My first patient of the shift hopped around like he had ants in his pants as he tried to describe to me what had happened to him, so I shall call him Zebedee. Cradling his poorly right hand with his left as if it were protecting a precious Faberge egg, Zebedee put it thus;
“I ain’t done nothing to it, I just woke up this morning and my hand was killing me, maybe I turned over in bed a bit funny while I was asleep”
“Yes, you do seem very uncomfortable there” I agreed, “but are you saying that you really don’t actually remember hurting it at any time then?”
“No, I was fine when I went to bed early hours of this morning but when I woke it was ****ing agony”
“Have you taken any painkillers?”
“Nah, they don’t work on me” he replied….. (See my previous post on my thoughts of people not taking simple analgesia).
“Well, what activities have you been doing in the last few days, DIY, sport, gardening???”
“Nah, I ain’t done nothing like that” he said with a look of such disgust on his face one would have thought that I had asked him whether he liked cat food on toast for tea.
I tried to examine Zebedee’s hand properly but he continued to bounce of the walls, I could barely touch him without him yelping loudly and jumping in to the air. Florence, his sympathetic girlfriend (not her real name) rolled her eyes with a distinct note of impatience in between updating her Facebook status. When I eventually managed to pin him down I found that he seemed to be particularly tender between the base of his thumb and his wrist so, suspicious that he may have fractured a bone there, I sent him for an x-ray.
When he came back we all sat down and I pulled up the x-ray to show him the results.
Zebedee had fractured his scaphoid bone and would definitely be going home in a plaster cast. It was most unlikely that he managed to cause this injury in his sleep; in fact I got the distinct feeling that he giving me the runaround so I decided to get firm.
“Now you are not being honest with me are you, what exactly happened here?”
“Just tell her!” said Florence as she updated her relationship status to ‘It’s complicated’
“Ok, ok I fell down an escalator”
“How far?” I asked
“Well I nearly made it all the way”
“You fell from the top to the bottom of an escalator? Did you fall head over heels all the way down?” I asked, suddenly worried that he might have sustained an even more serious injury somewhere.
“No, I slid down the handrail, but when I got to the bottom I hit a ****ing sign with my hand”
“Had you been drinking alcohol by any chance?” I probed
“When you say ‘a bit’…how many units had you drunk exactly?”
“I dunno, what’s a unit” he asked and I explained.
“About 30 then I suppose” he said after a bit of mental arithmetic.
“Ok, that’s quite a lot for one evening isn’t it….did you take any illicit drugs with that?”
He shrugged and it was obvious that he had.
“Just a bit of cocaine……and amphetamines”
The drugs explained the Zebedee effect and at least we got there in the end, even if it was in a bit of a roundabout way!
For drug advice visit Talk To Frank.