Wednesday, November 07, 2007

Just Say No?

From MedPage Today. Tales from the ER.

I thought I had heard it all, but I got a new threat recently. The context was one in which I felt a little bad about having to say no. The patient was a grandmotherly sort of lady in her middle years. She presented a sad and pathetic figure as she told me her tale of ongoing diffuse body pain which was poorly controlled even on high doses of methadone. Alas, she was out of her meds and wanted a refill (actually, her initial request was to be admitted to the hospital). She was unable to explain how she had come to be out of her pain medications.

She escalated; I explained my thought process. She yelled, she wept, and she begged. I held firm, and she was discharged. On her way out she stopped by the charting station and said, with a vicious spite in her voice, "I hate you. You are a terrible, terrible person, and I hope you suffer, and I hope your children suffer. In fact, I am going to make sure of it. I am going to go home and make a voodoo doll of you and all of your children and I am going to stick pins in all of them!"


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