fucking cheeseburger too! It’s painful and frustrating. I want to feel desired by my husband of 18 years, he has been so good to me. I should look the way I did when he married me, or at least close to it. He says it doesn’t matter, but it matters to me!
    There are more cases of Hormone Obesity then people recognize. Do you think women with pcos want to be over-wieght and infertile? Educate yourself before you judge an overweight person and resolve that they wisk themselves off to Burger King for breakfast, lunch and dinner. I have cushings not an eating disorder but sadly most people would assume the latter.

    CAM on September 1st, 2008
  • 20

    Correction I have MEN 1

    CAM on September 1st, 2008
  • 21

    Nocturnia I am sure things are done differently at JSUMC but, the pretinders and goodmen aren’t typical of all ER doctors.

    Solitltime on September 1st, 2008
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    Braden– Funny!!! If you have a blog I want to read it!

    EDRNKaren on September 1st, 2008
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    your readers seem to have too much time on their hands. Why on earth would someone elect to read something that they feel targets them and is infuriating to them? Is there a diagnosis for that??
    I am an NP in a health clinic and am also tired of people using the ER for their PCP because they want to go to the doctor at 8pm and it is more convenient for them (they are usually not paying for their care anyhow).
    The only thing better than that is patients who use the ambulance system for a taxi!

    Susan on September 1st, 2008
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    Susan, most of the patients who have posted on here were already hurt and infuriated from being sick in the first place. Is there a taboo against those who stand up for themselves or come out and say how they feel on a possibly controversial medical blog if they don’t agree with the medical community?
    Everyone is entitled to their opinion as are you. Personally, I think it is important for medical professionals such as yourself and ERP to hear from patients so you do not live in a bubble without having to hear how someone feels. Since we are not your patients, then why not learn what it is like to be one through our own stories. When you stop caring, you stop learning.

    HumblyTruthful on September 1st, 2008
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    As you said ERP, “All that said, it really comes down to respect.” I see ads on this blog. You make money on it. You make money by making fun of your patients “Yes, I will admit the dress sized like a tent crack was meant to a bit funny and illustrative of the patient’s size.” I am sure that none of your patients agreed to be the butt of your jokes. To make money from the humiliation of those who sought your help is disturbed behavior.

    If you find your job to be too stressful so that this is the only way you can cope, take a class, take some zoloft, get a hobby, see a shrink, or find another job.

    It does not justify you profiting from the misfortunes of those you have sworn to help– whether it be the elderly person who you wanted to die sooner, the inner city woman whos stomach size you found so amusing, the gay fellow and other fellow whose genitals you thought just had to be discussed, etc. etc. And going through your writings, there is a recurring theme of making fun of the downtrodden, the weak. I am a professional and I have worked with the homeless, people who abuse drugs and with the issue of child molestation. I have been in some of the worst public housing complexes in the country. I have walked, unescorted, through maximum security facilities in order to see a client. I have dealt with clients high on heroin, crack and other substances. And I have never heard anyone in my field or any of the related fields demonstrate the kind of misanthropy that is in your blog.

    You are right — it is all about respect — and being able to see other people, no matter what their circumstances, as fellow human beings, not objects of public derision and humilitation — much less for personal profit.

    Just tell us where you work, and we can all be sure not to cross your path, and we will be satisfied. We don’t care if you blog, we care that you might provide medical care for us or our loved ones, or frankly, anyone else.

    rose on September 1st, 2008
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    Your post is so truthful. As an ER nurse, I often question my choice of work environment. Yes, people are at their worst, but that is no excuse for you to yell at me, cuss at me, or spit on me. I treat every patient the same, with the utmost courtesy. But, if you choose to abuse me, then you will receive the minimum care necessary. I’m sorry you are sick, I’m sorry you are hurting, but that gives you no right to treat me like crap. And, if you continue to use the ER to get your “fix” of narcotics, you will be given a pain contract and will not receive narcotics again until you start seeing someone to “manage” your pain. If you are obese, honestly it doesn’t make a difference to me how you got that way. I will treat you with respect, but I shouldn’t have to put my health at risk to lift you into the bed.

    People need to calm down. This is a public blog, if you don’t like what is being written, don’t read it. It’s just like anything on tv or the radio, if it is offensive to you turn it off!

    Keep on blogging, I think your site is awesome!

    Susan, RN on September 1st, 2008
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    Susan, no one should treat you with disrespect as an er nurse if you have done nothing to deserve such treatment. No one should spit on you, swear at you, hit you, or be rude to you. Under such circumstances you can only be expected to do your best, and sometimes, you even have to protect yourself. Same goes for the doctors too.
    That would be expecting too much from anybody. I just wish for the sake of everyone that people no matter what they did or where they worked could just be nice to each other, but we all fail at this in some way or another. I just have my strong opinions on what is safe and ok to put in public for the sake of the patients or the medical professionals.

    HumblyTruthful on September 1st, 2008
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    I for one am not and never will be PC. I am going to to give it to you like it is. That is my motto, take it or leave it. It makes no difference to me.

    1: We have become a nation of pussies. This country was founded on a capitalistic backbone which fostered hard work and perseverance that in the end paid off. We have too many half wits with Intelligence Quotients less than 80 who make laws and regulations that have dumbed this society down along with making the population lazy.

    2: Blah Blah Blah you don’t know what it is to be sick blah blah. Bullshit, I have been through hell and back and guess what? I never complain about it, it has made me a stronger person. If you must cry about your weight gain, try living with Ulcerative Colitis through residency. I did it with a smile. You have two choices in life which I tell patients routinely. You control your disease or you let your disease control you. It is your choice not mine or anybody else.

    3: Nobody has forced you to read this blog or the comments posted. If you are offended their are over 100 million other blogs that you may find non offensive.

    4: ERP ! Bravo ! You write about what you prefer and how you prefer. Hundred of thousands of young soldiers have not died over the years to protect those who want a PC nation.

    Cynic on September 1st, 2008
  • 29

    Cynic, you may have successfully made it through residency with ulcerative colitis, but did you learn anything about the kinds of foolish stoicism and pride that leads certain patients to admit when they need help. You sound very bitter. Of course, a physician would have an advantage in being able to obtain more respect from their fellow doctors than a sick patient would. I could be wrong however.

    “You have two choices in life which I tell patients routinely. You control your disease or you let your disease control you. It is your choice not mine or anybody else.”

    In some cases, I would have to agree with you
    in theory. It is the individual’s choice so long as they still have the faculties about them to still make such a choice unless things just get to be too hard and they decide to take their own life. And even that could be argued is a choice. But when a patients illness has truly become too much for them to bear, and they can handle it no longer, the disease will take over in one way or another. If your ulcerative colitis had gotten so bad that you could not leave the toilet long enough to work, or were passing out from loss of blood…certainly you would not have been able to continue for some point of time in the medical profession. A patient can choose whether to accept the fact that they must suffer or not, and do what they can about it with whatever resources they have. But, that does not mean that they can control their disease all the time. When cancer takes over a patient’s body, you honestly believe that the patient has control over anything but how they decide to emotionally respond to such a thing? And then, if they emotionally cannot handle it, that means it is their choice? What about schizophrenics? Is it their choice that they see and hear things and can they control their disease without appropriate help and medication? One day, when a person truly faces severe illness that becomes incapacitating for whatever reason, even if it is in old age…that is the only time they can truly understand what it is like to not be in control of their disease.

    HumblyTruthful on September 1st, 2008
  • 30

    Doctors aren’t perfect and shouldn’t be expected to act as though they are. Taking care of yourself and not wasting public resources on nuisances are basic human responsibilities, and those who fail at them are justifiably mocked. Yes, sometimes even when you’re sick you get made fun of, so suck it up. Humorless PC people should all be rounded up and forced to live together with the fake fibro crowd.

    No, I’m not a doctor, but neither am I so deep in my own rectum that I can’t laugh at myself.

    Ramses II on September 1st, 2008
  • 31

    Really…. Does no one is this country have a sense of humor any more? This is worse then people that complain about how offended said move makes them. If you don’t like it don’t read/watch/listen to whatever it is that offends you and then guess what both you and I can live in harmony. All of you whiners will be none the wiser and I can read this blog in peace.

    MF_EMT on September 1st, 2008
  • 32

    ERP, keep up the good work. Anyone find it interesting that the people that work with system abusers everyday are your biggest supporters? Because what you post is what we also see day in and day out. And is one of the reasons Healthcare is so expensive anymore.

    I try to be compassionate with every patient I see. However like ERP if you spit, kick, punch, cuss at me, you’ll see the ‘anti-medic’. Also if you call me at 3 in the morning for a tummy ache that has been bothering you since 9 the previous morning and you tell me to be quiet because your husband is sleeping in the other room and can’t take you, you may not like me.

    Humbly… you may want to spend a little bit of time as an observer in a ER just to see what really happens. I’d suggest inner city. Maybe you too will be so frustrated at how our medical system is abused and the actions of patients that you too will have to write about what you see.

    firemedic15 on September 1st, 2008
  • 33

    Raises my eyebrows… Please keep blogging. I get it and understand the veiw from both sides of the stretcher. I do believe a troll from Nurse K’s blog at Crass pollination has made her appearance.COnsider it a rite of passage.I will be very UN PC in this next sentance but tis truth: Arguing with someone on the internet is like winning a medal in the special olympics; you may win but you are still a retard.

    Yvonne ED RN on September 1st, 2008
  • 34

    Wow. Blogs are public, and you can write whatever you want.

    I read the medical/doctor/nurse blogs because I find them interesting. Many patients think that Doctors are gods, and that they have no flaws. They are human, just like the rest of us. That have free thoughts and feelings.

