Time to Bite Your Tongue

I saw a patient in consult regarding her back pain a few months ago.

She was accompanied by her husband and actually when I saw the husband, my heart sank at the prospect that he might be my consult. He was morbidly obese with no neck and breathed very loudly. Sleep apnea until proven otherwise, I thought and I suspect his wife has not slept thru the night in the last 10 years.

Her family doc gave me some background. She had previous back surgery and complained mostly of low back pain with no leg pain. This was reasonably well-controlled with a modest dose of morphine and the family doc only wanted to see if I thought some type of block might help her. He also mentioned she looked after 8 children, 7 of hers fathered by her current husband and 1 of her husband's by a previous relationship.

I talked to her and examined her. She really didn't have a lot a findings and talking to her I got the sense that her pain was pretty well-controlled and nothing I could do was going to help her. So I gave her my "you're doing really well, nothing I can add to your treatment is likely to improve where you are' spiel.

At this point the husband awoke from his torpor. "Damn it", he said, "Don't you know she has to look after 8 children?"

Now what I should have said at this point was:

"So Mr. Doesn't-believe-in-birth-control? Why don't you get off your butt and help your wife out around the home?"

But I am such a wimp in matters like this.