The Waiter
So a well-known frequent-flying sickle cell princess is finally brought back into a room after a 3 hour wait in triage. I actually have a soft spot for these patients somewhere deep inside my crusty facade, because unlike many other chronic conditions that cause mystery pain, this disease actually harms those who are afflicted with it. You never see an old sickler, and it's rare to see even a middle-aged one. So I consider these patients to have terminal illnesses, and I have no problem giving them as much pain medication as they want or need.
And I hate to see them wait so long before they get treated too, but as usual, we were doing the best we could that day. Sicklers typically suffer alone; their families must have learned long ago that there are better places to spend half a day than sitting by the bedside of an alternately moaning, complaining, and snoring chronic pain patient, even if it happens to be someone they love. So the families usually just drop them off in triage, and hopefully they are available to pick them up if the patient improves enough to go home.
But not this guy.
She had literally been in the room all of 2 minutes, just long enough for me to check when she was last discharged from the hospital (one week prior) and look over the meds she had received during her last ER visit (about a pound of morphine), when her boyfriend was already at the nurses' station, asking when she was going to see the doctor.
So I went to see her and then came directly out to enter the medication orders in the computer. I'm just starting to type my note, when he's back at the desk, asking when she is going to get her shot. It'll be just a couple of minutes, I tell him. It's already ordered. As it is ordered, so shall it be done.
Two minutes after the shot, as the nurse is charting, he comes out again to ask for a cup of water for her. Five minutes later, it's a warm blanket. Then a sandwich. One of the other nurses tossed some slippers on the counter, just in case.
"Dude, she's got you running all over the place," I told him. "We'll get her whatever she wants, but maybe you could ask her to make a list or something so we can take care of it all at once."
Maybe we need a menu.
posted by scalpel at 7:31 PM
7 Comments:
You forgot to include the benzo platter on your menu. What kind of restaurant, I mean hospital, are you running anyway?
MJ
We've had a few sicklers who also are drug seekers, and we have to figure out when their pain is real and when they're faking.
We had identical twins who, when one had a sickle cell crisis and got admitted, the well twin would come "visit" the sick twin. They would swap clothes, the "well" twin would get in the bed, get a dose of dilaudid and some PRN meds for breakthrough pain, and the "sick" twin would go out for a smoke and some Mickey D's.
When I was a new nurse I had "them" as a patient. I finally figured it out when I kept having to put new ID bands on my patient because they "fell off." We ended up getting a witness to their antics by putting the "sick" patient in one of our few four-bedded rooms and putting a tech in there to "watch" one of the other patients in the room. She got to see them change clothes in the bathroom.
We used to have a group of sicklers who would tour the hospitals for their Dilaudid so they could sell their scrips on the street. One of them, it was real easy to tell when he was really sick: he's get all anxious and his SPO2 would bottom out. One weekend he showed up in police custody so we looked him up and saw he was on lifetime probation for delivery of controlled substances. I figured that would be the last of him for a while but on Monday he was out of jail and back seeking narcotics. The state wanted nothing to do with him and his insatiable apetite for drugs.
This is an honest question:
During the migraine wars, my interpretation of your stance was As follows: even with a "real" migraine the patient may be in a lot of pain but it was not life threatening. Thus, you did not mind if the patient had to wait a long time for meds because there were people who were a higher priority (MI, etc.). This made some sense to me. People don't die from migraine pain - thus they are not a priority in an ER. Sad, but true.
Yet, you appear to have more sympathy for sickle cell patients. You even call out their pain as real versus migraine pain which is a "mystery." True, sickle cell patients (sadly) will have a reduced lifespan, and this is tragic. But their pain alone does not reduce that lifespan - at least no more than other chronic pain suffers (I believe).
But, you even say that you hate it when they have to wait for treatment. Why? If I understand the science correctly (and forgive me if I am wrong), the patient will not die if the pain is not treated. Plus, it would appear that drug seekers exist in this population as well.
My question: in an ER setting, with non life-threatening, chronic pain, why do you feel sickle cell patients are more important than migraine ones?
Sickle cell patients need to be aggressively hydrated and oxygenated in addition to their pain control, and the sooner we start that process, the sooner they will get better and the less likely they are to have complications.
They often require blood transfusions, and the onset of a pain crisis absolutely can indicate a life-threatening condition that warrants prompt attention.
I have sympathy for every patient who is suffering, but my primary goal is to prevent death and disability. So patients who are simply in pain without much likelihood of impending doom will always have to wait until I have stabilized or at least initiated treatment on those in danger.
I appreciate your response. I thought the pain was an unavoidable and unfortunate consequence of the disease that was independent of other life-threatening complications. Thank you for clarifying (and correcting my misconception).
Here's an abstract of a study that details the early mortality of sickle cell patients, one third of whom died during an acute sickle cell crisis.
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