Georgia Johnson has been our most frequent flyer for the last year. Georgia calls five or six times a month with a complaint of being tired and hurting all over. She never calls her doctor, just 911. She is a big woman who walks with a cane and lives in elderly housing. The entrance to apartment is such that we can never fit the stretcher in, but she always says she can walk out, so we set the stretcher up right outside the door and help her walk out. She has gout and arthritis and is on several pain killers, including a fentnyl patch. Her pain has been bad enough that I have given her morphine before on a couple occasions – maybe twice out of thirty or more transports — but lately I do little more than take her vitals, and pop her on the heart monitor quick because she always mentions chest pain in her litany of places that hurt before she ends up qualifying it as “My body hurts all over.”
I took her in on Friday, and the triage nurse had us lower our stretcher and move her over to a wheelchair, and then wheel her out to the waiting room. I took her in again on Sunday. She seemed in a good amount of pain, more than usual. Her right shoulder hurt and her right wrist, and her chest, and her back, and her legs, and “my body hurts all over.” As I said, she was grimacing more than usual, and when I asked her the pain scale, she said, “It hurts real bad.” She had a couple tears in her eyes as she spoke, which was not unusual. I asked her what they had done for her at the hospital on Friday and she said, “Nothing. They didn’t tell me anything, just gave me more pills that don’t work.”
I was going to give her some morphine, but when I put the tourniquet around her arm to start the IV, she told me to only put the IV in her hand. She had a nice vein in her AC, but the hand veins were just little spidery things. “I’d rather put it up here,” I said, pointing to the big vein.
“No, that’ll hurt too much. Why don’t you just wait till we get to the hospital?”
“Okay, fine,” I said, thinking you’re the one in pain, not me. Your problem, not mine. I offered to help. You just suck it up. I’m tired of picking you up anyway.
The triage nurse had us put her in a bed. The nurse for the room looked at her and said, “What is she doing back here? She’s here all the time. She needs to be a social service case.”
“I know,” I said sympathizing. “She’s our most frequent flyer.”
Yesterday, while bringing another patient in, I saw Georgia sitting in a wheelchair in the hallway of the overcrowded ED. After I’d moved my patient into his room, I went back and talked to her.
“How are you doing, Georgia?”
“Okay, I guess.”
“Are you still here from yesterday or did they bring you in again today?”
“From yesterday still,” she said.
I noticed then her arm was in a sling. “What’s up with your arm?”
“I got a fractured shoulder,” she said.
“When did that happen? Did you fall?”
“I don’t know. They took an X-ray and said my shoulder broke and then give me some more pills.”
Fractured shoulder. No wonder she was in more pain than normal. I just assumed…