Chronic on Paul Nystrom

False Expectations

Wed, 25 Mar 2026 00:00:00 +0000

“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.

My Neurosurgeon

Sat, 10 Jan 2026 00:00:00 +0000

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.

Acute and “Next Steps”

Sat, 13 Dec 2025 00:00:00 +0000

There are many times in the ER when I see a patient and have to pause the conversation to break it into two very distinct parts: the acute problem and the chronic problem. It may not always be a truly chronic condition, so perhaps a better way to frame it is the acute problem and the “next steps” problem.

During a shift, I saw two patients with debilitating chronic pain.

Chronic Diseases

Tue, 07 Oct 2025 00:00:00 +0000

The ER is not for chronic diseases. The acute recognition of a chronic condition does not make it an emergency. It doesn’t matter how you describe it, how distressing it is to you, or that today is a worse day. Acknowledging that everyone feels better or worse on some days than others also holds true when you think about your disease process. Your arthritis will be better or worse on some days. Your residual symptoms from your prior stroke will be better or worse on some days. Your chronic chest pain, whether it’s from angina or any other cause, will be better or worse on some days. Your IBS, which, as I mentioned, is a controversial diagnosis, will be better or worse on some days. Virtually every condition you have has better or worse days. But at the end of the day, it’s still a chronic medical condition and not something that requires emergency attention.