False Expectations

“Life is pain, Highness.” — Dread Pirate Roberts, The Princess Bride

“Suffering is a precondition for existence.” — Jordan Peterson

It’s not realistic to believe you will go through life without any pain, hurt, illness, or discomfort. It’s also not realistic to expect that the ER can immediately eliminate those symptoms whenever you decide it’s time. The body simply doesn’t work that way. Healing takes time.

I frequently see patients who have broken a bone and explain that bones generally take about six weeks to heal. That’s a general rule, of course, and it varies somewhat depending on the patient and the injury. My youngest daughter broke her collarbone when she was a toddler. I have a video of her doing the “wheelbarrow” just two weeks later with no apparent discomfort. If you’re older or in poor health, however, six weeks may not be enough. There is very little that Big Medicine can do to meaningfully speed up that natural process.

Patients typically come to the ER when they’ve had “enough” of whatever is bothering them. That might be nagging chest pain for two months, shoulder pain for two weeks, or nausea and vomiting for two days. At some point, they decide that today is the day and this is the hour they want an answer and a solution. Often, nothing about the symptom itself has actually changed—only their tolerance for it has run out. Maybe they couldn’t get time off work, or they didn’t have a ride until now. When I ask what has changed “today” with a chronic complaint, the answer is frequently “nothing.” The patient simply wants it dealt with now. That suddenly puts the pressure on me and the ER team to provide an immediate fix. But that’s not how the body works.

Take the examples above: two months of chest pain, two weeks of shoulder pain, or two days of nausea and vomiting. In most cases, I won’t have definitive answers or quick solutions. True medical emergencies rarely last days, weeks, or months. Two months of chest pain is very unlikely to be an acute emergency. Even after we rule out the common serious causes, we usually don’t find anything life-threatening.

Two weeks of shoulder pain is almost certainly a musculoskeletal issue—probably inflammation in or around the shoulder joint or a rotator cuff problem. None of these typically require an emergency department visit at 3 a.m., and there’s little I can do in the ER to make the pain disappear. If you’ve already tried over-the-counter pain medication, I can offer something stronger like oxycodone, but that’s about it. An MRI and physical therapy may be in your future, but no one is acting on MRI results in the middle of the night.

I don’t control the “nausea and vomiting gods,” either. Most of the time, you ate something that didn’t agree with you, and your body is doing exactly what it’s supposed to do: getting rid of it. Before anti-nausea medications became so common, that’s exactly what we did—if you felt like puking, you puked. There were no medications for it when I was a kid back in the 1900s.

With rare exceptions, we don’t run specific tests to figure out exactly what you ate. There are no quick cultures or labs I can order on your vomit to identify the virus, toxin, or bacteria responsible. While we do have stool tests for certain diarrhea-causing pathogens that occasionally require treatment, this is uncommon. Nausea, vomiting, and diarrhea without fever, severe abdominal pain, or bloody stools are treated symptomatically the vast majority of the time.

So if there’s no specific cause I can treat, I can’t make your symptoms stop on demand. I understand that in our instant-gratification world—where almost everything is available at our fingertips—people assume the ER works the same way. But it doesn’t. The body doesn’t run on my timeline or yours.

The best I can do for two months of chest pain is reassure you that it’s not a disaster. (You probably already knew that, since it’s been going on for two months and you’re still alive.)

The best I can do for two weeks of shoulder pain is offer pain medication and a referral to orthopedics or physical therapy—something you could have gotten at a primary care clinic or urgent care during normal hours.

The best I can do for two days of nausea and vomiting is give you some anti-nausea medication and check that your electrolytes and kidney function are okay (which they almost always are). The human body is remarkably resilient. Even if things are slightly “off,” a little IV or oral hydration is usually all that’s needed, and life goes on.

What I can’t do is make those symptoms disappear instantly just because you’ve decided you’ve had enough and want them gone right now.