Recently, a woman came to my ER demanding the 'Full Monty' of post-hoc protections for unprotected sex. Before she left the department, I wrote prescriptions for Cefixime (an antibiotic for gonorrhea), Azithromycin for chlamydia, plus scripts for post-exposure prophylaxis against HIV. I spent twenty minutes answering picky detailed question after picky detailed question about everything from when to get tested for HIV, Hepatitis B and C to the side effects of each and every medication, not mention drug interactions.
I felt as if I was being questioned in an Examination for Discovery by a legal maven. Everytime I hesitated to answer her for even a nanosecond, she furrowed her brow and asked yet another question. Beads of sweat formed on my forehead. Seemingly satisfied, she turned to leave. I felt relieved. But when she got halfway out the door, she turned and asked in that "oh, by the way" kind of voice if it was okay to continue taking her daily megadose of vitamin D. That was when a ping went off in my brain.
In my mind, I suddently felt the urge to ask her a question of my own.
She spent twenty grilling me. I wondered to myself just how many minutes she spent asking tough questions of her partner of unprotected sex. Or, herself for that matter.
The patient I've just described isn't real; but she's an amalgum of many such patients I've seen over a long career in the ER.
I started thinking about the many times that sort of thing happens in my line of work. How many times have I been closely grilled about head injuries and post-concussive syndrome by a helmet-less bike rider who wiped out? How many detailed queries about long term side effects have I answered from the patient who made an impulsive decision to try the club drug Ketamine at a party?
If any of these patients asked those 'smart shopper' questions before they did something foolish, I'd have a lot less work and a lot less explaning to do.
I get it. You feel bad about what you did and you're projecting some of that guilt onto me. Just know there's a limit to my patience. And even if I don't say it, I'm wondering:
Just what were you thinking?