Pulling up the EMS ramp, the son-in-law got out, approached a pair of medics and said, “I need help.” They promptly wheeled him into Room 3 and yelled, “We need a doc!” Airway intact and a brief history aside, I noticed the bloodless white handkerchief on his right wrist and immediately called for my PA to help reduce the pulseless hand. We opted for immediate reduction sans analgesia. As we overpowered the spasm of the forearm; my new favorite patient screamed, “I want a Pepsi!” To our wide eyes and the PA’s chuckle, we felt a satisfactory clunk and brisk return of color and pulses.

Of my nurse, I requested x-rays and “two milligrams of morphine IV; and give it again until it works.”

We began charting and the transfer process to our regional trauma center. Our patient remained upset by his NPO status. His Pepsi out of reach, he jabbed my order “two of morphine IV, and give it again until it works” as requests for more analgesia. We loved him from the start. But he was nearing mascot status with his pithy sarcasm and recounting of the morning’s events. He was successfully transferred and his father-in-law was discharged with rib fracture precautions and treatment.

The same team was back when our patient arrived at triage on the way home from the trauma center. He was thankful and said the doctors at the trauma center reported that we saved his hand. I thanked him and wished him a speedy recovery.

As I sat down next to my PA and casually remarked the guy from yesterday was just here and looked good, my PA jumped up and sped thru triage. He returned with a wide smile; when I inquired he replied “I asked him if he got his Pepsi.” The patient said he’d been assured he would get one if had still wanted it.

With this tale of near insurmountable ability to cope, the medical students grasp the prudent layperson standard that we will lie down and die for. The next time you have no idea what to do with a routine complaint that has been plaguing someone for decades, take heart. You only need to improve the patient’s coping ability enough to make it to definitive care.

Dr. Carter is an attending physician at the Southern Ohio Medical Center Emergency Department in Portsmouth.