Mr. Parise is an alcoholic. He'll go out and drink a liter or two of vodka and then stumble into our ER, where he always complains of the same thing - pain in the epigastric region that extends around to the back. And he says the magic textbook words - "like a rubber band."
Then he gets admitted for pancreatitis.
And we give him fluids and pain medicine.
Even though he doesn't have any abdominal pain when distracted. Even though he can change positions easily, but then has severe pain if we so much as try to poke him. Even though his CT scan shows no evidence of chronic pancreatitis. And his lipase and amylase are all within normal limits. And he's starving, asking for 2 trays of food, while we all know that patients with pancreatitis normally don't even want to think about putting anything in their mouths.
But I get it. Pancreatitis can present in different ways, and this guy has the number 1 cause of pancreatitis in men - alcohol. So we have to treat the patient - not the imaging, and not the lab results.
Yet, inevitably on day 2, when we start to decrease the frequency he receives his pain meds, he freaks out, and demands that we go back to what it is, or he'll leave AMA (against medical advice). So then we have a huge long discussion with the patient, telling him that he doesn't require such high doses of meds, but it's important for him to remain NPO (nothing by mouth) to prevent further inflammation of his pancreas.
He then asks for an AMA waiver, signs it, and heads out.
Then, 3 hours later, or if we're lucky, 2 days later, we get a call from the ED saying that our patient is back, reeking of alcohol, and complaining of the exact same symptoms.
And I know this probably makes me look like a terrible doctor-to-be, but I gotta wonder when it stops. If someone signs out AMA and then comes back complaining of the same exact symptoms, I feel like there have to be some repercussions. Especially when we have an ED full of people, and no beds for any one.
