“No.”
“Has he been in contact with anything different lately? Food, clothing, detergent, medication?”
“No.”
“Nothing at all that might have irritated his skin?”
“Not that I can think of.”
I couldn’t make sense of it. Allergic rashes as startling as this one usually have a readily identifiable precipitant. Examining him didn’t reveal any further clues. I asked his nurse to start an IV and administer some corticosteroids and antihistamines. Two hours later he was looking and feeling much better. I decided to allow him to go home on oral medications, provided his mother promised to bring him back in the morning so I could recheck him.
The next day it was his dad who accompanied him. Once again he was covered head to toe in the same horrific scarlet rash. I asked his father if he could think of anything his son might be reacting to.
“Well, I suppose he could be allergic to those magic markers he was playing with yesterday,” he speculated. “He got marker all over his body – his arms, legs, face, belly…everywhere! The rash started about an hour after that.”
“Ah, that’s probably what triggered it,” I said with satisfaction. Another mystery solved.
“I don’t really see how, though,” he continued. “He’s played with those markers lots before, and besides, the ink wasn’t on his skin for very long. The minute my wife saw what a mess he was she marched him straight up to the bathroom and washed it all off.”
“Hmm,” I said. “Perhaps it’s not the markers, then. Could it be the soap she used that irritated his skin?”
“Oh, she didn’t use soap, doc.”
“What did she use?”
“Fantastik.”
“She used Fantastik?”
“Yeah.”
“Are you talking about the spray-on cleaner? The stuff you clean countertops and stoves with?”
“Yeah, that’s it. She sprayed him down in the bathtub and then scrubbed the marker off with a rag. That stuff really works!”
“That stuff is corrosive! It dissolves glass!”
“Hey! Maybe that’s why he’s been so itchy!”
The Drug Seeker
The first two lines of the triage note on my next patient indicate he wants a prescription refill. That sounds like an easy one. Scanning a bit further down I see the word “painkiller.” Uh-oh. Next comes the word that throws up more red flags than a parade of matadors: “OxyContin.” My heart sinks. I compose my face into something appropriately neutral and walk into the cubicle. Not too far in, mind you – I like to have an unobstructed escape route in situations like this. Just in case.
Patient X looks pretty much like I expected. He’s in his late 20s with grubby jeans, a frayed black leather jacket and tattoos crawling up his neck. He also has the obligatory “OZZY” tattoos on the knuckles of both hands. I make a mental note to get myself an incredibly original masterpiece of body art like that in the near future. I’m sure it’ll turn me into an unstoppable babe-magnet. What cute chick can resist a guy with “OZZY” tattooed across his knuckles?
“Hi Mr. Piltdown. I’m Dr. Gray. How can I help you this evening?”
“I’m in some serious pain, man.” Hmm… .
“Where is your pain located?” Please don’t tell me “everywhere.”
“Everywhere.” Damn, I asked you not to tell me that… .
“What do you usually take for it?” Surprise me and say Advil!
“OxyContin.” Oy vey… .
“That’s a pretty strong painkiller. Have you tried anything else for your pain?” Like maybe heroin?
“I’m allergic to everything else.” Wow, what are the odds?
“Who usually gives you your prescriptions?” A guy in a trench coat?
“Dr. Feelgood at the health clinic in Buffalo Groin, Saskatchewan. I just got off the bus from there and they can’t find my suitcase. It had a six-month supply of my pills in it.” They lost your luggage on the bus? Really? When did Air Canada join the bus industry?
“What other pills did you lose?” I really shouldn’t ask that, but sometimes I can’t help but be curious as to how far they’ll go with a story that’s already more improbable than anything Lewis Carroll ever wrote.
He lights up. He senses a patsy!
“Uh, just my sleeping pills and my Ritalin and my nerve pills and… .” And a partridge in a pear tree?
When I was younger and more foolhardy I used to tell these critters I had some difficulty believing their sketchy stories and was not comfortable filling their Fantasy Island drug wish lists for them. That usually spawned a whine-fest that would inevitably degenerate into either grovelling or death threats. Once I was rooked into calling someone’s out-of-province doctor to verify his story. His girlfriend’s dog had eaten his pills, as I recall. I wonder how it got the cap off? Must have been related to Lassie.
“Hello?” I began.
“I told you man, quit bugging me! I’ll have your money by next week at the latest!”
“Um, is this (416) 867-5309?”
“Oh, sorry dude, I thought you were someone else! Wazzup?”
“My name is Dr. Gray and I’m looking for a Dr. Jenny.”
The person at the other end covered his receiver for a moment and gave a few phlegmy coughs. When he started speaking again, his voice had magically descended an octave.
“Hi, this is Dr. Jenny speaking.”
“Never mind.” Click!
Trial and error has led me to an expedient solution to these encounters: “I’m sorry, but I don’t prescribe OxyContin to any emergency room patients ever, and I don’t make any exceptions to that rule.” The vast majority of miscreants seem to accept this. I guess they can tell when the jig is up. Oh well, all in a day’s work in the ER. I wonder who’s behind the next curtain?
Two-for-One Special in the ER
It was another barmy Monday morning in the department. I picked up the next chart and reviewed the triage note. Mrs. Stewart, an 85-year-old woman with a rash. I knocked on the door and entered.
An elderly, blue-haired woman was seated on the stretcher. There was also a woman in her mid-50s standing in the far corner of the room. I nodded at the younger woman before turning to face my patient.
“Hi, Mrs. Stewart. My name is Dr. Gray.”
“What?”
“I said my name is Dr. Gray.”
“You made a special tray?”
“MY NAME IS DOCTOR GRAY!”
“Oh, hello Dr. Gray. Please call me Grace. Would you like to see my rash?”
She lifted the back of her shirt to reveal a diffuse, non-specific, red rash. Damned if I knew what it was.
“How long have you had this rash?”
“What?”
“I SAID, HOW LONG… . Never mind.” I addressed the younger woman. “Do you know how long she’s had this rash?”
“I’m sorry, doctor, no.”
“Is she on any medications?”
“I don’t know.”
“Has she ever had a rash like this before?”
“I really have no idea.”
I was beginning to develop an irresistible urge to roll my eyes.
“In what way are you two related?”
“We’re not.”
“Oh, are you just a friend?”
“I’ve never met her before in my life.”
“What?! Then why are you both in the same examination room?”
“I’m not sure, doctor. Half an hour ago a nurse brought me here and told me to wait. A few minutes ago a different nurse brought her in. I think maybe someone made a mistake.”
Good thing Mrs. Stewart hadn’t come in to get her hemorrhoids checked!