Last year I had a lower back ouchy that had me at the ER ’round about 10PM. How did this happen? I slept in a weird position the night before and my discomfort escalated over the course of the next day, culminating in the lower back ouchy when tucking in for the next night’s sleep.
Off to the ER! Insurance check in, triage, nurse asks for name, date of birth, age (“Calculate it yourself” is what I thought), and then wait about for the ER doc. And from the ER doc, one additional bit of demographic info asked of me was, “Where do you work?”
“Within the heart and guidance of my Lord and Savior Jesus is where I do my best work” isn’t what the ER doc was looking for.
“Fine. I’m a geologist. Self-employed.”
I was given instruction for bed rest for one week. I was given flexiril as a muscle relaxant. I was given tylenol in a size better suited to a horse suppository than human oral intake. And I was given wishes of speedy recovery.
Kicking it in bed catching up on professional papers, correspondence, and plain ol’ sleep for a whole week was magical. I never give myself this much downtime. Lots to do always, but a lower back ouchy sucks soggy donkey tail and I decided to follow the ER doc’s instructions perfectly.
Granted, the sleep part was rough because my lower back was still ouchy, and this required a best effort with gradient success. Still, by the end of the seven day run my back was feeling much better.
Ten days after my ER visit, thus three days after diligent bed rest, and again around 10PM, my lower back tweaked, completely unexpectedly whilst brushing my teeth. And this time, a stretch of real estate down the middle of my left buttock went numb. I recognized what this was because the ex-wife lived with this for months whilst pregnant. This was sciatica. This can easily turn serious with long term recovery. It took six months of physical therapy for my ex.
No thank you. I don’t have months available for physical therapy. The time to address this is exactly now. 10PM, and urgent care was closed. So back in to the ER I trudged. It was a different staff and ER doc this night, so I went through the explanation of what brought me to the ER ten days prior. The new ER doc was not listening. She was reading my chart instead. When she read far enough, she interrupted me abruptly.
“You’re a geologist.”
“Yes,” I replied.
“And you were instructed to rest for seven days,” she continued.
“Yes. It was magical.”
“But you chose not to rest. You chose to go back to work instead. And now you’re back here,” she said.
“Errrr… no, that’s not right. I jammed on the bed rest for seven days. It was magical.”
“And if you didn’t rest, I’m sure you didn’t take your prescriptions, either,” she further challenged.
This was confusing, this dismissive confrontation. “I took my meds explicitly. I have much practice with the procedure and purpose. I take bipolar meds and have for years.
“Doc, you’re acting goofy. Did we used to date?” I asked her. “Or did I accidentally run over your cat with my 4Runner yesterday on Eubank?”
She took no notice of what I said, launching into a scolding lecture instead.
“The ER isn’t where you come over and over and over because you cannot follow medical instructions. You’re a geologist so I assume you’re after worker’s comp. That is fraud. And insurance won’t cover fraud or bogus ER visits.”
“Hey, doc. Look. Listen,” I interjected. “I’m self-employed. No worker’s comp. Who am I trying to defraud? Myself? Pointless. Besides, I have only limited success at fooling myself. Just ask my therapist. And my ex-wife. And Jesus.”
The ER doc, once again, took no notice. She was scratching new notes for my chart, with a safe wager she was so enthralled with her own haughty medical logic acumen she was directly transcribing just how witty she can be, with the intent of publishing her skillful condescending bravado in a series of professional tweets over the next several months.
“Doc, my back hurts. The flexeril helped. The tylenol horse suppositories worked. The bed rest worked. And yet, my back is ouchy again. so I’m here again, ten days later at 10PM.
“And before you accuse me of trying to score opiates, fully read my chart. I refused opiates last time. They make me vomit and dry heave.
“I’ve got a pinched sciatic nerve. I haven’t been using a garden trowel to dig an open pit mine through the very center of Mars all week. I’ve been on ER ordered bed rest. Which I did. because having a back ouchy sucks soggy donkey tail and I want to feel better. So unless I’ve been fighting crime in my sleep again, I don’t know how this happened.
“And for this moment right here right now I suppose it really doesn’t matter how it happened. It happened, I’m here, so please just do your job. Work with me so we won’t ever have to see each other again. Help me heal.”
With that she left the room. Many minutes later the nurse came in with my discharge orders, which were exactly the same as the orders ten days prior with the addition of “follow up with primary care within TWO DAYS.”
And I did. And I shared this story with my PCP. And we shared a hearty and jovial guffaw. Silly ER doc. I suggested the ER doc achieved her medical degree by mailing in five Honey Nut Cheerios box tops, and she did her residency with Snap, Crackle & Pop, and perhaps she was a real doctor in the same way Cap’n Crunch is a real nautical captain. My PCP didn’t disagree. And we heartily and jovially laughed again.