    I am a cancer survivor with diabetes and other chemo related complications. I find reading these makes me understand that I have treated people with respect, possibly even made some doctor’s or nurse’s day trying to make things easier on them. I also find out what I should put up with and what I should not.

    PC does not a good blog make. Share your feelings, people don’t always agree with you, and that’s normal. Opinions are like assholes… :-)

    If you don’t like what you are reading, then don’t read. It’s as simple as that. As far as privacy goes, there are no incriminating words or extreme identifying remarks that I have read. It could easily be anyone that is being discussed.

    Love the blog.

    tink1272 on September 1st, 2008
  • 35

    Thanks for the support, people - I think I try to balance my frustrations at work with my inherent love of taking care of people who are in the throws of an emergency. This blog will not be sanitised and PC, but nor will it be a continuous rant and ripping of people. Like my job and me, it has both sides. We as docs, nurses, and medics are certainly not Gods or saints, we have flaws, prejudices, and things that we are simply not good at. We do our best to ascend above them to render the care the patient needs. We are humans treating other humans. I think also the tone I take is pretty close to what you might experience or hear in an ER if you were to eavesdrop on the staff talking amongst themselves. We will go from sadly empathising with one patient to being disgusted and frustrated with the one next to him. Occasionally a morbid or off colour joke will be told. It is just the way it is. If you think that is horrible, just Think about what it must have been like 100 or even 60-70 years ago. If you could not pay, you pretty much just died in the street and that was that. There are no angels here - just people who ultimately try to just do the right thing in a very difficult environment.

    ERP on September 1st, 2008
  • 36

    I’ve worked in EDs from East Coast to West and in both Canada and the US. What has that taught me? Every ED staff member faces the same crap every day. MIs, CVAs, DKA, HTN, obesity, drug-seekers. There are almost no unique situations. Thus, our experiences (and our reactions) are pretty universal. WHY? Because we are HUMAN (read carefully all you bitching complainers HUMANS DOES NOT EQUAL SAINTS JUST BECAUSE WE HAPPEN TO WORK IN HEALTH CARE, SO STOP EXPECTING US TO BEHAVE LIKE ONES)

    People are ABSOLUTELY at their worst in the ED. I’ve NEVER seen a bank teller spit on, hit, kicked, cussed at and belittled the way almost every ED staff member has been. And if they were, that bank teller would have the “customer” arrested and charged so fast it would make their head spin. Does this happen in the ED? Nope. We forgive and forgive and forgive, long after forgiveness should no longer be an option.

    Just because you are (insert whatever complaint you’d like), does not give you the right to act like a two year old throwing a temper tantrum. So…if you wouldn’t say it to your priest, and if you wouldn’t do it to your mother, then you sure as hell better not do it to me. Or you’ll be asked to leave. End of story.

    I bet our ED visits would decrease by at least 30%. Any thoughts?

    ONT-RN on September 1st, 2008
  • 37

    I always wonder what all these peoples’ moms would do if they saw them treating a doctor and a nurse how they do.

    Lately, I’ve just left the room when people (who aren’t sick) start cussing me out if they don’t pipe down after a couple of verbal warnings to do so. “I’ll be back after you can speak to me respectfully. Here’s the call light; when you feel like discussing this in a respectful tone of voice, please ring me.”

    Yawn. Buys me a little time to take care of an emergency patient at least. I don’t think nurses should put up with as much sh*t as they do.

    Nurse K on September 1st, 2008
  • 38

    I think that people need to be very careful when labeling someone with a chronic illness that is being treated for pain by narcotics an addict or to view them as “an addict” because of a need for drugs. Narcotics are physically addictive. Stay on them long enough, you will have physical dependence on them. That means that if you don’t have them when you need them, you will start to experience withdrawal symptoms, feel really horrible and will want relief. If something causes you pain level to increase unexpectedly, then, the medication won’t last as long or as well as it did before, and guess what, withdrawal symptoms. There is no shame in being medically dependent on narcotics any more than there is in being dependent on your heart medicine, your metformin or your anti-epileptics. For example, if you have RA and the majorty of the joints in your body are bone on bone, including your spine, you are going to be really dependent on those narcotics, as well as other meds to address nerve pain and other sorts of pain. You may not believe that FM is real, but guess what, the CDC disagrees with you.

    Good pain managment aims at keeping pain levels at a certain level — so that the patient doesn’t feel the “crash” which, if it happens enough, results in psychological dependence and fosters “drug seeking behavior.” In addition, in a chronic patient, pain begets pain — if there is too much pain over time, the nerves just start perceiving pain whether there is a cause or not. If a chronic pain patient has an increase of pain that cannot be controlled by the set pain regimin — they belong in the ER. Why — 1) if there is something bad enough that a pain med patient notices as painful, it can be something really bad, like a broken bone, or a blocked intestine, or a bad infection. 2) the pain doc isn’t going to be taking a call at 2 am because of 1) and because if there is something so bad that the patient needs more pain meds, he wants medical proof of it — he’s not going to just refill the prescrip early or give the patient another one and 3) its important not to get into a negative feedback loop where pain begets pain. So, if the FM patient had more significantly more pain than usual, she most certainly belongs in the ER. If she took one of her scheduled pain meds early waiting for the doc, then she might in fact be joking — or maybe that is her way of distracting herself from the pain pending treatment. If she’s showing up four times a month, well, then there needs to be a conversation between the pain specialist and the patient. To decide that a patient is “drug seeking” simply because of the dose of the narcotics is not a valid conclusion. A visit to the DEA site on prescribing narcotics is clear on this point. In point of fact, withdrawing narcotics from a patient who validly needs them and is physically dependent on them is a good way to create an addict and can cause medical risks.

    Not my theory — what I have been told by MDs specializing in the field.

    rose on September 1st, 2008
  • 39

    ERP- I really enjoy reading you blog and I really do not think you need to change anything. I happen to be one of those unlucky people who has Hypothyroidism, chronic pain from migraines and from a sugury almost 3 years ago, and I struggle w/ anxiety and depression. None of these conditions make me enjoy reading your blog any less. In fact what your blog does is reveal why the one time I went to the ED becasue my chronic migraine was so bad that I got treated like I was just trying to get painkillers (I really wasn’t). I might not have liked being treated like that, but knowing now that that is one of the most common excuses drug seekers will use makes me understand the doctor’s view better. The only other time I have been to the ED was for a completely different reason and I was treated very well by everyone there - I was actually treated w/ courtesy both times.
    I have had to work very hard with dieting and exercising to get back to my goal weight and I am only about 10lb over right now. My own PCP was actually constantly on my case to get me to lose weight and since I have been he has been very supportive and encouraging. It makes complete sense for any doctor to encourage patients to lose weight because healthier people usually have fewer health problems and being healthy tends to result in weight lose. It defiantely takes a lot of effort to get back to a proper weight if you have medical problems that result in weight gain, but I am proof that it is possible.
    I also go to my PCP because he knows my records, knows my history, and knows me so it makes more sense to go see them then it would to go to the ED when I do not know that doctor and s/he does not know me.
    Keep up the great blog! Even as a non medical person I love reading them because you make the ED real.

    TDB on September 1st, 2008
  • 40

    “None of the patients who have responded to this blog are the so called “chronic panieurs” that you are assuming. They have cushings or adrenal disorders. They have jobs, and family members, and are perfectly sane. ”

    I’ve been a….’fan’ of ERP’s blog since I found it via someone else’s med blog. I’m not a medical professional and have never worked in a hospital or ER. Unfortunately, I have spent my fair share of time in ERs. I’m a “fat chick” with 2 chronic pain conditions (Trigeminal Neuralgia and a ruptured lumbar disc) and ::gasp:: I still mostly enjoy reading here.

    When the Neuralgia first made itself apparent, I honestly thought I had something seriously wrong such as an eneurism (and I know I spelled that horribly wrong but I’m on a roll and not looking it up). I was in the ER 3 times in 1 week. Once the problem was figured out I ::gasp again:: went to the referred physician for treatment instead of going back to the ER.

    Unfortunately, there have been times that I have been rendered immobile by the ruptured disc (which was recently repaired surgically). As ERP pointed out, because I am respectful and patient and try not to be a bitch when I go into the ER with back pain, I am generally treated with respect and care. That also may be because I’m not there every week. I once had to go to the ER, while on vacation in a resort town, for the back problem. I woke up and made it from the bed, to the floor, and that was as far as I could go. While I was in the ER, the man in the bed next to me also was there for “back pain”. Once he got his prescription (for OxyContin) and the nurse left he was immediately on the phone telling one of his friends where to pick him up and discussing how much he was going to sell them for. As someone who was there with real back pain, if I had been able to get over to his bed and choke the shit out of him, I would have. He is the reason ER doctors, and nurses, are suspicious of people who come in complaining of back pain or head aches, and I don’t blame them. Doctors and nurses spent a lot of time in school and in training to doctor and nurse, not to be drug dealers.

    As someone who is “above average size”, with chronic pain conditions, I haven’t really been offended by anything ERP has said. I don’t abuse the ER or treat it as my personal pharmacy. I’m not abusive to the doctors or nurses. Maybe, if you are offended, the comments hit a little close to home.

    June Cleaver on September 2nd, 2008
  • 41

    Why is it that when these angry self-righteous support group members suggest we find other lines of work that they always suggest jobs such as trash collectors or sewer workers?

