Here we go again!
Today was a scheduled IV sedation case. Typically, these cases are reserved for patients requiring full mouth extractions, multiple tooth extractions, MR patients, or severly anxious patients.
Today's patient, who I will refer to as Ms. Bully, for privacy matters, HAD to be the most interesting case I've ever had the pleas..eerr umm... I've ever had to work with!
Ms. Bully had a reputation for being pretty brash, and inappropriate at times. She had been described as a 'know it all' and had been described as extremely demanding. She was INDEED a bully! No problem though, because I've dealth with those kinds before, and I was pretty good with calming patients down and getting them ready for their surgeries. Well Ms. Bully was the exception. The appointment went a little something like this.
Ms. Bully's appointment time: 8:00am... she shows up at 8:30am. She is to check in with the nurses and get her vitals recorded, then to my chair for me to do an H&P, then start her IV line. Well at 8:45am, the nurses told me they were finished with vitals and wondered if I had seated her. I hadn't in fact. So, Ms. Bully is missing- for almost 20 minutes. She finally makes it to my chair, and I begin the patient interview.
Me: Hey, how are you today? Well, before we get started on the procedure, I have to do a little interview, find out somethings first.
Ms. Bully: Wait... looka here, I need you to know that demerol does NOT work for me at all... so ya'll gonna have to do something more for me...sh*t!
Me: Well, we'll get to that in a few minutes . Okay, so I have a few papers for you to sign.
Ms. Bully: (OBVIOUSLY nervous- sweating, extremely talkative and fidgety). Umm hmm, I ain't crazy, these the papers in case ya'll kill me in here, I'll sign this and it'll say that ya'll are innocent and sh*t. You know my sister is a lawyer and I have a degree in psychology, went to undergrad at the age of 16.
no ma'am. This form is just saying that you have agreed to undergo moderate sedation for this procedure. This one is just saying that you agree that we will take out these teeth. This one is saying that you realize you'll be a little groggy afterwards, and that you are aware that you shouldn't make any important decisions immediately after surgery. And finally, this one is the post-op instructions that I'm about to go over with you.
Ms. Bully: Awww hell! This that sh*t that say I can't smoke for blah blah blah time huh? Well does weed count? Is that smoking? Hey, I'm obviously gay right?
You got it! You can't smoke for at least a week...INCLUDING weed and...
Ms. Bully: Hmphf. I know you heard me...you know I'm gay huh? well look, umm you single? when you getting married? Naw, seriously though I'm glad I just went outside and rolled me a fatty before I came back up here!
Me: Ummm, excuse me- what did you just say? Ma'am, did you really? I need to know if you've used ANYTHING in the last 24 hours. And I don't care if you're gay, just wanna get you comfy so we can get your teeth taken care of okay..haha, ummm okay, well, lay back and let's get started.
Ms. Bully: what happens if I can't NOT smoke for a week? What's gonna happen.
Me: Well, there's a really good chance that you could develop a dry socket. And it's painful! Can't really be treated by OTC, you'll have to come in to a dental office and have it treated...
Ms. Bully: can you just give me a lil bit?
Me: No ma'am. You need to not smoke and you won't have that to worry about now will you?!? NOW, please lay back, relax and I'm about to give you a lil happy juice!
Ms. Bully: see girl, I told you this sh*t ain't gone (yawn) work (yawn) for me. I need something stron...ZZZZzzzzZZZzzz
The procedure begins, goes PRETTY well other than the occasional/usual 'ouch', 'uh-uh', 'moan.moan.moan'. Meds were continuously monitored and administered as needed. After such a rough start, with her anxiety and endless questions, flirt attempts, and plain ole inapproptiateness, the top teeth had been taken out and sutures were beginning to be placed, when BAM- it happened...
Wait, what the f*uck you doing? you told me I was gonna be sleep during this procedure. Sh*t I'm scared, this ain't what I signed on for. Ya'll need to just stop, I can't handle this sh*t it hurts! I swear it hurts. My sister is lawyer and I have a degree in psychology. I went to college at the age of 16..blah blah blah.
