Control Thyself

In the ER we treat a lot of infections.  Skin infections are very common.  We see a lot of abscesses (pockets of pus under the skin) that need to be drained.  This is not a fun experience for either myself or the patient.  It is quite an uncomfortable thing for the patient, even with good local anesthesia.  It is not fun for me because first of all it is pretty gross, and secondly, the pus that comes out usually has a very foul odor.

I recently saw a patient that had an abscess that had spread from her tooth to encompass the entire roof of her mouth.  It was very large and I am sure was very painful.  This patient also had chronic pain and so was on very high and frequent doses of narcotic pain medication.  She was also very dramatic.  These things put together make for a not very pleasant patient from my end.

I was trying to inject anesthetic into the area so that we could drain the abscess, but the patient was not being very cooperative.  Every time that I would get close, she would jerk her head away so that I could not do anything and then she would scream about how much it hurt.  I explained to her that I needed to drain the abscess or the pain would continue to get worse and to make it as easy for her as possible, I needed to numb the area.  She said that she understood and to go ahead and she would hold her head still.  She did hold to her word and held her head still.  Of course, as soon as I started to injected the medication, she kicked up with her leg and hit my arm with her knee.  This, in turn, jabbed the needle into the hard palate of her mouth quite forcefully.  Needless to say, I was quite exasperated at this point and what sympathy was left in me for her was quickly draining away, much like what I wished the abscess would be doing.  I finally was able to drain out the infection, although it took about 5 times longer than it should have.  I am sure that the rest of the department thought that I was actually trying to murder the poor girl as well.

So, the moral of this story is, even if it is painful to have a procedure done, try and hold still so that you don't get needles shoved into places that they shouldn't be going.  And also remember that the doctor, or nurse, gets to choose what size of needle they use.  Just a thought to keep in the back of your mind.