Now, ending a yarn on a laugh is an excellent exit. Nothing more is needed. To continue beyond a logical conclusion to a story is an exercise in assumption as perilous as our collective assumption Star Wars needed to carry on beyond “Return of the Jedi.” And we all know how frustrating, disappointing, and soul-murdering that was. After the Ewoks, humankind thought, “That’s it. That’s the worst betrayal of the human heart Star Wars can inflict upon the universe.” We assumed this. Three prequels and three postquels later, and now that we’ve all died and rotted inside as punishment for our assumption, consider Jar Jar Binks, miticholroians, a bitchy angsty proto-Vader, and the baffling return of Palpatine at saga’s end as penance for our assumptive hubris.
And that’s just the issue with my ER visit and the issue with the ER doc. Assumption. Perhaps presumption. Any sort of sumption was uncalled for, this hubris of the ER doc. Let’s follow ER Doc Logic.
- My back was ouchy.
- I went to the ER.
- When asked, I shared I am a (self-employed) geologist.
- Ten days later, my back was ouchy again.
- Because urgent care was already closed at 10PM, I decided to visit the ER.
- The ER doc assumed because I’m a geologist I went back to work immediately.
- Further, the ER doc assumed I didn’t fill and employ the prescriptions.
- Further, the ER doc assumed I was up to nefarious scheming and plotting, with worker’s comp fraud as my Bond Villain dastardly intent.
- Further, I love wombats.
There’s a serious medical hazard in the weave. To my recollection, the ER doc not once asked how I hurt my back. If asked, I would have explained the up and down motion of my toothbrush created an unexpected angular momentum of significant magnitude, and as my lower back rests as a central fulcrum it was severely torqued by my driving desire for spotless dental health. That’s pretty close to what happened.
Just as likely is I was battling a grumpy lowland gorilla for the only parachute on a crippled stealth fighter over Nebraska. Or, I might have been attempting to sexually satisfy every woman on the planet named “Amanda” in the span of 12 heroic hours. Or, it could have occurred petting a soft, adorable, and loving kitty cat.
The point is the ER doc didn’t ask. She didn’t ascertain if this visit was even related to my visit ten days prior. And there’s the hazard. Her assumption directed her medical choices, and thus affected her medical treatment of my injury. Her assumption had the potential of missing my medical needs entirely.
Relatedly, it’s heartbreaking to reveal this ER doc is not the only provider I’ve called upon already stoked with medical assumption based on limited information about me.
Psychiatric care holds the majority of my medical care over the last two decades, and in that time I’ve had numerous med managers guiding my treatment. And there are some scary tales in these years.
I recall one pdoc who was trying to push opiates on me to treat psychosis and anxiety. He insisted upon it, so much so that he threatened not to prescribe useful bipolar meds because I was “medication non-compliant.”
I tried to explain opiates made me vomit. No luck there. So I took the script, filled the script, and flushed the script. I take full responsibility for the opioid crisis in the silvery minnow population south of Albuquerque. Only in hindsight do I feel the well-earned shame.
Then, I had a pdoc who was hellbent on “proving” bipolar is rampantly misdiagnosed and when someone has manic symptoms that was their “baseline personality.”
I tried to explain how much trouble I caused in the throes of manic episodes. He asked for examples. I overspent and maxed out credit cards. Nope. If it was truly mania, I would have bought three houses and three cars. I felt grandiose and unstoppable which led to being fired from job after job. Nope. If it was truly mania I could have taken over the business and then I couldn’t be fired. I had sex with five women in one day, a sure symptom of hypersexuality. Nope. If it was truly mania I wouldn’t remember the number of women.
None of this is hyperbolic exaggeration. This fool wouldn’t prescribe a mood stablizer for me. If you have bipolar and have been on only an antidepressant, you can attest to how much joy your resultant mania-fueled behavior brings to the world. I’m banned from three hotel-casinos in Reno. I am also required to remain at least 500 yards away from all North American migratory birds.
I suppose a more truthful way to explain medical assumption is it’s preconceived bias. And when that bias ignores the needs of the patient and directs a treatment plan ignorant of the needs of the patient, the severity of consequential harm is immeasurable and irretrievable.
Ask any sandhill crane if in doubt.
It’s malpractice at the very least and dangerously irresponsible for sure. That’s how I feel. And I feel this very strongly based on twenty years experience of receiving psychiatric care.
We’ve got a STS provider education program for just this. Get To Know Me. In ten years of running peer support groups, it’s such a universal lament among peers that somewhere in their treatment history they’ve said, “My doctor never listens to me!” This shouldn’t be a thing. But it is. Bogus, dude.
So, want to know what happened to the two whackjob providers from my history? The first had his license revoked for overprescribing opiates. The second lost his license for sexing up a few of his patients.
You know, I just recognized that ER doc made her medical assumptions based on my profession. I was stigmatized for being a geologist. Is this a real thing? Google, find me a shamed geologist peer support group, please.