    That seems rather insensitive towards those hard-working men and women who make a living in those professions.

    scalpel on September 2nd, 2008
  • 42

    The danger comes in when doctors are completely unwilling to consider that there is something else going on with the chronic pain patient. I have an as-of-yet undiagnosed chronic back pain issue (I know, the worst sort). Last fall, I went to the urgent care clinic for abdominal pain so bad I couldn’t stand up. The urgent care doctor suspected either pancreatitis or gallstones, and sent me to the ER with paperwork requesting they do an abdominal ultrasound to diagnose me, as they didn’t have a U/S machine. I went to the ER. They did a CBC on me, and that was it. No other testing, in spite of another doctor suspecting something relatively serious. I was clearly dismissed by one nurse as drug-seeking, even though at no point did I mention medication (apart from “this is what I’m on for my back”), and again, refused to do the requested test.

    I was back in the ER a day later, when they did bother to do the ultrasound. HUGE stones blocking the common bile duct got me admitted and my gallbladder removed two days later (when I could be fitted into the surgical schedule). Had my pain been taken seriously to begin with and not just seen as a grasp for drugs, my insurance company would’ve been paying a lot less for my treatment and I’d have been out of pain a lot sooner.

    I’m fully aware that knowing that only certain drugs help with pain spikes makes me look like a drug-seeker. When I ended up in the ER for suicidal ideation because my pain was at an unrelenting 9-9.5, they refused me any pain medication because I was already a pain patient. I ended up doing the horrible thing of going to the other local ER in the hopes of some relief. He very cautiously told me that he wasn’t going to give me any narcotics, but he was willing to give me an anti-inflammatory and a muscle relaxant. The shock was visible on his face when I readily agreed to that and didn’t argue for something stronger. It helped. It didn’t take the pain away, but took it to a level where I no longer wanted to die.

    I don’t have a problem at all with medical blogs being a place where physicians, nurses, techs, whoever vents about their jobs and the problems that they run into. Every job comes with its stresses, and unfortunately, one of the biggest stresses as a medical professional is other people (patients and co-workers and management alike). What I do have a problem with is that same attitude which is put up as venting frustration on a blog being shown to me as a patient, when I’m hurting and scared and just want someone to tell me what’s wrong with me, or barring that, give me some sort of relief or tell me that they don’t see anything serious going on (i.e. no DVT, brain hemorrhage, etc.) I am unfailingly polite and unassuming when I’m forced to go to the ER yet again, and I really hate feeling like I’m being treated like less than a person because I happen to be a pain patient. And no, this is not every person I’ve seen in the ERs. In fact, the majority are neutral to excellent. The ones who don’t manage to get past their own prejudices long enough to see me as an individual who is suffering are the ones who make me wary and give the ED as a whole a bad reputation.

    Beth on September 2nd, 2008
  • 43

    No one should be abusive to another human being ever…period! The does not only include patients mistreating doctors, but this also includes doctors mistreating patients. But when people get angry, they say things they should not…including me.
    I have no shame in admitting this. But doctors are held in the highest regard in society, and they have to uphold laws and regulations. For those of you who think that you can say whatever you want on a blog without censor ever or possible ramifications…You are living in fantasy land. I am not referring to ERP here. I am referring to anyone anywhere who thinks that you can say whatever you want on a blog. Free speech may be ideal, but there are still things to abide by. Patients are not supposed to go listing their doctors names and slamming their doctors on a public forum even without names but with graphic indentifiable detail. Please, look at legal implications and such on a blogsite such as wordpress if you were to join. If a doctor were to find such information he or she would have right to sue the patient. Psych. professionals are highly regulated and are not even supposed to discuss their cases in public even without a name or date just in case someone in the community were to overhear them and sue them for everything that they have. Not to mention, the damage it causes the patient or family member.
    If just one person were to pick up on too detailed a story, and it resulted in a lawsuit…what a shame really. So whether we are talking crass comments about other human beings, to patient confidentiality…the internet is open for all kinds of people, irregarless of race, creed, color, race, or disability. Please please for your own sakes, think before you act. We all know how sad the consqences of foolishness can be if we truly have made huge mistakes in life.

    HumblyTruthful on September 2nd, 2008
  • 44

    This debate is two days old at this point.
    The long and short of it, is not that I don’t disagree that there are pain seeking obnoxious patients that are using the ER in the same manor that some people abuse the welfare system. I do agree. I have had the misfortune of having to use an ER, and I’ve seen non emergent people waiting to be called upon like it was some sort of clinic.
    My only ‘bone of contention” is that ERP tagged this thread, Disgusting, Obese, Pathetic. I thought it was heartless, cruel and insensitive. We all know that you did not mean that her “attitude” was disgusting, that was a back pedaling afterthought. I was disturbed that you described her dress as a tent used to make the story “what funnier”. Would spandex leggings and a half shirt been more appropriate attire?
    If you are within 10lbs of your goal weight, then I am truly happy for you. For some with hormonal/endocrine disease, diet and exercise simply don’t work, I don’t care what you believe or don’t.
    In 2005 I had gone for my annual OBGYN visit only to have her lecture me about my 28lb weight gain AND that was AFTER I had explained what my labs were doing over the past year. She looked me straight in the face and said well “calories in, calories out?” When she asked me to “slide down”, I was so infuriated I asked her if I had time for a snack?
    Many of us have been let down by the Medical Community time and time again. I’m sure ALL of you will agree that Doctors and not perfect, and by human nature many take the path of least resistance. Endocrine is a very intricate specialty, and the bottom line is, very few are really good at it. Treating diabetes and Thyroidism does not make you an endocrinologist or a specialist in my opinion.
    Heck there are still Docs tell sickly thyroid patients that they are within normal levels when their TSH it 4.2 just because the lab range is .3-5.5, leaving them scratching their heads and wondering why they feel so lethargic and fatigued. The Thyroid values were updated and changed in 2005, I don’t care that the labs have not caught up with the times. Doctors are SUPPOSED to be on top of these changes in the same manor that our accountants have to be aware of new tax laws come tax season.
    I am fortunate to live in the Northeast and have bounds of Specialists at my disposal. There are many in the midwest and the deep south that are NOT so lucky.
    No one deserves to be spit on, yell at, or attacked. But YOU do know what you are getting yourself into when you decide to be a ER Nurse or Doc. You made a choice don’t complain about it when you have to treat a drunk and disorderly, it’s your job.
    Emergencies come in all forms, shapes and sizes, not all of them are slip and falls, car accidents, and heart attacks. Pain pill seekers, drunks and drug addicts will continue to clog up our emergency room. Some of which I’m sure would have made different choices in hind sight if given a chance. At times it must be hard to keep from being jaded, but try a little more empathy when it comes to appearances anyway. In the sake of sounding redundant, not all obese people SuperSize their value meals. I hope that hearing some of these stories has enlightened some of you to a point that you will think twice about cracking jokes about the fat chick.

    CAM on September 2nd, 2008
  • 45

    I have seen the inside of an ER more than I would like in the last six months to ever go back. I did not go because for pain management, once. If it would help with the doctor shortage and help with increasing the bedside manner of hopefully only the few (and I really hope it is only a few) (not all), but certain physicans or medical professionals who were rude to patients without reason, I really think that they all should get paid a hell of a lot more and be given shorter shifts and more vacation time ideally. My husband used to work in the ER and I had a friend who was in medical school before she developed a terminal illness. In a former life,…I worked with people who had mental and physical handicaps. I had been threatened, cornered, pushed, shoved, gotten my glasses broken, swore at, spit at, and even had a client with a problem spreading body fluids and chasing the staff down with such. But I never discussed it outside of work or with a professional. A few general details like I am putting here are as detailed as I would ever go in public about the work I used to do. I have seen in front of my face a patient abusing a doctor er in the last month and she was a nice one.
    Under such circumstances, I can understand that the medical professional is put under extreme limitations when they probably would like to go off on such a patient. The ones that hold up the best are truly amazing. The ones that do not, well…they have bad days too. Unfortunately for all the other patients who were not rude or mean to a doctor, I would only hope they would not be targeted. What is even more sad, is when a specialist or office physician doesn’t want to help a patient within their ability (not with unreasonably high expectations), and they screw up to the point where a patient has to suffer needlessly and find a new physician who easily can identify and treat the problem. Personal experience…
    You must see all sorts in your line of work.
    Stay safe…

    HumblyTruthful on September 2nd, 2008
  • 46

    What attracted me to this Blog is your ability to express many of the same emotions I feel. Certainly I don’t agree with everything you say but I understand your frustrations of trying to do what is essentially a thankless and impossible job. Being rude and crude here is not the same as practicing medicine at the bedside. I have no doubt the vast majority of your patients are very happy with your care. I, too vent but at my desk, not at the bedside. Your only mistake as I see it, is allowing non HCP to view this blog because they haven’t a clue of what its like to work in the ED. However, this is YOUR blog. So by definition you can say whatever helps you keep your sanity. People who can’t handle your style should just move on.

    Mike Yerardi on September 2nd, 2008
  • 47

    ERP: They’re just trying to stifle your inner Samuel Shem! Don’t let them get you down.

    “House of God” was published in 1978. 30 years ago. His cynicism, angst, and labelling didn’t scare off the malingering masses, nor did it bring the medical community to it’s knees. They still come in droves, and maintain faith in their providers. He was much harsher than you are. It was/is a great piece of literature. This is a great blog.

    And Hell, you’re not even getting a commission.

    ParaCynic on September 2nd, 2008
  • 48


    “No one deserves to be spit on, yell at, or attacked. But YOU do know what you are getting yourself into when you decide to be a ER Nurse or Doc. You made a choice don’t complain about it when you have to treat a drunk and disorderly, it’s your job.”

    My job is to stop people from dying, NOT to indulge their drunken, drugged, idiotic behaviours. Being drunk is NOT A MEDICAL EMERGENCY.

