“Sorry, I had to ask. We’re doing an X-ray.”
She shot him another startled look. “Do you have to? I don’t have insurance.”
He considered it a moment. He’d like to see an X-ray, but with the other tests, it may not be necessary. “Okay, we’ll put a hold on that for now, but we still may need it, depending on what the other tests show.” That could be what was bothering her.
She looked slightly relieved.
“Hello.” There was a knock at the open door, and Kaye, the respiratory tech, walked in. “Are you Darlene Knight? I’ve got orders to make you start feeling better, or I lose my job. Got a few minutes?”
Lukas smiled at her. “Thanks for coming so quickly, Kaye. Darlene, I’ll be back after your treatment.” He braced himself to face the man with the migraine.
“Do you make a habit of abandoning your patients in this emergency room?” Mr. Little demanded as Lukas walked back in and laid the clipboard down on the counter.
“Not if we can avoid it,” Lukas said calmly. “Would you mind stepping to the bed?”
“Why?”
“If I’m going to treat you, I’m going to check you out. Please move to the bed. If you need some help, I can—”
“I don’t need help,” the man snapped, then grudgingly obeyed Lukas.
Lukas checked heart, lungs, reflexes. Normal. Then he lowered the lights and checked the eyes. Bingo. They were pinpoint, no dilation. In this dimly lit room, that didn’t fit.
He picked up the chart. “Mr. Little, it says here that you’re allergic to Imitrex and Reglan. Those are our drugs of choice for migraine. What medications have you taken before?”
“Demerol and morphine work best.”
“But I can’t in good conscience give you a narcotic without running some tests to make sure you’re not in danger. I need a CT and a urine—”
“What?” Little brought his hands down from his head and glared at Lukas. “What’re you trying to do to me? I just want some simple pain relief! No urine test.”
Lukas checked the time. Forty-five minutes until Camp took over. No problem with this patient; he was about to leave. Federal law had to be satisfied first, though. Lukas knew the regulations well. Unfortunately, Little probably did, too, if he was habitual.
Darlene was another problem. For some reason, Lukas wanted to finish her himself.
“Okay, Mr. Little, I’ll send the nurse in with a shot for you.”
The man visibly relaxed. “It’s about time.”
Lukas had Beverly take a dose of Toradol to Mr. Little in room three while Lukas looked for and found the young man’s old chart at the central desk. Very interesting—eleven E.R. visits in four months, all for pain shots and pills. How many other area hospitals had records on him?
“Carol, please call the area emergency departments and check to see if Mr. Dwayne Little has visited them recently for pain medication.”
Carol raised a brow at him. “Yes, Doctor, but you know who he is, don’t you?”
“Yes. Thank you for your concern.”
Lukas returned to Darlene in room six.
She still wore her mask and the finger probe. Her O2 sat was still low, but better. Her arterial blood gas turned out to be better than Lukas had expected. He checked her breathing.
The wheezing was louder. Good. That meant more air movement. She was still working for her air, but she was holding her own.
“Well, Darlene, you’re doing better, but we’ve got a way to go yet. You’re still doing some inspiratory and expiratory wheezing. I can’t send you home like this.”
Her eyes grew wide. “Please, Doctor, don’t put me in the hospital. I can’t stay.”
“We’ll see. I want to give you a couple more treatments. How long have you been breathing this poorly?”
“Not quite a week. It didn’t get really bad until yesterday. I know I should have come in sooner, but I already feel much better.”
The woman was slightly more animated than she had been a few moments ago, but not much. Lukas would guess by the circles beneath her eyes that there were other things going on he hadn’t discovered yet. Stress could bring on an asthma attack, especially when exacerbated by lack of sleep.
“Dr. Bower,” came Beverly’s flustered voice from the doorway. She glanced at Darlene, then back at Lukas. “The patient refuses the shot.”
Lukas excused himself with Darlene and walked with Beverly to the central desk. “Of course he refuses the shot,” he said. “It’s not a narcotic. He probably requested Demerol.”
“His usual,” Beverly muttered.
“Please make a notation on your chart that pain relief was offered and he refused it. Did he give a reason?”
“Said he’d had it before and it upset his ulcer.” She looked around and lowered her voice. “I don’t think it’s a good idea to mess with this guy. He could cause a lot of trouble for all of us. I told you, I can’t afford to lose my job.”
“We could cause him a lot of trouble, too. It doesn’t change the treatment plan. There’s no record of ulcer history or medication. Time for our trump. Would you please call for Kaye to give Darlene another treatment? Then I need you to join me in room three. I need a witness.”
“For what?”
“You’ll see. Carol, what did you find out?”
The secretary bit her lip and glanced toward the room where Little waited. “He’s been to at least three different places several times each in the past two months.”
“Thank you. Call them back and warn them that he may be a drug seeker and he may be headed their way soon.”
While Beverly called for Kaye, Lukas filled out his part of the form he’d placed with Little’s chart earlier. They went together to room three.
“Mr. Little, so sorry to hear about your ulcer. Is it still giving you trouble?”
“That’s not what I’m here for,” the patient snapped.
“Sorry. You’re not allergic to morphine in any way, are you?”
The man couldn’t hide his surprise. “No.”
“Good. I think we can fix you right up.” Lukas couldn’t resist a glance at Beverly. She gaped at him in shock mixed with relief. He grinned. “First, Mr. Little, I have a form for you to sign.” He pulled out the sheet he’d just filled out and put it at the top of the papers on the clipboard. He placed it under Little’s nose. “I need you to read this over first, of course. It states that you are aware of the nature of the drugs I am going to give you, and that you understand the effects Narcan has on you if you are an addict. It will precipitate violent withdrawal symptoms, up to and including death.”
The man’s mouth flew open. “Narcan!”
“Yes. Maybe you’re familiar with it? It’s a narcotic antagonist. You’ll still get good pain relief from the morphine, but you will not have to put up with the resulting high. I was sure you would approve.” He pushed the sheet forward. “Your signature, Mr. Little.”
The man jumped from the bed. “You’re saying I’m a junkie!”
“Not at all. I’m saying that if you aren’t an addict, you should have no problem with this course of pain relief. If you do have a problem, we can get you into a drug treatment prog—”
Little