I'm working currently in the Emergency department of a major government hospital. Sadly, people's perception of what constitutes an emergency is seriously flawed. Half the time I'm dealing with ankle sprains and the flu. Occasionally, though, we get one of those ER-type medical drama situations.

Had one of those day before yesterday...

This young guy came into my room and said that he had a cough. He claimed that most cough syrups made him throw up, but there was one which didn't, and he wanted me to prescribe that particular one. He reminded me twice during the consultation to prescribe him that cough syrup.

I got suspicious. You see, this particular cough syrup contains codeine, which is an opioid, and addictive. And there are a lot of people out there who get a high from drinking this cough syrup. So I told him to take a seat in the waiting area, and then went to do some detective work.

I must say, I love the fact that online medical records make this easy -- and in fact, even possible. Five years ago, I wouldn't have been able to find this out, but now, because all the public hospitals and clinics are linked, I was able to discover that this fellow had visited various clinics over the previous few months, and had been prescribed some sort of cough medicine each time.

So, I advised him to stop smoking (duh!) prescribed him a cough syrup that doesn't contain codeine, and told my nurse to send him on his way. I warned her that he'd ask for the other cough syrup, and told her to tell him he couldn't have it.

Problem was, this guy wouldn't leave. He came back into my room and kept demanding the Procodin. I told him, look, I'm giving you promethazine. He said promethazine made him throw up. Well, in that case, so should Procodin, which is promethazine + codeine, and I told him so. He insisted that he needed to have Procodin. I offered him promethazine together with an anti-emetic. He refused. I told him no, and sent him back out of my room.

Now, it was the end of my shift, and I wanted to leave, but thanks to this, I couldn't. My nurse came to tell me that this fellow's relative was now making trouble in the waiting area. I went out and found this boy, together with another fellow who claimed to be his cousin, arguing with my nurses and clerks at the registration counter.

I went up and spoke to them. I didn't bring them back into my consultation room, because one of the things we've been taught is that if you're dealing with an aggressive patient, stay in a public place where there'd be a lot of potential witnesses if they were to get nasty or violent. So we were standing in the middle of the waiting area, and these guys were arguing with me.

My patient's cousin decided that he was going to be the spokesperson, and began demanding Procodin on his behalf. I gave him all the same explanations, but he also wasn't being logical about it. He starting raising his voice and shaking his finger in my face. I figured he wouldn't actually touch me, because there were a hundred people watching, including the three policemen at the police post we have in the EMD. (Sigh. Yes, those guys could obviously see what was happening, and were happily sitting at their station and watching the show, and ignoring my attempts to summon them with eye contact.)

I told my nurse to go get my consultant. During any shift in the EMD, we have at least one senior doctor on duty. I was beyond fortunate that my senior on shift that day was this particular guy, let's call him Dr X, whom I knew would back me up 110%. He came, and calmly asked what the problem was. The young man's cousin said that I had promised to prescribe his cousin Procodin and now wouldn't give it to him.

Now comes my favourite part. As I was opening my mouth to deny having made any such promise, Dr X completely ignored me, looked the fellow in the eye and said, "I don't care what she promised you earlier. I am saying now that she cannot prescribe you the Procodin. Okay?"

Woo hoo! My hero! I do de dance of joy!

Dr X continued to speak to the guys, and when they refused to listen to him also, and the cousin starting making threats, he sent the nurse to the police post to get the police (who were still sitting there and watching). We sent both of these guys off with the police, and didn't hear from them again.

Later on, we found out that the fellow's aggressive cousin had also registered as a patient that day, and had been given a prescription for Procodin -- further cementing our case.

Now, this incident makes me think of a few things:

I know my work quota is going to go down due to incidents like this. They actually measure our speed and calculate a "patients seen per hour" statistic. Thing is, giving this guy Procodin would have taken me two minutes. Refusing to give it took me an hour and a half. Sigh. But if I had to do it over again, I would.

I wonder what would happen if I ran into either of these fellows somewhere in a public place. It's a scary thought. I knew that they wouldn't hit me or try anything there in the waiting area in front of so many people and the police, but tomorrow on the bus, or next week in the mall... what if?

I found myself thinking, if something were to really happen, if I knew that those guys were going to come after me and I was going to get hurt or worse -- would I still have stuck to my guns and refused to prescribe the drug? And after thinking long and hard, I decided, yes, I would, because it was the right thing to do. Doing the right thing isn't always easy. I'm glad to say I'm willing to take that risk -- and knowing that Dr X has my back makes me that much stronger.

Another senior doctor, in another department, might have said, "Ah, just give him the Procodin." Or they might have agreed with me that I shouldn't prescribe it, but might have told me to call the police and left me to handle the situation on my own and not stuck their own necks out that far.

In no other department I've worked in have I found senior doctors as willing to stand by their juniors as in this EMD. It was the reason, I think, that I once thought of specialising in emergency medicine, before I decided that I wasn't really cut out for it. Having your senior doctor back you up 400% makes you that much more confident. In spite of the high stress levels, busy shifts and the difficulty in getting approval for leave, I still like this department. A lot.

The only thing necessary for the triumph of evil is for good men to do nothing. -- Edmund Burke