    Your attitude that it “is our job” to be abused is laughable. Walk a day in my shoes and see how empathetic you are when the drunk who just pissed all over you is the same one who threw up on you the week before, and the week before that. Oh, and should you weigh more than 300 lbs??? I’m happy to lend a hand, but if you suddenly develop “ER paralysis” despite being perfectly mobile at home, you’re on your own. I’m not busting MY BACK and ruining MY HEALTH to help hoist you up in bed, or onto the commode or whatever.

    I’m here to save your ass, not to kiss it.

    ONT-RN on September 2nd, 2008
  • 49


    Get out of the ER, it’s too much for you anymore and I don’t think you are cut out for it. I think you would be better suited in geriatrics where you can save lives all day long and not have to deal with one drunk and disorderly.

    If your job makes you that angry and bitter it’s time to think about a change, for everyone’s sake not just your own.

    CAM on September 2nd, 2008
  • 50

    I find it is funny that the people who disagree with ERP seem to all be lay people. Likewise they all have had to turn to ad hom attacks to try and make their point.

    That said, I also backup what has been said over and over here. The ED is NOT a pain management clinic for CHRONIC PAIN. Get this through your heads! If you are in the ED every other week, you bet your ass you are going to be annoying the staff.

    Just to reiterate.

    emergency room

    Likewise, to the tubby readers who are offended by what ERP said. Remember, you are the one who chose to read, likewise you are the one who chose to be offended, not him.

    Cynic on September 2nd, 2008
  • 51


    “This debate is two days old at this point.”

    Actually, its not a debate. It’s you saying silly things, and reasonable people ignoring you. Last time I checked, that does not a debate make.

    I see no debate here personally. Folks in emergency medicine put up with a tremendous amount of BS, and they are well within their rights to not be thinking fluffy kitty and rainbow thoughts about the obnoxious wastes of time and resources they encounter.

    And if the lady is wearing the size of clothing I tend to see on the morbidly obese, well, if I could use it as a lean-to, I believe it can accurately be called it a tent….

    Erica on September 2nd, 2008
  • 52

    You are just so fabulous, when I grow up I want to be JUST LIKE YOU!

    I’m surprised you’re not kissing your elbows in your blog. Good thing you’re in love with yourself, because I doubt anyone else could.

    CAM on September 2nd, 2008
  • 53


    Does it make you feel better by attacking people and calling them names. Your (ET HUM clears throat) Napoleon Syndrome is really showing.

    CAM on September 2nd, 2008
  • 54

    You are right on Doc! I love to read your blog and althought my ER experiences are limited (my child’s broken arm and my own kidney stone AGGGGG!), I read enough to know that your ability to help those who belong in the ER is limited due to those who cause problems. My few experiences in the ER were pleasant (or as pleasant as could be under the circumstances) and I was treated with respect and dignity. Could that have been because I treated the doctors and nurses with respect and used my manners (please and thank you)? You deserve a pat on the back for what you do. A big thank you from me to you and all the individuals that you work with.

    Janet on September 2nd, 2008
  • 55

    I have been overweight or obese most of my adult life but was only able to lose weight if I starved myself and went to the gym excessively. Which of course backfired because who wants to eat next to nothing. When my knees started to hurt and I got a high number on a cholesterol screen I went to the doctor for advice on how to lose weight. He told me to stop eating junk food and soda. Neither of which I have had in 20 years but he wouldn’t listen. He blew me off. Three years later I found a sympathetic doctor who did some tests and found a metabolic disorder. I started an Rx, saw a dietician who taught me how to eat to help manage my condition and now I’m off the Rx and maintaining a healthy weight in a liveable way.

    It’s sad but true that all people think very little of fat people. Even doctors. I spent too much time being uncomfortable with myself and not living my life to the fullest because a doctor didn’t take me seriously.

    Sarah on September 2nd, 2008
  • 56

    I love it! You are great fun to read. This post was dead on accurate. I think you should keep up the great work and vent away because it’s good for you.

    Gertrude on September 2nd, 2008
  • 57

    I am a floor nurse and I just have to say that I completly understand and agree where the writer is coming from.

    I am not an ER nurse, but those same people that are in the ER, are many times admitted to the floor because ER docs don’t know what to do or quite frankly are afraid of being sued. (at least at my hospital.) I feel that I’m a nice person and I try my hardest to take care of people to the best of my ability.

    I share many of the same frusterations in the above post. For instance, Saturaday, was a bad day..had too many patients, many of them fairly sick and needed a lot of my time, which unfortuanly I couldn’t give as much as I wanted due to the lack of staff. I had a patient that had drug seeking behavoir. She was quiet and not making a sound until you came into the room. Then she loudly started moaning and crying from belly pain. She had several narcotics ordered,but she only wanted morphine, because that “worked best.” There was actually issues from the last night nurse, saying that morphine gave her an allergic reaction. I took time from my other sick patients to figure things out with our pharmacist so she could have her morphine. (She stopped with the crying as soon as I told her she would be getting what she wanted.) Her belly pain was not the typical. It was in both lower quads and when you palpated she did not have any gaurding at all. Most people with true belly pain will gaurd that tender spot unintentionally. She had a ton of test ran and everything was coming back normal from blood work to CT scans. Then after all that, the MD came in a couple hours later and discharged her. My mom brought my daughter in for lunch. (I would not have gotten to go to lunch or take one break at all that day, but my daughter was there and I was going to take a break.) Anyways, I took a 20 min lunch break even though i get 30 and came back to the LPN I was working with saying the patient wanted pain meds before she was discharged. I really do not like giving narcs before I send someone home. I was just about to go talk to the patient when I heard something over head. The patient had called a number which is supposed to be used for people that are having a life threatening problem that staff is not recognizing and then the supervisor is supposed to respond. She called this number because she wasn’t getting her pain medications and wasn’t being discharged fast enough.

    You see, she wasted the supervisors time and wasted others just because she wasn’t getting the narcs she wanted. That number was supposed to be for LIFE THREATENING problems. She waited only about 15 min while I had my one and only break of the day and the doc had just came in to discharge her about 30 min prior. So my supervisor gave her the pain meds and discharged her. and for some reason her pain in her belly was cured and she went happy on her merry little way.

    I guess she thought that she was better than my 8 other patients that I had and that I should have dropped everything to care for her. I did my best for her, was nice to her and I get a slap in the face for it. I pride myself on good work and never wanted any of my patients to call that number even for a BS reason.

    And for those of those people that say that she probably doesn’t like to be dependent on drugs and that we should have given her help…we can give all the help that we want..send her to a drug rehab and talk to her, help her get to the appriopriate places, but until these people admit that they have a problem, there is nothing we can do. Its not the medical professionals problem..its the patient’s. Its time they take responsiblity for themsleves. I would go to the end of the earth to help someone, but we can not help someone that doesn’t want to be helped.

    So for all those people out there who have something against the nurses and doctors..why don’t you just try thanking us every now in goes a long way. Sometimes I think I got my BSN, just to get yelled at, spit on, hit and treated like a piece of dirt on the bottom of someones shoe..but there are those few patients that make the day worth while and for those patients I thank..I treat my patients with respect, and just expect a little in return. I think thats what most medical professionals want.

    the people that come to the hospital and abuse the ER and such with narc demands and act like everyone owes them the world, just waste everyones time, including many other patients. They suck time away from staff and the people that are really sick dont’ get the care they need. Its sad.

    Anways, i’m sorry this comment was long, but I just wanted to say I agree and share in this frustration!

    another erica on September 2nd, 2008
  • 58

    […] Whoa! […]

  • 59

    I deferred a recommended surgery - I have a fairly large thyroid nodule causing compression symptoms that interfere with swallowing and speaking. I am euthyroid. There is a significant risk of impaired thyroid function after removal of half of the thyroid, about 20 to 30 percent of patients will suffer…with symptoms appearing gradually and with high-normal TSH’s that can be overlooked and left untreated.

    I asked for and didn not receive reassurance that I would be treated if these symptoms appeared, unless my labs met “traditional” high values.

    I could not bear the idea of being ignored and rudely treated when fat, and tired, (let alone deal with those symptoms themselves) and having to beg for treatment. So I skipped the surgery. I hope that the biopsy was not a false negative.

    Seen it happen on September 2nd, 2008
  • 60

    Humbly Truthful needs a job or something, seesh.

    Also, I agree with cynic’s argument that most of the people that are bitchin’ on here are lay people. I wouldn’t argue with an, say, accountant about stuff that pertains to his work because I don’t know shit about it. Stay with what you know people.

    And Fibro is fake…just thought I’d throw that out there too.

    ee on September 2nd, 2008
  • 61

    Geriatrics! Now that’s an idea.

    Most old people are really skinny, and if they complain about anything we can just give them Haldol instead of narcotics.

    scalpel on September 2nd, 2008
  • 62

    Repeat after me:

    Common things are common, uncommon things are uncommon.

    Xerxes1729 on September 2nd, 2008
  • 63

    […] M.D. - Medical Weblog Is it really too much to ask? Rating:  (No Ratings Yet)  Loading […]

    Health news - Respect on September 2nd, 2008
  • 64

    To all the people who think we are uncaring (and CAM, who is just full of attitude)

    What is it you do? Are you a bank teller? A civil servant? A grocery store cashier? You better be happy and polite and empathetic and caring every SINGLE SECOND you are at work. Oh, and efficient, and perfect too. And this behaviour had better continue after you’ve worked 9 hours without a bathroom break/lunch/time to sit down to write a single note AND while you continue to juggle 5-6 other critical patients.

    Good luck.

    Funny how those of us who actually work in the ED manage to come back day after day after day. We’re not burned out. We like what we do, and we do it because we’re good at it. You NEED people like us in the ER. We put people in their place when they’re out of line, and work our asses off to save those who need it.

