legal1108.qxp 10/23/2008 10:54 AM Page 98
Would a severed nerve
have been recognized had
the patient been less
confrontational in the ED?
BY ANN W. LATNER, JD young man,Mr.R,on a gurney.Blood was gush-
Difficult patients go with the territory for every Mr. R began ing from the man’s left arm near the wrist, and
clinician.They can wear on your nerves and chal- cursing again one paramedic was applying pressure to the
lenge your professional demeanor. as the PA began wound in a valiant attempt to stem the bleeding.
But what if a difficult patient has a valid con- Mr. B and several colleagues rushed to aid the
cern? Sometimes, as one physician assistant to suture the paramedics and got the patient into an exam
found out, a patient’s unpleasant personality can laceration. room.The young man reeked of alcohol and was
color your reaction to an actual complication. “Damn it! That yelling profanities. Mr. B glanced questioningly
Mr.B,38,had worked as a PA in the emergency at the paramedic who was stanching the wound.
department of a mid-sized hospital for close to hurts,” he “White male,22 years old,apparently punched
10 years. He enjoyed the variety of cases, the yelled.“What his arm through a glass shower door during an
urgency of care, and his relationships with col- the hell are argument with his girlfriend,” the paramedic re-
leagues and supervisors. ported. “Suffered deep lacerations and major
But the job had two downsides: the periodic
you doing!? bleeding.The girlfriend called an ambulance for
night shift (he was a morning person and found Get off of me!” him.We’ve tried to hold back the bleeding, but
the schedule change jarring) and the occasional it’s a ‘pumper.’”
cantankerous patient. Generally, Mr. B was He moved his hand from the patient’s arm,and
known for his calming bedside manner. But blood spurted out uncontrollably.“The guy lost a
every now and again he encountered a patient he lot of blood on the way over here,”he said.
One night, both of Mr. B’s pet peeves came Cases presented are based on actual occurrences.
together. He was working the night shift, and Names of participants and details have been changed.
around 2 AM fatig