Using logic with some ED patients is as useful as ejection seats on helicopters. Take, for instance, my patient, Cletus, whose name I changed so he will sound more intelligent. Confession time: I have never been bitten by an opossum. Cletus, on the other hand, has lost count of how many times he has been “attacked.” He wears his scars from raccoons, skunks, and creatures of all types with pride.
Cletus was outside at 3:30 a.m. deep in the northern woods of Michigan, just minding his own business with his friends, his truck, and his beer. Lots of beer. Then, in a belligerent and triumphant blurt, he exclaimed, “THASSA POSSUM!”
Logic would dictate that one might just want to stay away when spotting an angry-looking, sharp-toothed, hissing marsupial. Cletus (of course) came to a different conclusion. He had to “get it.”
Cletus embraced his inner Daniel Boone and, with some luck and horrible fate, managed to trap said opossum in a crate. Now, what would you do?
If you answered, let it go, you have never read my column before. It could have ended differently if Cletus had used his gun (did you doubt he had a gun?), but he chose against shooting the trapped creature. Cletus' last remaining non-beer-saturated brain cells instructed him to open the crate, step on it (barefooted, of course), and hold down the poor creature while he jabbed it with a sharpened stick.
One bloody and chewed foot later, Cletus triumphantly hobbled into the ED. He desired sutures, a tetanus shot, and a rabies vaccine. I asked him why he decided to trap and the kill the creature. He looked at me as if my hair were on fire. “Well, I had to get him, right?” Logic!
Let me just stop here to explain my formula for the effect of alcohol on logic. Start with an individual's IQ (remember 100 is average). By my double-blinded, placebo-controlled ability to make up random statistics, the IQ of any human decreases by seven for every beer consumed.
Cletus started with a room temperature IQ. Now add 14 beers. A quick calculation will indicate that Cletus has just rendered himself a negative IQ. Many of you might say this is impossible, but those of you working weekend nights in the ED have seen patients with a wit as sharp as a marshmallow.
Cletus was shortly followed by another patient, who, though also inebriated, managed not to step on any animals that evening. I will call her Bryttanee. She came into the ED for a cough. I tried to have a rational conversation with her. I failed.
We have all met Bryttanee. She's so dense that light bends around her. The following conversation is not as made up as you might think. What I'm thinking is in parentheses.
Me: So what brings you to the ED today, Bryttanee? (This girl smells like a vodka-soaked chimney.)
Bryttanee: I'm really short of breath. I've had a cough, and I haven't been able to breathe for two months.
Me: Well, it says here you have asthma. (Two months?)
Bryttanee: Yeah, but whatever, I don't think it's that.
Me: Uh-huh. Have you been taking your medications? (Why do I ask questions when I know the answer?)
Bryttanee: Whatever, no. I can't afford them; they cost too much.
Me: Most of them are really cheap, like $4, and some of them are free.
Bryttanee: Whatever, well, I don't like taking them either.
Me: I see. (I don't see.)
Bryttanee: Phenergan with codeine cough syrup is the only thing that helps.
Me: Yeah, this is asthma. (Now I see.)
Bryttanee: You think so?
Me: Do you smoke? (We both know this answer.)
Bryttanee: Not much.
Me: How much do you smoke? (Why are you lying to me?)
Bryttanee: Well, I've been cutting down with this cough.
Me: How much do you smoke? (Your lies kill puppies and pandas.)
Bryttanee: About five cigarettes a day.
Me: Really? (Poor, poor panda.)
Bryttanee: I mean, about a pack a day.
Me: You know, you really shouldn't smoke (duh), especially if you are an asthmatic.
Bryttanee: Whatever, I've heard that before.
Me: You know, if you stopped smoking for one week, you could afford your medications for a few months.
Bryttanee: Yeah, well, I don't think that's causing this.
Me: You're a wheezing asthmatic smoking a pack of cigarettes every day. (Why do I keep trying logic?)
Bryttanee: So, can I get an antibiotic and some Phenergan with cough syrup?
Me: Um ... no. But a breathing treatment and steroids actually might help. (Please don't say “whatever.”)
Bryttanee, who is now breathing easily, is just angry enough to give me a terrible satisfaction score for withholding codeine and having the audacity to suggest smoking might not be the best treatment for her chronic cough. Cletus' foot lacerations are now sutured, and he lived to protect the world from more animals minding their own business.
All we can do as providers is attempt to use logic, present facts, and hope that the next patient we see will take our advice to heart. Or, when they do not, we can try not to think, “Whatever.”
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