    Yes, pain sucks. It does. We all know this. The majority of our patients show up to the ED simply because they are in pain. But we also know this: pain won’t kill you. So you’ll wait. Because the guy in the bed next to you who just looks a little sweaty? That heart attack he’s having WILL kill him.

    ONT-RN on September 2nd, 2008
  • 65

    You go ONT-RN!

    ArkieRN on September 2nd, 2008
  • 66

    Honey, I hate to say this but I will..and furthermore I don’t give less a chit whether you believe me or not. I am a lot of things, but I am not a liar. I have accolades out the wazoo, I have two beautiful teenage children in high school. Both who are in high honors, not by accident. A grandfather who went to Brown and then obtained a Law degree from Harvard. My Father graduated from Annapolis then went on to obtain his masters degree form Columbia. I went to Emerson with a BA in communications. I have done well. I am currently fighting a Chronic Disease, I am 1/4 of who I was 5 years ago…but I bet you that I drive a car that is worth 3xs your salary and that’s if you work in the Northeast. I float in the Atlantic on my 33 ft Formula on Sunday afternoons just to catch the rays. My pedigree alone would cause you to wince. I am not without disease despite my pedigree. I am strong! I don’t whine and complain. I push on everyday and struggle with the who I am vs. what I am. I am expected more of then you can ever fathom, or what you are capable of accomplishing in a lifetime. Just know that! Bank teller? laughing out loud. My GG-Grandfather was the Co-founder of what all of you now know as CHASE MANHATTAN BANK… and that my sweetie is NO LIE! Still….it doesn’t change how I feel about simple humanity. Period end of story!

    cam on September 2nd, 2008
  • 67

    as a footnote…my family donates more then your worthiness every fiscal year, move over..there is definitely room for more!

    cam on September 2nd, 2008
  • 68

    Amazing lack of compassion!

    These trolls cycle between understanding and indignant.

    Plenty of people tell ERP that they know what happened. None of these know-it-alls were there. Why pay attention to such childish attention seeking self righteous behavior? Because this abuse needs to be opposed. These trolls - and not all of those commenting are trolls - justify the misbahavior of rude, violent, and addicted patients. For shame trolls! Back under your bridges!

    Rose appears to keep seeking information to initiate nuissance law suits are the legal equivalent of blog trolling. Rose apparently annoyed the staff at a prison, that left her alone. Rose seems to think that she will be able to get ERP to give specific information, so that Rose can get someone, anyone, who was a patient at any hospital (where ERP might have worked) to sue. Nobody expects those who bring nuissance law suits to be polite or reasonable, but if Rose talks to a judge the way she writes to ERP, Rose will probably end up doing some jail time. :-)

    rogue medic on September 2nd, 2008
  • 69

    Good lord CAM, I wasn’t trying to compare wealth. And I don’t much care about your family pedigree. Plenty of wealthy families still produce children with the “asshole” gene. Perhaps you inherited that.

    You proved nothing with your rant about who and what your family is. Oh wait. You did prove something, but it certainly wasn’t what you were intending.

    Now, perhaps Emerson would like to consider recalling your Communications BA, since you don’t seem to know the difference between “your” and “you’re”. Oh, and you really love those run-on sentences!

    ONT-RN on September 2nd, 2008
  • 70

    […] Is it really too much to ask? […]

    Respect | The amazing on September 3rd, 2008
  • 71

    The people posting here are not trolls. Most are trying to initiate conversation and trying to understand where you all are coming from. I feel a lot of anger and hate from many of the people commenting, and that doesn’t help anything or anyone.
    I could give a rat’s ass what you write, I will probably never look at your blog again. I think you should be able to write whatever you like, as long as it is not about ME. What concerns me is that you do not seem to see people as people anymore. I think that the main thing is that it seems that you have begun to look at all patients as if they are malingering drug seekers, and that’s just not true. (I know, I know…you have compassion. You told us about it.)
    This post is definitely written in a different tone than most of your blog though, I do agree with that.
    My husband is an EMT, many of my close friends are nurses. I love my doctors and consider some of them friends. Many do use their senses of humor to get them through the rough times. But none of them are hateful enough to make the comment “Die already” when a person is lingering on death’s door.
    In closing, let me say that I hope you are treated well when you are in pain and scared, and not blogged about in a nasty manner later on. It’s the least anyone could ask for.

    Lily on September 3rd, 2008
  • 72

    Kudos to you for telling it like it is and sticking to your convictions, my blogging comrade. I’m a little overweight, and I don’t use it as an excuse for anything, let alone a reason to go to the ER for pain pills, I don’t even like the ER (no offense).

    It’s also nice to know that other people are dealing with controversial topics on their blogs, makes me feel better about doing it too even though my site is for a completely different career field having nothing to do with medical work. I’m a server, and before any of you in the peanut gallery here say anything about my finding a “real” job or getting an education or something, I like what I do in general, just not the clientele that I’m currently dealing with 85% of the time. I love the industry, much as our Doctor friend here loves to help people when he’s given a real opportunity to do so.

    Something I’ve learned in my time reading these medical blogs, and in running my own blog is that when people post the blunt and honest truth on their site it will generally get people riled up like it has here. The people who are the most pissed off about the issues at hand are usually the ones who are being called out whereas the people who support the author of the post are ostracized and accused of being horrible people.

    Doctor, this sobering and honest post is the first I’ve read on your site, and it was enough to make me add a link to your site on with the rest of my medical blogger links, and I rarely add new links anymore because it’s not often I can actually find authors of quality anymore. Keep up the good work, and if I ever had a problem near you I’d be glad to have you as my own Dr.


    Ribeye of your Dreams on September 3rd, 2008
  • 73

    And for a real live (and named) physician’s take:

    Dr. Deborah Peel, a psychiatrist and founder of the group Patient Privacy Rights, thinks physician blogs often step too close to the limits of patient privacy.

    “The problem with physicians blogging about patients is the danger that that person will be able to identify themselves, or that others that know them will be able to identify them,” she says.

    Peel’s group worries that information about a patient’s case could be traced back to the individual and adversely affect his or her employment, health insurance or other aspects of his or her life.

    Certainly if a doctor violates a patient’s privacy there could be legal consequences. Under the federal Health Insurance Portability and Accountability Act, physicians could face fines or even jail time. In some states, patients can file a civil lawsuit if they believe a doctor has violated their privacy. Still, it’s not just privacy issues that trouble Peel.

    “If you are unhappy with the people that you’re supposed to be serving and taking care of, you probably need therapy,” she says. “You don’t need to be venting your frustrations in a public manner like that. That’s very inappropriate and unprofessional.”

    From Doctor Blogs Raise Concerns About Patient Privacy

    by Deirdre Kennedy (NPR)

    rose on September 3rd, 2008
  • 74

    The possibility that a patient may recognize themselves is very real. However, it’s much more likely that a reader may identify with aspects of the fictional character. People see (and hear, and interpret) what they want to. It isn’t any different from a social worker, or a waiter, or a lawyer, or a babysitter blogging about their own personal experiences. So, basically, the NRP (and that horrid woman) are saying that all blogging is unwise and potentially dangerous. In essence, that means that free speech should not be allowed.

    Now that’s just BS

    A Quiet Voice on September 3rd, 2008
  • 75

    “Honey, I hate to say this but I will..”

    You know, if you’d played it down to midwestern housewife rather than pretending to be rich and fabulous (and pedigreed? What, are you a poodle?), it may have been just a smidgen more believable. Just a note for next time. I’m thoroughly amused, I’ve just been reading about Munchhausen by Internet, but didn’t expect to see a case so soon.

    Also, A Quiet Voice, you have a very good point. Well said.

    Erica on September 3rd, 2008
  • 76

    To surmise,

    I feel that health care related blogs are not something we all should take for granted. In essence I feel they are therapeutic to many if not all in the health care related field.It provides a means of venting, along with knowing you are not alone in this. Which is well shown in the supporters.

    Thank you ERP for doing what you do. I for one greatly appreciate it.

    Physcians, nurses, medics,techs etc. all suffer from the same disorders that eventually catch up to us. Some like to refer to it as burnout or a differential form of PTSD.

    Working day to day with the sick, dying and abused takes it toll on us all. What the lay person does not understand is that when your day revolves around coding a 14 month old that is a victim of shaken baby to the child who is a VOSA to the drunk that just crashed out and took an innocent family with him. Guess what ? It fucks you up as a person. There is no light way to say this. You have to put up walls and barriers so that you can concentrate at the task that is at hand. If you do not, it will eventually eat you up. We as health care professionals have a job to do. We give up a lot emotionally to do the jobs that we do. You will never understand. Do not feed me some nonsense that you do.

    SO for those who feel I or others need to be more compassionate to their bullshit, spend 15 years practicing emergency medicine and tell me you feel the same way. Those who deserve compassion by all means will recieve it. Otherwise you are just wasting my time.

    Cynic on September 3rd, 2008
  • 77

    “SO for those who feel I or others need to be more compassionate to their bullshit, spend 15 years practicing emergency medicine and tell me you feel the same way. Those who deserve compassion by all means will recieve it. Otherwise you are just wasting my time.”

