First, I am not trying to stereotype anyone, but I have noticed that a certain subset of the elderly population are always on some sort of hustle. With me, they are always trying to hustle pain meds. (If you've ever seen the Academy Award-nominated film, Hustle and Flow, then you'd know his type because he is a carbon-copy of the man that sells the main character a keyboard.) I removed this poor guy's last eight teeth yesterday, and before I had the gauze packed in his mouth, he was already telling me that he needed enough Vicodin to last him until he got his dentures made. That's what he said. What I heard was, "Doc, I need about 200 Vicodin." Fat chance, sir!
I informed him that he'll need the narcotic pain meds for about two to three days post-op. If he has pain that ibuprofen or acetaminophen (APAP) can't handle, then call us back, because there may be a problem. Typically, I hate telling patients this, but I have to. Most patients are pretty realistic and understand that there is a little bit of soreness to endure after a surgery. Some patients don't want to feel anything. Those are the one's that are calling back the next day wanting antibiotics because they think they have a flesh-eating superbug.
Pain management can be a tricky deal. I typically won't prescribe a narcotic pain meds unless I do something for the patient where there will be pain afterward e.g. extractions, surgery, root canal of an infected tooth. Vicodin/Lortab (same drugs essentially) can be sold on the street for $20 per pill! So in my mind, I had better have a iron-clad reason for giving them to people in case the DEA comes asking about my prescription-writing tendencies.
People with chronic pain maladies are either very easy or extremely difficult to manage. They're either already on super high doses of pain meds, like Lortab 10 (10mg of Hydrocodone, the narcotic,) so nothing I prescribe would even come close to it. These people don't even need anything else. Others, however, think they need pills for everything. Once they develop a taste for high strength pain medicine, that's all that will ever work for them. I can spot them immediately, because they already know the name and dosage of the pill they want afterward. I'm usually stubborn and argue with them about it, and I usually win. There are times, though, that I just compromise and give them less than they want but more than they actually need. Just get out of my face! Please!
Back to my newly edentulous (toothless) friend. I ended up giving him a few extra pills, so he won't be calling us up next week demanding more. The great part about this experience is that the teeth that were removed were loose, not decayed. I need some pristine teeth to practice a new endodontic (root canal) apparatus that I'm about to order. I spent the afternoon disinfecting them, so I can safely drill on them later. They bathed for a few hours in sodium hypochlorite (dentist-speak for bleach) and now they're marinating in formalin for their date with a drill.
So now I'm sitting here waiting for my last patient to get numb. I don't think it'll happen, because every time I try to inject him, he bites down and his tongue deflects the needle. I've earned my brown belt in tongue-jitsu, but this guy is especially tough. Not something I want to have with my last patient before the weekend.
Okay, J, my young assistant says we're good to go. I know this will be a battle. I start thinking about Tom Hanks calmly giving orders aboard the landing craft on Saving Private Ryan. "Port side, stick. Starboard side, stick. Move fast and clear those murder holes... Keep the sand out of your weapons, keep your actions clear... I'll see you on the beach."
6 comments:
Love it and I am SO glad you have joined the blogging world. You write so eloquently...I'm so lucky that your my hubby. :)
Wow! I learned a lot, just in this post. Had no idea that narcs can go for $20/pill on the street! I haven't seen Hustle and Flow, because it's not Disney or Veggietales, but I can just imagine...
I am the BIGGEST dental chicken you've met. Just the reading of your blog is actually helping reduce that fear, because you are real and funny, and you aren't trying to get my money or drill on my teeth.
I don't want painkillers, I want to not be awake as you fill my cavities or crown my teeth. Pain I can live with. That smoke and cracking...that is horrible.
So....on that cheery little note, I'll be reading often. Try to keep the smoke down.
(And I'm not going to go so far as to proclaim you "eloquent", but you're a great storyteller and I love it!)
Well, Farmer's Wife, you shouldn't have too much smoke when you're getting worked on. The dentist should be using a water spray that will keep the tooth cool. Otherwise he/she will burn up the nerve!
I still like the story you told about the gal who said the only med she was allergic to was marijuana! I am looking forward to more war stories. They ought to be good.
Did you give the guy a break on his bill for the use of his teeth. Those are personal property buddy. If some dentist is keeping my teeth, I'm going to want some cash-ola. Say fifty a tooth.
I will rig up you an old livestock syringe with 2 inch needle, one of those 25 cc with the lever to inject the meds. You can fill it with colored water..say purple. When you have to fight off the tongue, you can get out the syringe with a named taped to it..."tongue stabilizer"...Hold the syringe up, like you are removing the air...pull the lever so that 5 cc liquid squirts into the air...say, "oops"...look at patient and say..."trigger a little stiff"...Of course the patient will be asking about the syringe. Tell them that you only use it when the tongue interferes with the dental procedure..You look them directly in the eye...say.."your tongue won't know if its in the mouth or on the floor"...then warn them to not eat for the next 24 hours, because the food would fall out of their mouth.
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