The Tale of Two Toothaches

It was one of my “usual” shifts and was busy as all get-out. Multiple admits, two transfers, a code in the ICU I had to run, and the ambulances kept coming like they were on a merry-go-round. Amidst all of this, I was trying to squeeze in the patients who weren’t so emergent but who had been waiting patiently to be seen. A couple times we would get some of the non-urgent patients back to a room, then we’d get an ambulance run and we’d have to ask patients in the rooms to go back out to the waiting room to sit and wait for another room to open up.

Among the non-urgent patients waiting to be seen were several patients with toothaches. The first thing that runs through everyone’s head when a patient comes to the ED with a toothache is “drug seeker.” I try my best to remain neutral. I had a toothache while working one time which ended up being the beginning of a sinus infection. Every time I opened my mouth, my whole upper gumline throbbed. It was giving me a rocking headache. I couldn’t think straight. I sprayed lidocaine on my gums with no relief and eventually stuck a needle in my gumline and did a nerve block on myself because the pain hurt so much. Toothaches are no fun.

Two toothache patients got brought back to rooms at about the same time. Both had been waiting a couple of hours to be seen. I was finishing up admitting a patient and was going in to see one of them when we got another ambulance run.

The nurse went in toothache patient #1’s room, told the patient that an ambulance was coming and that we needed to use his bed. He asked if the patient could go back out to the waiting room and wait a little longer. The patient jumped up off the bed, offered to help change the sheets, and said “No problem at all. I know I’m not an emergency here. Would it be OK if I took my sister home really quick and came back? It looks like I may be here a while longer.”

Shortly thereafter an elderly patient came to the registration window who couldn’t breathe and whose pulse oximeter was in the mid 70s on room air (usually like to see the pulse ox above 92%). The nurse goes into toothache patient #2’s room, says that we need to use the bed for a patient who can’t breathe, and asks the patient to wait in the waiting room. This guy gets mad and says “I was here first.” Again, he was told that he needed to go back to the waiting room. Then he goes into a tirade about how the hospital “sucks” and asks whether “a f%#@ing doctor is ever going to see him.”

Both had legitimate causes of pain. One was an abscess, the other one ended up being TMJ.

Can anyone guess which patient’s chart the nurses put at the head of the “to be seen” list after the two emergencies were stabilized?

Can anyone guess which patient received a shot of pain medicine from the nurse before the doctor even went to see him (as in “Hey WhiteCoat, I’m going to give the guy in Room 3 with the toothache a pain shot, OK)?

I’ll give you a hint … they nicknamed him “the really nice toothache guy.”