    Isn’t this the real issue here laid out in black and white on the table for everyone to see? I really wish in reality, that showing kindness and caring in whatever profession or walk of life you may be in, that it would beget compassion and respect. Unfortunately,
    that does not happen anywhere consistently. It happens, but not as much as it should. Truthfully, it is just sad in this day and age that adults have to resort to such behavior. I admitted on another post, I was not an angel. WE all have to work on ourselves, and not one single person on here is perfect. There were some things I have written to ERP on here that were out of anger because I feel that certain things should not be used for the whole world to see. I try to play my part to make this world a better place just like everyone on this planet should be doing. I have not read the entire blog, but there is one portion on the blog that sticks out and has some very graphic, possibly indentifiable detail. I am not sure if there are others, and I am not going to bother worrying about it. Free speech is great, but where does one draw the line? I personally do not go around all the time calling people fatties, or retarded, or stupid, or ugly and throw those words around like confetti. But I have been guilty of calling names and saying stupid things on occasion. I have made harsh judgements and said other things that are just as bad at points in my life. I have been guilty of sin, and I have no problem admitting my faults. When does remorse come into play in our daily lives that we actually take a look back and say, “I should have been a better person. I should have not said that, or yelled at him/her. Maybe I should say I am sorry?” What is a real shame, is that most of the medical personnel and patients who have posted here, are all hurt and cannot find any common ground because all they see is a dividing line. Many of you doctors, nurses, etc. have written how hard it is for you and I believe it. If people working in a diner, or a bank, or a grocery store were to be rude to their customers and got enough complaints written against them, they would be fired. Their jobs are no less important to them, than a medical professional’s job is to him/her. But, medical professionals (especially physicans , nurses, psychology clinicians) are handling the most sensitive of work there is all the time “PEOPLE” and the human being’s health. I know there are other areas of work that deal with such too, but these are in the limelight. Their jobs are not as easy to come by, and they have to put in years of studying, and many end up spending years paying off their debt. Shouldn’t doctors and patients be cooperating no matter if a diagnosis is difficult, or if they have differences of opinion? If there is a true conflict, then of course the patient should go somewhere else or the doctor should redirect them. But overall, people should be doing their darndest not be be cruel to each other. When they are, they should apologize whether they hold only a Medical degree, a GED, or a State ID.

    Yeah, I know… people are always going to be mean and we all just need to get over it…
    Especially me…

    I would hope that maybe someone could learn something from all this, patient, medic, doctor, nurse, internet sufer, etc. etc. etc.

    For anything I said that was mean. I am sorry. WE are all still people here.

    HumblyTruthful on September 3rd, 2008
  • 78

    Some interesting terms to note…
    Severe pain and Neurogenic Shock
    The long term effects of pain on the immune system

    Even heart attack patients have chest pain.
    That is why they went to the ER in the first place.

    HumblyTruthful on September 3rd, 2008
  • 79

    If you don’t like, don’t read it. CAM, get a life and what’s that all about your pedigree, are you a dog?.
    Braden, you made my day!
    ERP, Thanks for everything you do.
    I used to work in a major city ER and that has been my favorite job ever!

    Micky on September 3rd, 2008
  • 80

    I love your blog, as well as many other ER docs’ blogs. I have nothing but respect for you and your profession, and I don’t claim to know one bit about the real goings-on in an ED.

    My husband went to the ER twice a few weeks ago, and the staff was great. We made it a priority to be polite (not that we’re not already!) and they were just wonderful.

    Jenny on September 3rd, 2008
  • 81

    Whoa! | ER Stories…

    My view (and very likely others’ in the health care field - especially those who work in the ER) on obesity, chronic pain, psychiatric illness, and what it is like to work in an ER….

    Healthcare Today on September 3rd, 2008
  • 82

    Eh, thats okay. As soon as they get done bitching at you they waltz right over to my store and give me both barrels as well. Usually its because I’m calling to verify that you really did put down “12o(twelve)” (a 12 changed into a 120 but still has (twelve) written out next to it) Vicodin ES.

    TheAngryPharmacist on September 3rd, 2008
  • 83

    Woah! is right.

    Why do lay people think they have the same education as professionals ’cause they read some stuff on the ‘net and a couple of books? They say they ’studied’ or ‘researched’ things, and that makes me laugh.

    Come work a few shifts with me. Work a week with EE or with ERP or Nurse K or Braeden or RogueMedic. See what we see every. fucking. day. See the abuse that goes on, get lied to time after time after time and then see how you deal with it.

    It’s really very easy to sit at your computer desk or on your couch and play Monday morning QB. It’s not so easy to take the abuse day after day - btw, I know quite a few medics and I don’t know of a single one who has NOT been assaulted by a patient. NOT ONE. I know people (myself included) who have been slapped, punched, bitten, kicked, hair chunks of their hair yanked out, stabbed and even shot on duty.

    CAM, I don’t give a rat’s ass about your pedigree, where you live or what you drive. It doesn’t (and wouldn’t, if you were my patient) make an iota of difference to me. The fact that you bring it up here speaks volumes.

    ERP, blog on. That’s all I have to say ’bout that.

    NinjaMedic on September 3rd, 2008
  • 84

    It is sad this happens, but it does not just happen to medics, physicians, and nurses. It happens to security officers, police officers, cnas, and even direct care workers.
    I have seen people bitten. I have been pushed into a wall and had my glasses busted.
    One lady I knew got her nose broke by a client who was psychotic. My husband has a permanent problem with his arm after having surgery on it twice because of an unruly drunk in the ER. OH, and please don’t take someone’s knowledge or interest in a subject or research as a desire to diagnose or think that one knows more than all medical personnel. I know that correlation, does not imply causation. I listed the points above for nurse arkie since she wanted research and not anecdotal reports. One does not have to be in medical school to have an opinion if they have an interest in a topic, or have known people in the medical profession.

    HumblyTruthful on September 3rd, 2008
  • 85

    One more note, my interest in chronic pain stemmed from my studies in psychology and
    from seeing the suffering of others.

    HumblyTruthful on September 3rd, 2008
  • 86

    HT: I used to work with a PD, was an armed security officer and am also a CNA. I’m here to tell you that I’ve seen more violence perpetrated on members of the medical profession than I EVER saw when I carried a gun to work or worked with the elderly, demented, infirm or mentally ill.

    I had a head on collision with a semi a few years back that not only nearly killed me but also left me with injuries that I’m STILL having to have surgically repaired. Among other things, I had a spinal fusion that left me with permanent neuropathy in my lower extremities. I know what chronic pain is, I live with it every day. I was, at one point, being prescribed 5 different medications, 2 of which were narcotics. I came off of all of those meds; I got sick and tired of being on them and decided I’d rather deal with the pain and be full present than lay on my arse on the couch, getting fat and feeling sorry for myself. I’m now an EMT, doing a more physical job than people who’ve never been injured do daily, and I love it. I got in to this career to help people who were hurt, I wanted to save lives and make a difference….not get urinated on by drunks and punched in the head by junkies who didn’t get what they wanted. I know about pain, both from a personal and a professional standpoint, and I will say it again: the ER is NOT the appropriate place to treat or address chronic pain. It is, as it’s name suggests, for EMERGENCIES, not because someone wants to get a ‘free’ fix.

    Ninjamedic on September 3rd, 2008
  • 87

    I have no doubt in my mind that those in the ER, on on their way with patients are at the most risk for injury. MY husband was brawled and he wasn’t a medic because he had to handle all the patients as well as the other officers on call because where he worked they had high incidences of drunk patients that were left. There is no way the already busy nurses or physicians would have been able to deal with it. My husband had to help the medics with such even those with severe psychosis or drug problems. Do I believe that the ER should be used as treatment for chronic pain? Nope. I do think that if pain is acute and severe enough it warrants a trip to the ER, and that the patient should be evaluated and yes made comfortable but even moreso to make sure nothing serious is going on. Usually, that kind of pain is associated with an injury or illness that needs other treatment Working with people with severe psychosis, I saw more than I would like to admit. I saw more people get hurt than I would like to admit. But compared to the ER, or your experience, I am sure it was mild…but it was my experience. The ER is the place that such patients were taken, thus you would have ended up having to deal with the worst of it all. So, I appreciate what you do and I am sure you are not mean to your patients. I think it is awesome you were able to work again and get off all the pain meds you were taking and still can do the work you do now. I believe there are those who do need pain management, but not every single person and not without good cause. And pain management of course doesn’t necessarily mean narcotics. What is a shame, is that you went into this to help people and you get pissed on and punched because of it. I only hope that knowing that you save lives can somehow, some way make up for it as well as the experience. Not everyone can be an EMT. I wouldn’t have the stomach or the resolve. And no one should go to the ER for a free fix, no one. The people that do that merely to feed an addiction need help and psych evaluation. I don’t know you, but even if it doesn’t mean a whole lot…I appreciate what you do.

    Please stay safe…

    HumblyTruthful on September 3rd, 2008
  • 88

    I have been in the ER/ED a few times over the years, both for my own problems and for those of friends and family members. I have to say we’ve always been treated with kindness and respect, and I hope have given the same in return.

    ERP, I don’t like the way you expressed a few things–from a patient’s perspective, they were painful to read–but you’ve certainly opened my eyes to the kind of problems you front-line (Drs, nurses, medics, etc.) face on a daily basis. That made the reading experience worthwhile.

    I know you all don’t hear it often enough, but thank you for the excellent care, treatment and support you give us patients under such (often annoying and) difficult circumstances. You may not be saints, but you are truly a blessing.


    m (2) on September 3rd, 2008
  • 89

    Can’t we all just get along” ~Rodney King of California

    Jody on September 3rd, 2008
  • 90

    I hate all these pussy whiners that say “please respect and love everyone” assholes on this site. F__K you! Go read another blog you fat bastards!! Take control of your own life. I can hate you and make fun of you all I want!!! This is the U.S of A!! I can say whatever I like about fat bastards, psycho’s and cushingfreaks!!!

