Mr. D has been coming to the ER by ambulance with 10/10 chest pain for weeks. States he has had a triple-bypass (with no scar), and loves his narcotics. Every visit his EKG's and enzymes are totally normal, but he has been getting narcs galore then signs out AMA when we suggest he be admitted for evaluation by a cardiologist since his chest pain is not responsive to any treatment.
Yesterday he came in again, reeking of cigarette smoke and alcohol. EKG-normal, VS-normal, Labs-drawn. The ER doc decided that there would be no narcs this visit, and told the patient. I brought him some tylenol and ibuprofen for his 10/10 chest pain. Poor guy was in so much pain he couldn't even lift his arms to hold the cup.
Miraculously, within five minutes, he was able to get off the stretcher, pull off his leads, rip out his IV, and get dressed. I had to chase him as he was leaving to try to get him to sign his AMA form, which he refused. He was in a hurry to get to a 'Hospital that can help me'.
As far as I'm concerned we did help him! After all, before the tyleprofen he couldn't even lift his arms. :)
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This charming gentleman ended up returning to the ER last night stating he was riding his bike and a motorcycle forced him off the road and into a ditch. He had no signs of injuries and when the Dr. refused to give him narcotics he left again, AMA.
He returned by ambulance this morning with complaints of chest pain, he wanted to go to another hospital but complaints of chest pain are brought to the nearest hospital, he refused to let any of our staff see him, and called 911 from his exam room to take him to another hospital...then he left, walking towards town. Five minutes later we got a 911 call for him again, with chest pain. This time the medics took him to the next closest hospital. He left there when they refused to treat his narcopenia. He called 911 a third time and was on his way to the FMH again as I was leaving. Unbelievable!
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