sin and the ER

Let's play You Be the Doctor.

1. A 30 year-old male comes to the ER complaining of right back pain of two hours duration. He gives a history of frequent kidney stones. He is moaning in pain during your exam. A urinalysis confirms the presence of blood in the urine.

The diagnosis is:

A. gallbladder stones

B. kidney stones

C. drug-seeking behavior

2. A 50 year-old female presents to the ER complaining of a migraine headache. You order an injection for relief of pain; then you write her a prescription for ten capsules of a narcotic pain medicine.

Which of the following do you not write on the prescription?

A. No refills

B. Dispense: 10

C. the patient's name

D. today's date

3. A factory worker sees you in the ER. He complains of flu-like symptoms that began yesterday. His exam is normal. You treat him and give him a work excuse for yesterday and today. When the discharge clerk asks him for a picture ID, he says he left it at home.

What do you do next?
 

A. notify the police

B. tell him to bring his ID to the ER later

C. demand an ID before giving him the  

    medicine and work excuse

D. call his work place to confirm that he works   

     there

     

4. An elderly female with confusion and agitation is brought to the ER by ambulance. A list of her daily

medications includes Valium (an anti-anxiety medication) and codeine (a long-acting narcotic pain reliever). Her urine, however, shows no evidence of Valium and narcotics in her system.

What is the best explanation?

A. drug overdose

B. drug withdrawal

C. drug allergy

D. lab error

Now, the answers:

1. C (drug-seeking behavior)

The patient, a known drug abuser, was asked to give another urine specimen under direct observation by a staff member. There was no blood in that urine. When confronted, the patient confessed to pricking his finger and letting his blood drip into the first urine specimen. His goal was to make it look like he had a kidney stone so that he could receive pain medications.

2. B (Dispense: 10)

All doctors who prescribe controlled substances must be alert to the potential for patients to alter a prescription. With one stroke of a pen, "Dispense: 10" can become "Dispense: 100". For this reason, it is always best when prescribing addictive medications to spell out the number of pills: "Dispense: 10 (ten)".

3. C (demand an ID before giving him the

        prescription and work excuse)

It is not uncommon for a patient to pretend to be someone else. In this case, the man was trying to get a work excuse for his friend, an illegal alien. Only by looking at an ID could it be known that the name given did not match the face.

4. B (drug withdrawal)

The patient's daughter sold her mother’s valium and codeine to drug addicts, producing drug withdrawal in the patient. That's why her urine drug screen was negative and why she was confused and agitated. And that's why the local police arrested the daughter later that day.

My intent here is to reinforce the reality and universality of sin. Every day in our ER sin lurks its ugly head, and we as caregivers must be alert to it at all times. If you deny the existence of sin, you must somehow justify the acts above. You must explain how faking a diagnosis, altering a prescription, falsifying an identity, and stealing a medication for selfish gain are not sins. You must keep your head in the clouds and carefully avoid the trenches, for it is in the trenches – in places like the halls of the ER – that sin is palpable and undeniable. Here you will rarely, if ever, find a worldview that denies sin.

- If God Is "I AM", then Who Am I? (Day 19)