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!

PART TWO

Ma and Pa Kettle: The Rural Years

Ch-ch-ch-ch-changes

In the fall of 1990 my good friend Barb the hairdresser announced she had found the perfect girl for me.

“Yeah, right, Barb,” I replied dryly. I’d witnessed some of her previous matchmaking attempts. Not good.

“No, trust me, you’ll like this girl! She’s really cute and she’s got a great sense of humour!”

“Okay, if you say so. What does she look like?”

“Five-foot-four with light brown hair and greenish eyes.”

“What does she do?”

“She’s an elementary school teacher.”

“Sounds promising. What’s her name?”

“Janet.”

After a few phone calls, Jan and I scheduled a blind date at a nearby Perkins restaurant. The day before we were to meet she came down with a wicked flu. She considered cancelling, but ultimately curiosity got the best of her and she decided to proceed. Aside from her having shaking chills (plus Barb and my buddy Raj unexpectedly sliding into our booth halfway through the meal to mooch some fries and inquire how the date was going), everything went pretty well. We agreed to continue seeing each other.

Meanwhile, back at the ranch, I had come to the conclusion that although I enjoyed working as an ER physician in Winnipeg, I wanted to see what life was like on the other side of the urban/rural divide. Several telephone calls and reconnaissance trips later I accepted a position as a family doctor in a small town in northern Ontario. I shipped a few moving boxes, loaded up my MR2 and headed east in July of 1991.

Making an abrupt transition from a city with a population of 600,000 to a remote hamlet of 6,000 is much like doing the legendary Polar Bear Dip – extremely shocking at first (what do you mean there’s no Starbucks here?), but then you quickly grow accustomed to it. Then you die of hypothermia. Kidding!

My new gig was a bona fide cradle-to-grave family practice. Technically it was a solo practice, but I shared ER call and hospital responsibilities with a congenial group of four other family doctors plus a general surgeon. On a typical weekday I would do rounds on my hospital inpatients early in the morning, perform a couple of minor procedures in the emergency department, and then go to my office for a full day of scheduled appointments. When the office wrapped up I would usually return to the hospital briefly to check on my inpatients’ progress and review the results of any tests I had ordered earlier. On weekends I’d do my regular hospital rounds first and then spend some time at the local nursing home.