Not long ago I cared for a healthy appearing young woman who was under arrest for a non-violent crime.  While being arrested, she suddenly took a number of muscle relaxants.  She said she was afraid she’d have a drug charge if she was found with them, though alleged they were hers; she just didn’t like carrying the bottle.

In the midst of evaluating her, I asked why she had the prescription.  ‘For back pain.  By the way, while I’m here, can I get something for my back?’  She asked it without any hesitation, or any sense of the remarkable impropriety of her question.

‘Let me get this straight,’ I asked.  ‘You’re under arrest and took an overdose, and you think I’ll give you pain medication?’

‘Well, yeah, it’s the ER.  I just thought since I’m here…’

‘It isn’t going to happen,’ I said, and walked out.

‘Whatever,’ came the universal response behind me.

Fast forward.  While caring for a man with chest pain and chills, I asked for a urine sample.  The patient’s nurse brought the urine to me and said that it looked murky and she had a funny feeling about it.  Indeed it did.  Under the microscope it was, in fact, full of bacteria and white blood cells, consistent with a bladder infection.  Astute and appropriately cynical, my nurse felt that the urine belonged to the patient’s wife.

When confronted with his ‘bladder infection,’ the patient asked, ‘shouldn’t my wife be on some antibiotics, too?’  Later, a specimen directly obtained from the patient was clean as a whistle.  I suspect he was originally hesitant because he thought I was ordering a urine drug screen.  I wasn’t; not until the second specimen, at least.

The average person, the normal citizen, the otherwise functional patient has no idea of the remarkable degree of dysfunction and deception we see in the modern emergency department.  Furthermore, they have no idea of the incredible boldness, the unflinching willingness to lie, misrepresent and manipulate to get what they want; and get it all for no charge.

I shake my head at the end of the day.  I love knowing the things I know, I love caring for people and treating sickness and injury.  Heck, I even like opening MRSA filled abscesses day after day, everywhere from head to buttock.  I do, however, become weary of being the recipient of constant lies.

It’s difficult to be lied to in medicine.  We inherently want to believe the stories we are told.  We hate to imagine that people are deceitful and wicked.  We want them all to be honest, forthright and truly in need of the things we offer.  It isn’t that way, unfortunately.

But if there’s any benefit, I can say that my eyes are open wide.  I am appropriately suspicious and by now, much wiser than I was in my youth.  The scriptures say to ‘be as wise as serpents and as innocent as doves.’

My patients, God bless every tricky one of them, have helped me to have that reptilian wisdom.  Maybe, hopefully, God willing, my suspicions, rather than making me dislike my human brothers and sisters, may save a life now and then.  Or at least, help me to see through the fog of bold deceptions in order to do the right thing.

May you be blessed with clarity and holy cynicism, today and always!

Edwin

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