Fool Me Once, Shame On You…

… fool me twice, shame on me.

I’m a pretty liberal guy when it comes to pain relief. My philosophy is simple: if you’re hurting, I try to make it stop. Acute pain is not a character builder, and it is one of the few conditions most paramedics are well-equipped to manage. I don’t like to see someone hurting if there is something I can do about it.

Now, if I broke out the fentanyl for everybody who complains of pain, I’d never have any narcotics in my pouch, and The Borg would be scheduling me for more “random” drug tests. But I do try to administer analgesics to the people who need it, without judging the patient. You can’t always tell by a patient’s vital signs if they’re in pain; a chronic pain patient will often have “normal” vital signs, and be experiencing pain that would have the rest of us curled up and whimpering in the corner, sucking our thumb and begging for Dilaudid.

But still, a seasoned medic with even a smidgen of compassion left develops a pretty good feel for who is legitimately in pain or not. Still, I try not to consider the patient’s motives when they call me. If they say they are in pain, I generally take them at face value. If I’m on the fence on whether to administer analgesics or not, I’ll generally ask the patient, “Would you like me to give you something for the pain?”

You’d be surprised how many people refuse the narcotics, including some people in no-shit pain.

I don’t particularly care if someone is drug-seeking, either. It’s not like I’m paying for the fentanyl, and even if they are drug-seeking, the doses we give are unlikely to get a chronic narcotic user high. Besides, withdrawl symptoms are very real, and unpleasant.

All that is to say, I try not to judge. One person’s agony is another’s minor discomfort,  and once you start making judgments on whether a patient is worthy of you relieving their suffering, you start killing the compassion that brought you into the profession, one call at a time. It’s only a matter of time before the career you loved, and the provider you were, is just a distant memory.

So yeah, I’d much prefer to be a chump than an asshole.

Musculoskeletal pain? I’ll medicate you.

Kidney stones? Hellz to the yeah.

Granny fell and broke her hip? Granny gets her pain relief before I even move her off the floor, because splinting and packaging itself is painful. And it doesn’t much matter to me if her house is across the street from the ambulance bay at the local ED.

Burns? Here comes the magic fentanyl fairy, baby. Relief is only a couple of minutes away.

Sickle cell crisis? Your normal saline bolus will likely be provided with a narcotic chaser.

Undifferentiated abdominal pain? Oh hell yeah, and don’t give me any crap about analgesics complicating the surgeon’s assessment in the ED. That’s mostly myth anyway, and hasn’t been valid for 20 years, if it ever was. This is the age of diagnostic imaging. No surgeon is going to cut into a patient these days based on physical exam alone.

Chronic pain condition and you’re out of your prescription painkillers? I’m the medic you want, and I don’t particularly care how good or bad your story is. Maybe you legitimately haven’t been able to refill your prescriptions, or maybe Sumdood stole them, or maybe you stumbled while reading your daily Bible verse on the way to your volunteer job feeding homeless people and rescuing kittens, and an entire month’s supply of oxycodone fell into the gutter. If I think you’re hurting, the reason why doesn’t much matter to me.

So yeah, I’ll pretty much medicate the ever-loving snot out of you if I think you’re hurting, and ignore the eye-rolling I get from the nurses at the Emergency Department…

… right up to the first time I catch you lying to me.

You’d be better off just telling me, “Dude, I’m hooked on the pills, and I’m jonesing right now. I’d give my left nut just to stop shaking and vomiting.”

For that, you earn my respect and my sympathy. No testicular sacrifice necessary.

But when you tell me you haven’t been to the hospital in a month, and five minutes later (and 50 mcg of fentanyl), I discover we last transported you to one hospital less than 12 hours ago, and you now want to go to another one…

… your candy train just ground to a screeching halt with this medic, sister.

Don’t lie to me to get drugs. Fool me once, shame on you. Fool me twice, shame on me.