Foggy Rainy Night

A thirteen year old flies off a snow bump on a backyard hill spins off his saucer and lands on his leg. It hurts when he moves his knee or ankle, but the pain is located in the mid-tibia. There is no deformity, just a little discoloration. We get him in a position of comfort and carry him across the yard on a board. His father rides in the back of the ambulance with us. The boy says his pain is 7 on a 1-10 scale, but he doesn’t seem in that bad pain. I talk over the options with his father, who says he doesn’t think the boy is quite there yet as far as needing morphine.

We are sent to the lockup for a female patient with sickle cell anemia, who is complaining of pain. The guard says, “another patient with a case of jailitis.” The woman tells me she has an IV port under her skin. She is crying, but doesn’t seem in that great pain, although I know sickle cell can cause excruciating pain and is a true crisis. She tells me she takes 30 mg pills of morphine, along with percocet, oxycodone and vicodin. I carry a total of 40 milligrams of morphine and I think maybe, just maybe if I unloaded all of it into her, it might get past her tolerance and give her a slight ease. Plus I would have to call for permission and I don’t think any doctor is going to let me give 40 milligrams of morphine on one patient without laying his own eyes on her, particularly a patient in police custody. I explain all of this to her and ask her to be patient, I promise her that they will take her condition and pain seriously at the hospital.

They say kids often have their pain underestimated by health care providers and sickle cell patients are rarely treated with enough medication. I have a vague feeling of dissatisfaction like I let them down.

We do a hospital return from a nursing home and are sent for a man passed out behind the wheel of a green car, but when we get to the address we can’t find a man slumped behind the wheel of any car, much less a green one. We clear unfounded.

Diabetic in an elderly high-rise. We find him sitting in an armchair in a neighbor’s apartment. He is an elderly black man, she is an elderly Hispanic woman. The woman says he is her best friend. He can tell me his name and shakes my hand, but he is a little slow to answer some questions. He's not right, she says, he's not my John. I check his sugar. It’s 34. I give him an amp of D50, and he is back to his old self. He admits he didn’t have lunch. The woman says again he is her best friend, he looks after her ever since she broke her leg in three places. He says she is his best friend. He visits her everyday. She asks us if he is going be okay? He doesn’t want to go to the hospital. We get his list of meds. He asks us to come downstairs to his place where he’ll show the other medicine he takes, raising an eyebrow. We tell her he’s okay, but we take a pass on meeting his other friend Jack.

Foggy, rainy night.