    Jimmy on September 3rd, 2008
  • 91


    You pussy! They should ship dicks like you off to Iraq as IED fodder. Whiners and PC’ers like you are making this country weak with all your complaining about being offending and my “feelings are hurt” bullshit. They ought to round people like you up and ship you off to an Island so you can offend each other there. You were a waste of sperm.

    Jimmy on September 3rd, 2008
  • 92

    i say doc you prescribe a marathon session of ER video watching to refresh their stupid asses for a hint of how crazy life in an ER is. I distinctly remember my 12 hrs in Dallas in Parkland Hosp ER for a fractured patella. I saw a lot of folks go ahead of me but they obviously needed treatment STAT as they tended to have active bleeding, were unconscious, and/or protruding bones.

    I ended getting the top ortho doc on that shift and the techs working the clinic where I got my casts were all great. I came in with 12 mm of seperation and had 110 cc of fluid drained. The only pain I experience in the treatment was the movement of my knee for the X rays.

    Personally I am just glad there are folks like you who continued to work in ERs are they find out just how crazy they can be.

    I wait tables for a living so I fully understand how a few of your ‘guests” need special handling so that you can take care of everyone else.

    ANd finally to all the Doc haters -do us a favor go write you own blog-the obvious purpose of this one is to vent the excess stress from his job in a healthy manner-would you rather he turns to booze and eating twinkies to the point he becomes a patient?!!?

    Food Service Ninja on September 4th, 2008
  • 93

    I would feel truly sorry for the doctors,medics, and nurses and anyone else who would have to be the brunt of your temper, especially if you were drunk and on the way into the er.
    Matter of fact, you sound like one of the patients in an ER that was harassing a poor doctor.

    HumblyTruthful on September 4th, 2008
  • 94

    I hear ya loud and clear. I dislike paedophiles, and rapists as much as you guys dislike time wasting junkies, and chronic pain peeps. Actually junkies really get on my tits, and I hate having any form of association with them. They are manipulative, liars who would sell their own mothers. I have come across a few in my life, and they will drag you down, and everyone around you. I in the past worked medically with people, then animals.My ex husband was a Dr and I spent many years living in hospital accommodation associating with other medics, and hearing tales. Anyway my point is that drug seekers make it hard for those of us with real issues. I actually hate going to hospital. Many reasons why. One of them is the thought of being judged and bundled into a category. Mine isnt fibromyalgia,migraines,drug addiction, whatever blah blah. Its because many people also get labelled if they had a past hx of abuse in their childhood, or domestic abuse. It’s in my records for all to see. I got over my past abuses, others haven’t. This in itself can hold someone back from moving on. I had my bladder removed and neobladder formation 8 months ago, and was also left for 10 days post operatively with a Mechanical Bowel Obstruction, my bowel was stuck to my incision. I had several other complications also. It didn’t stop me from walking around, or wanting to go home though. I had meds on board, and I was trying to not use any so I could go home. I was frustrated that I couldn’t cope with the pain. In retrospect I looked 8 months pregnant and also was vomiting faecal material. What hurt more though was the doubt in the odd nurses eye, when I said I couldn’t eat. Because of that experience, and subsequent surgery on the day (I thought I was going home). I am terrified of the hospital. I try to tough it up while in their, nether less I am a vulnerable patient. Yuck. What does make it harder is judgement. I don’t need to be treated like an imbecile because of past suffering. I just want to say there’s Scum, and then there’s Scum. Not everyone should be lumped into one basket. Try to keep the cynicism, bitchiness, and bitterness to a minimum. I could be a total bitch from hell for what I have lived through in my life, but I’m not. Im just glad to be alive.

    bladdergirl on September 4th, 2008
  • 95

    Yes, I think all health care providers have to be prepared to modify their take they have on any particular patient - one person can seem like a manipulator and then suddenly you realise they are legit. The next guy who you take for real turns out to be modifying your prescriptions. Then there are the drug seekers who incidentally have something new and life threatening. Sometimes it ain’t easy…..

    ERP on September 4th, 2008
  • 96

    And Jimmy, please try to keep your language more PG-13 rated.

    ERP on September 4th, 2008
  • 97

    Humbly, you tossed out some terms there. You have not provided any names of studies or research that proves scientifically that pain causes death. I challange you to do that. I really don’t think you can because there isn’t any scientific proof.

    ArkieRN on September 4th, 2008
  • 98

    Just an a psychological exercise, it’s interesting to note that all of the haters who posted here started by posting long, exceedingly detailed medical histories. I imagine these people pull out these (true or not) well-worn tales in every situation imaginable, but what could they possibly be looking for here? A free second opinion? To “wow” us with their second-hand medical knowledge? I think they’re looking for sympathy — and from anonymous people on the Internet, no less. Which is much sadder than their tales of medical woe.

    Dobby on September 4th, 2008
  • 99

    I know one reason there are so many psych patients in the ER, because it’s darn near impossible to see a psychiatrist without an appointment a month in advance.

    My husband’s having serious mental issues (hearing voices, delusions, paranoia, likely schizophrenia), and both his therapist and MD told us to go to the ER. His MD did prescribe Geodon, by consulting with a psychiatrist. The psychiatrist he consulted with still can’t see us for three weeks, and that’s with a referral from the MD. Every psychiatrist we cold called was more like 4-6 weeks out.

    We live in a major city, have decent insurance, and still can’t get help. He won’t go to the ER because he’s afraid he’ll be admitted and not get out (part of the paranoia), and as long as he’s not a danger to himself or others and is getting some help, I’m not forcing him to the ER. But I can see why people would go to the ER.

    I can also see that after dealing with mental illness even for a short time (a few weeks), and trying to get help from non-emergent medical professionals with out success and weeks of waiting, when the patient finally gets to their wits end and ends up in the ER that they might not be the nicest person in the world for staff to deal with.

    Not that it excuses or justifies bad behavior or rudeness or abuse of staff, because it doesn’t.

    Kate on September 4th, 2008
  • 100


    If you were actually well-educated, you would know that it’s a “Napoleon complex,” not a “Napoleon syndrome.” Also, you would be able to form grammatical sentences. (For future reference: your BA in communications probably doesn’t intimidate the MDs.)

    You may be rich, and you may even come from an old, rich family. I doubt it. For one thing, “what is known as the Chase Manhattan Bank” has been known as “JPMorgan Chase” for about eight years now. If you were really descended from either Burr or Thompson, you would almost certainly own shares in the company and would have most likely known of the merger. Also, if you really came from “old money,” you almost certainly wouldn’t be so vulgar as to actually bring it up, much less brag about how much you paid for your car. If you actually do come from that kind of family…wow. Generations of breeding have clearly done you no good.

    ERP -

    Also, as someone who has never worked in an ED, let me take this opportunity to berate you with my Wikipedia-based knowledge of disease. What I have to say will fill in the gaps left by your undergraduate and medical school curriculum, as well as your residency and further clinical practice.

    I would try to publish multiple treatises on my health problems, which confine me to commenting on blogs instead of working, studying, exercising, or socializing. Unfortunately, my fibromyalgia is flaring up…

    Jake on September 4th, 2008
  • 101

    In Dedication to Nurse Arkie:

    Foundations of Nursing: Caring for the Whole Person - Google Books Result
    by Lois White - 2000
    pg.1154-references neurogenic shock can occur in response to severe pain

    Pathophysiology: A 2-in-1 Reference for Nurses - Page 209
    by Lippincott Williams & Wilkins
    References severe pain as a cause for neurogenic shock.

    Here is an article abstract and an excerpt :
    “The body’s response to acute pain can cause adverse physiological effects. Pain can impede the return of normal pulmonary function, modify certain aspects of the stress response to injury, and alter hemodynamic values and cardiovascular function. It can produce immobility and contribute to thromboembolic complications. In addition, pain can slow a patient’s recovery from surgery and contribute to increased morbidity” from the following abstract with link and article included
    “Effect of analgesic treatment on the physiological consequences of acute pain
    KS Lewis, JK Whipple, KA Michael, and EJ Quebbeman”, American Journal of Hospital Pharmacy, Vol 51, Issue 12, 1539-1554
    Copyright © 1994 by American Society of Health-System Pharmacists

    These are obviously manuals used for educating medical professionals and would have to have been written based upon research and not mere anecdotal evidence.
    My knowlege of shock being caused by severe pain was what would consider to be common knowledge that I thought in society most people knew about including training my husband had received for first aid, but also I had a friend who was in medical school and reference had been made to shock as a result of acute pain in one of her pain management books because she had shown me. My friend was studying to be an physician until she got sick. It was written by nurse practioners I believe for educating physicans and med students. Pain in extreme cases can cause shock, and shock can kill if not treated. I studied with her help because I had an interest in helping others because I was studying psychology and was also interest in the concept of chronic pain and its effects upon mental health and also on the human body. The comment made that pain is not an emergency by someone who claims they are a nurse on here is rather frightening. Chronic pain is not an emergency unless it becomes so severe that it would possibly precipitate suicidal ideation. But in cases of severe pain,if pain is severe enough it is an emergency or associated with an illness that might be one and it should be evaluated. I stand my ground that Pain can kill even if along a string of linear events that take place. If pain can cause shock in extreme events, and shock can cause death, then pain can inadvertently kill someone. If pain leads to depression and depression is a direct result of a person’s suffering, and the person chooses to take their own life..then pain can kill. I do not believe in everyone needing to take narcotics for pain, because that is irresponsible and stupid. That is why there are doctors for such. Just as pain can be deadly so can the effects of drugs.

    HumblyTruthful on September 4th, 2008
  • 102

    Here are some other various topics and blurbs of interest :

    Liebeskind JC (1991), Pain can kill. Pain 44(1):3-4.