Me: I know Ms. Bully, I know..none of the meds are really helping you at all, BUT by you being here, I have to give the meds to TRY to help out- okay? (all the while knowing that she was JUST snoring!!! classic sedation!)
Ms. Bully: get your ass over here and help me. this boy
is hurting me and nobody's trying to help me!
Me: Ms. Bully, you're going to have to try your best to calm yourself down. You being so worked up is working against the sedation meds.
Ms. Bully: Sedation! Sedation? you call this a Sedation! I'm lucid. I'm lucid! I'm as lucid as I was when I defended my thesis! Sh*t I can feel everything ya'll f*cukin doin in my mouth!
Co-Resident (who did the procedure): ma'am, if you could just breathe for me, try to relax and calm down, the meds will work for you and help us all out.
Ms. Bully: F*ck YOU and F*ck this hospital! My sister is a lawyer! ZzzzzzzZZZZ
As we are all recovering from the almost 2 hour ordeal, our assisant calls me into the treatment room where Ms. Bully was supposed to be SITTING down and recovering. I walk in to see Ms. Bully rambling through our dental materials shelf! I saw her grab a few items, read the labels, and place them back. I saw her grab the 'dry socket paste', cut her eye towards our direction, pretend to look out the window and then sit down. I pretended to get gloves from the shelf to find that the dry socket paste was missing! (she had obviously planned to smoke and wanted to steal the paste to keep from coming back to the office when she gave her self dry socket!). One of the assistants was about to call the hospital police when my co-resident walks in...sticks out his hand and says in the CALMEST voice ecer: 'so, I hear you have our dry socket paste...if you do, Imma need that back'.
Ms. Bully: What? I got What? Are you serious? Ya'll sit up here and kill me hurtin my mouth and NOW you accusing me?
awww man, but Imma need that though
Co-resident: no, you won't. dont' smoke!
Ms. Bully: that's F*cked up man... I came for ya'll to help my ass and ya'll stressin me more. That's why I hate all of yall!
Co-resident: here is your pain meds script.
Ms. Bully: ha..you think this lil sh*t gonna work for me? Hell naw, I need something stonger and I'm not leaving in pain and not gonna have pain tonight so SOMEBODY gonna get me something that will work!
Co-resident: well guess what? I am that SOMEBODY who you need to talk to. I AM that somebody who is making the call on what you need. You can take it or leave it, but this is it. Take it and manage pain, don't and be in pain!
aight, I'll take it...
REMEMBER- this was a moderate sedation case. These patients are typically WAYY too groggy to move on their own until about 30+ minutes afterwards, but this lady, who darn near BEAT all the sedation meds recovered from the meds and was completely ambulatory in about 10 minutes afterwards. She REFUSED a wheelchair and/or escort to downstairs! And BTW- the fact that she did combat the meds so effectly, and caused us to max out the dosages led ME to believe that she may have acutally smoked prior to the procedure. And her difficulty to remain sedated for longer periods of time led ME to believe that she has PROBABLY done a little more than just 'weed' and had done it more recently than she would ever admit - of course, because her sister is a lawyer and she has a degree in psychology
LOL, anyway, she leaves all angry, but her bad teeth are out and she'll be much happier and healthier in a few weeks or so. Mind you... 5'5 258 and THAT afraid! College graduate and THAT ignorant and disrespectful! Please understand that I am not trying to down play dental phobias. I KNOW they exist and I KNOW they are real, but an anxious patient who is ALSO a 'know it all' and who is also so 'exacting' is a heck of a mix for a patient to try to manage. Over all though, I think we as a team did a good job to manage her. Lord knows if she had gotten any more aggressive though...whew it would have been smoke in the city!
That just goes to show no matter how big you are, you can still be a big baby. And no matter how many 'degrees' you have, it doesn't always qualify you as intelligent!
AND always remember... If you keep regular maintenance on your teeth (INCLUDING PROFESSIONAL INTERVENTIONS), the pain is slim to none... Ignore your teeth and they WILL go away- and almost certainly NOT pain free!