Q - giving my nightmarish recollections of my days working in the correction center - can’t pay me enough to take urine samples anymore (though I worked w/the women which gave them additional options for adaulterating the samples - got flame orange once, green another time, once a piece of string fell out, once an entire small makeup bottle… )
they were pretty good, though at convincing medical personnel of their pain- I recall one once getting a 14 day supply of narcotic pain meds 'cause “her pelvic bones hurt”. A few months later, I was at the same ER, with second degree burns covering my torso and they gave me 4 tylenol 3’s - didn’t want me to get addicted ya know. I thought the potential existed for a happy medium.
As your average run-of-the-mill high school teacher, I didn’t have trouble getting pain medication when it was needed until I married a young man with long hair in the 1970’s. Pharmacists would refuse to fill perscriptions for pain meds when he was present (and if it wasn’t our neighborhood pharmacy). That made for some difficult times when I developed a god-awful tooth problem on a vacation and when I had a Jones fracture in my foot.
I guess in your position, I would be suspicious of just about everyone.
Well, I’m NOT a doctor. But I must say this guy was motivated as hell if he’s willing to fuck with a hangnail–not just once but at least twice for urine samples–until it bled! I’m surprised his vitals were normal with a boo boo like that!
geh!** Q**, didja at least give the poor guy a bandy-aid for the hangnail?
Couldn’t you have cut him a little slack and slipped him a couple of Percsets off the record just between friends? After all, you are both “in” prison and that is what buddies do for each other. What if you need something from him sometime?
What do you mean? Noticing that someone’s symptoms don’t quite add up to a certain problem and looking for other causes is pretty standard, yes. In this case, the patient’s symptoms didn’t fit together for kidney stones. His scarring was in the wrong location for kidney stone removal, his CT was clear, and usual treatment for kidney stones wasn’t working. Clearly, something else needed to be done for the patient beyond stronger pain control, since pain meds don’t fix the problem. The cystoscopy QtM suggested is the next test they tend to do for unexplained hematuria and pain. (They’re vastly unpleasant, but when you’ve felt that horrible for a few weeks, they really don’t seem so bad.) Re-examining the urine to make sure there’s still blood is also a standard part of monitoring a patient with hematuria.
And in this case, the signs and symptoms add up to classic drug-seeking. Complaints of horrible pain with no associated changes in vital signs is a big one (pain tends to elevate the pulse and blood pressure, and often causes changes in respiration), along with a history of drug abuse and requests for specific narcotic drugs, not to mention his refusal of tests to figure out why he has this issue and get it stopped long-term. When you suspect a patient is faking symptoms to get narcotics, you’re then faced with trying to differentiate between fake symptoms and real ones. The easiest way to confirm hematuria is to get a witnessed sample and do a urinalysis and sediment on it. (Unwitnessed samples give the patient a chance to spike the urine with blood from a hangnail, needleprick, cut, etc.) That’s all standard procedure in a case like this. If there had been true hematuria, Qadgop would have pursued further testing to take care of his patient. Since this wasn’t true hematuria, he kicked the guy out the door. Again, pretty standard.
I was referring to the fact that after I’d read Qad’s story I didn’t understand how the prisoner’s scam had worked prior to Qad exposing it, because Qad didn’t tell us. I thought this might be a symptom of an underlying trait in the profession when another doctor wrote something I couldn’t make head or tail of.
Hence elliptical, as in an elliptical, indirect, implicit conversational style. Just brought out the discourse analyst in me, I guess.
To me, the OP was rather clear and it drew me into the narrative quite well. It essentially outlined the series of events leading up to the denoument (when the whole scheme is laid bare), including his thought processes.
True, he didn’t give it all away right at the beginning. That would have ruined the effect. He went through the detective work that is required to make a diagnosis from a list of (often vague) complaints and a bunch of (often inconclusive) diagnostic tests. It was a chess match between him and the patient, and the checkmate was when the patient was forced into pissing under observation: All his avenues were closed, all his pieces were sacraficed, and his king was under persistent, unavoidable threat.
I admit, I caught on rather quickly because I have experience in reading what physicians write. I enjoy perusing case histories and diagnostic adventures. But I fail to see how the OP could be any clearer.
Qadgop, I’m not a doctor but after 22 years of working in a prison you have my fullest sympathies. It’s amazing that as you were relating this conversation I could actually envision it happening.
I didn’t think it was that hard to get yourself to bleed, really, especially if you’re determined to get a drug-type fix. I assumed it was something like biting/tearing a cuticle, opening a scabbed-over wound, perhaps biting the inside of one’s cheek or lip, that kind of thing. Hangnail fits within that realm easily.