    Bedside Clinics in Surgery By M.L. Saha pg.540-shows a listing of the causes of shock in patients with burns, and neurogenic shock has severe pain listed beneath it

    The Effect of Pain on Leukocyte Cellular Adhesion Molecules
    Biological Research For Nursing, Vol. 7, No. 4, 297-312 (2006)
    DOI: 10.1177/1099800405286071

    Suicidality in chronic pain : a review of the prevalence, risk factors and psychological links
    TANG Nicole K. Y. (1) ; CRANE Catherine (2) ;
    Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
    (1) Department of Psychology, Institute of Psychiatry, King’s College London, ROYAUME-UNI
    (2) Department of Psychiatry, University of Oxford, Oxford, ROYAUME-UNI
    Porter FL, Grunau RE, Anand KJ. Long-term effects of pain in infants. J Dev Behav Pediatr 1999;20(4):253-61
    (obviously some kind of worksheet or presentation showing information on neurogenic shock)-and if you see it says pain is one of the causes

    Romano, Thomas J, Chronic persistent pain can kill: a
    clinician’s perspective, Am J Pain Management. 2005
    April; vol 15 no. 2, p. 59-65.

    A full article:Chronic Pain Conditions and Suicidal Ideation and Suicide
    Attempts: An Epidemiologic Perspective
    Gregory E. Ratcliffe, BSc,* Murray W. Enns, MD, FRCPC,*w Shay-Lee Belik, BSc (Hons),*w
    and Jitender Sareen, MD, FRCPC*,Clin J Pain 2008;24:204–210

    Nurse Arkie, I agree that Mere anecdotal reports are not evidence of things. I know this. Like I said before…correlation does not necessarily imply causation. But, basically you are calling all of those who have put their time into writing medical manuals and doing research ignorant of any relationship between pain and its varied effects on the human body if you think that pain cannot affect the immune system, does not ever lead to shock, does not lead up to possible suicidal ideation, and that it is not an emergency.
    You should have access to a heck of a lot more research then any of us “laymen” have.
    Perhaps it is time you renewed your interest in reading up on it even if you do not believe there is any research supporting pain and detrimental effects on human emotion and physical well being that could result in death. It would at least be good to know that your patients coming into the ER with severe pain wouldn’t be considered as a waste of time because of your “Pain is not an emergency comment”. Perhaps you meant “Chronic Pain is not an Emergency”. But what you wrote seemed otherwise. I would think that being a nurse would also include having the knowledge and empathy for those who truly are suffering from even pain. Isn’t that why you go into the field in the first place, to help those who are in pain and are sick?

    HumblyTruthful on September 4th, 2008
  • 103

    You’re on Shrink Rap.

    dinah on September 5th, 2008
  • 104

    HumblyTruthful, what’s with the personal attacks. I haven’t insulted you personally so I expect the same courtesy. I do assure that I AM a nurse. I don’t know what gave you the idea that I work in the ER. I never said so and it’s not a requirement for commenting here as evidenced by your own posts. I do have family and friends who work in the ER. I also have experience with managing medical emergencies and critical patients.

    If you had kept up with my comments, you would have seen that I specified that I was speaking of chronic pain (the focus of ERP blog post - remember?). As I was speaking of chronic pain, your articles focusing on acute pain are irrelevant. I am aware of the problems associated with acute pain.

    Lest you think I am ignorant of the effects of chronic pain, let me tell you that in 2005 I was diagnosed with very late stage cancer which I was not expected to survive. I underwent high dose radiation and an aggressive chemotherapy regimen. High doses of IV steroids were part of my treatment protocol. I experienced multiple life threatening issues including intercrainial bleeds and extensive blood clots. I also experienced pain. Lots and lots of pain. I was even dependent on narcotics for a period of time. So, I know pain.

    I am also aware that chronic pain can be associated with suicide. I do agree that suicide ideation is an emergency. But it doesn’t logically follow that medically speaking pain was the cause of death.

    Chronic pain is not an emergency. Because of the afore-known status of the condition it could have been (and should have been) managed earlier. Emergencies are unexpected, sudden, acute, unforeseen, etc.

    Many times people live with chronic pain that is not controlled properly. They may experience drastic worsening if they run out of medicine. However, that does not mean that it becomes an issue that should be seen in the emergency room. They should anticipate this and arrange for it ahead of times.

    Some people may be completely unable to arrange for physician services so they come to the ER because by law they can’t be turned away. The ER has become a catch-all for people who fall through the cracks of medicine. This does not make it a proper use of the ER. The staff are not trained to deal with these issues and doing so takes resources away from true emergencies.

    People who abuse the ER are causing the entire system to fall. ERs are being shut down across the US. When the system fails completely, who will take care of the emergencies?

    ArkieRN on September 5th, 2008
  • 105

    Whoops! Sorry for the grammar and punctuation mistakes. I accidentally clicked the message through before proof reading.

    ArkieRN on September 5th, 2008
  • 106

    Hi Nurse Arkie,

    “It’s an EMERGENCY room. Pain is not an emergency!!! People do not die or lose limbs from pain. Wait until the morning and see an appropriate physician. If you choose to come to the emergency room anyway then sit down, shut up and be grateful that your non emergency is being taken care of.”

    This statement from the other post was what alarmed me. I assumed because of this that you worked in the ER. MY Bad…
    I also assumed because of your statement, that you were not a nurse because from my experience, and those in my family who work in the medical field, and my old friend who was in medical school…that pain never being an emergency and/or never could cause death was very shocking. Perhaps there is a dichotomy in what some in the medical field think as opposed to others. I would believe there is a consensus for what constitutes
    nonesensical use of the
    ER for no matter what the reason and with this I do not dispute. People should not abuse the ER unless they have an emergency. Sadly enough, emergency can have a wide array of meaning.

    I wrote another statement admitting my own flaws and my opinions and as an apology. That also went for any mean things I may have said to you.
    But, I took on your initial challenge and provided you with at least some research and what I consider fair support.
    If I said anything that came off as an attack, again I am sorry. My other questions were meant to be rhetorical. I believe that people need to be more openminded in general and that having a narrow view can be a dangerous thing. SO if
    nothing else, I have learned a lot more from seeing what healthcare workers feel and see and what they have to deal with that many of us are not exposed to every day. I would only wish that healthcare workers who hopefully have been treated with respect when they are patients could understand how hard it is to be a patient who is struggling and has become fearful because of some very bad care or rude comments. The stigma associated with chronic pain keeps many from getting treatment. The stigma of being
    obese already in society has in some
    circumstances caused a patient to have something else going on, but only a “fat” person is seen. The stigma of being mentally ill (not so much as it used to be), carries over and can cause patients with mental illness to be treated like everything is in their head. These are generalities, but people really do feel this way….not just me. I included things associated with chronic pain as well not just acute pain.
    There is a whole hodge podge of resources listed here, and I read the excerpts or articles or websites.

    I am sorry you have had to suffer with cancer and the pain associated with it.
    I cannot presume where you are at this time in your illness, but it sounds like you are a survivor. I can only hope and pray that it goes away and/or does not come back. Hopefully it is gone and you can have many many years to do what you do best.

    As for assuming or not assuming you are a nurse, just as in anything else. We can only go by someone’s word. Again, I apologize. I can only go by the words on the screen that alarmed me.

    I have given the research. I have not asked you for any. I took up your challenge. I feel I covered it extensively. Now, I think we should agree to disagree.

    Pain can kill…

    HumblyTruthful on September 6th, 2008
  • 107

    I agree with the statement that patients need to be respectful toward ER staff, but it would be nice to see that level of respect reciprocated as well.

    All of our local ERs are also advertised as walk-in care clinics for people on vacation, between doctors, or who cannot get an appointment to see their local doctors. The reason behind this is that we’re very rural and the ER often has only one or two patients in it at a time. They advertise that they have affordable care, but when you go in and specify that you’re there for the walk-in care, you get a $500 bill just for setting foot in the ER. Then the service is really poor and the lack of respect is disgusting.

    I’ve never abused prescription medications or taken illegal drugs, yet I was accused of seeking pain meds when I came in with uncontrollable upper-back spasms. I was asked to touch my toes and could; when I tried to explain that I couldn’t stand upright, I wasn’t listened to. Instead I was lectured that most people would love to have the flexibility I had. And I was given a strep test when my complaint had nothing to do with my throat. I was told it was standard and everyone has to have a strep test. (I was also given one years later when I had weeded poison ivy and it had gotten into my bloodstream, causing a very serious reaction.)

    Another time I came in with a swollen, infected, hard lymph node in my neck and was told that I was just faking an illness because I’m a teacher and I was due to return to work the following week when summer vacation ended. Following that comment, the doctor also asked that I visit an ear/nose/throat specialist for a biopsy of the lymph node because it could be cancerous. My final prescription: go home and rest and come back if I wasn’t feeling better in two days! I wasn’t aware that rest cured cancer, but an ENT specialist was able to prescribe antibiotics for an infected lymph node and diagnose me with mono and strep a few days later.

    I agree with your post that a lot of us create our own issues due to obesity and smoking, yet I am neither obese nor a smoker, drinker, or drug user. I’m a normally healthy person, eat a balanced diet, exercise daily; and the few times in my life I’ve walked into the ER hoping to receive good medical care and respect, I’ve been seriously disappointed and treated disrespectfully. My last ER visit was a little over 7 years ago, and I dread ever having to return again. I hope I never actually need urgent care at our local hospitals!

    Kari on September 7th, 2008
  • 108

    I have been working in the ER as a scribe for a little over two months now. Your post has helped me understand so much of what I have been observing. Some of it I had figured out, but this makes things so much more clear. I just wanted to say thanks.

    Premedjourney on September 8th, 2008


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