My Neurosurgeon

I was doing a ride-along with a friend of mine who works for a suburban police department. It was a call for an elderly lady with back pain. We were the closest unit and arrived before EMS did.

The patient was about 80 years old, lying in her bed fully dressed, simply waiting for the ambulance. She had a history of prior back surgeries and reported that she had “broken rods” in her back. She was scheduled to have another surgery in a couple of months. She had a back brace and her rolling walker at the bedside. She was very calm and reasonable. She did not have any pain at rest, but she said it hurt too much to move, so that’s why she wanted to go to the hospital. There was no report of any new trauma.

We helped gather her things while waiting for the ambulance: her jacket, her purse, her medical records, her shoes. She even got up on her own and was able to get herself to the bathroom with her walker before the ambulance arrived without any assistance from us.

The patient told the paramedics that she wanted to go to a certain hospital, which was a long way across town, because “that’s where my surgeon is.” Despite the fact that there were multiple hospitals and ERs much closer than her preferred one—some of which are even in the same healthcare system as her preferred hospital—the medics obliged and took her there.

What the poor lady doesn’t know is that the ER is not going to solve her problem. They may or may not get some new images of her back to make sure that nothing has changed; however, without any new trauma, it’s very unlikely that anything significant is going on. They will likely give her a dose of pain medicine if it’s completely intolerable, but again, it’s very hard to dose pain medicine for patients who have no pain at rest but severe pain with movement. Which level of pain are we obliged to treat? If you can be completely pain-free without moving, it’s hard to live your life that way—that’s true. But giving a large dose of pain medicine for extreme pain that goes away with rest doesn’t really make sense either. There is no pain medicine that turns on and off for symptoms like that.

Furthermore, there’s almost zero chance that she will see her Neurosurgeon. That person may work in the same healthcare system; he may even work in the same hospital. But that person is not going to drop what they’re doing and come see her.

Generally speaking, surgeons are doing one of three things on any given day: they are in the operating room actively performing surgery, in the clinic seeing patients they have previously operated on or are preparing to operate on, or it’s a day off. Granted, there are always some “on-call” shifts built into their schedule, which are shared among all the members of a surgical group that takes “call”. But there are very few surgical emergencies, particularly in the field of neurosurgery. Head trauma that needs an emergent operation would probably be the most common, and fortunately that serious issue is very rare. Spinal cord trauma or an acute vertebral disc problem compressing the spinal cord would maybe be the second most common, and I would say that is even rarer.

For this lady, who already has a known problem that needs surgery and is feeling worse than she has been but is still functional, she’s mostly just wasting a trip to the ER, and she will likely get sent back home very disappointed.