Letter from a Chronic Pain Sufferer
I get letters like this from time to time, so I thought I'd share this excerpted one along with my reply.
Doc,
During a flare where my pain is intolerable, how can I present myself at my local ER/ED to where I don't have to go through an hour of verbal jousting with the doc, even when I bring my pain contract and a personal letter from my neurologist explaining the situation and giving directions for treatment? I take along all meds with me, including the Actiq suckers so the doc can see when it was prescribed, when it was filled and how many suckers I have left.
You struck a chord with me with your comment to the effect of leaving someone in the waiting room for an extended time because they are seeking pain control.
I really am asking for your honest opinion here.
Thank you,
A Reader
First, I don't believe I ever wrote that I would leave someone in the waiting room because they were seeking pain control. However, someone with pain might have to wait in the waiting room a long time if we're busy and if they don't have a life or limb threatening condition. That's just the way it is. And if that person acts out or is rude or abusive to the staff, then they might wait longer than they would otherwise. That's just the way it is too.
Second, you should understand that ER docs don't take orders from Neurologists or pain doctors who aren't on staff, particularly in letter form. If you have a letter which either recommends specific heavy-duty narcotic treatment or is an open-ended "give him whatever he needs for pain" then you might be better off not flashing it around to everyone and expecting us to follow it like it were etched in stone, because it's just as likely to have the opposite effect. A letter that details your medical condition and some of your test results would be better received. There are plenty of unsavory doctors who write the first type of letter, and we hate them.
Third, I wonder what your goal of coming to the ER is. At best, you might get a shot or two providing a maximum 4-6 hours of relief, then you're right back where you started. If you come to a new ER with certain types of pain, they're likely to order lots of expensive tests to work you up for dangerous conditions, which will cost you a bundle and delay your pain therapy. You already have Actiq, and no ER doc is going to prescribe anything stronger than that for you to take at home. You might be better off trying to arrange better pain management from your personal physician.
How to present yourself if you do decide to come to the ER? Just be polite, be patient, be honest, and don't try to BS anyone. If you do those things (as it seems that you already are) and you still aren't able to receive appropriate treatment, then you should write a calm and rational letter to the hospital administrators explaining your dissatisfaction with your treatment. I don't think complaining to the administrators at the time of service helps much, and the letters honestly probably don't help much either, but if the hospital gets enough letters from different people then they might make a difference eventually.
Unfortunately for people who suffer from chronic pain and seek care in the ER, their condition is not (usually) a true emergency, and their management is purely dependent on the mercy of the individual physician they draw that visit. Some docs are assholes, but even the ones who aren't are often cranky, tired, busy, or stressed out from time to time. The bottom line is that we are under no obligation to give anyone narcotics ever, so once an emergency medical condition has been ruled out, then all we really have to give anyone is our advice. Anything more than that is personal preference and medical judgment, which is quite variable (as you have undoubtedly discovered).
Good luck with your condition, I hope you get some relief.
-scalpel
Doc,
During a flare where my pain is intolerable, how can I present myself at my local ER/ED to where I don't have to go through an hour of verbal jousting with the doc, even when I bring my pain contract and a personal letter from my neurologist explaining the situation and giving directions for treatment? I take along all meds with me, including the Actiq suckers so the doc can see when it was prescribed, when it was filled and how many suckers I have left.
You struck a chord with me with your comment to the effect of leaving someone in the waiting room for an extended time because they are seeking pain control.
I really am asking for your honest opinion here.
Thank you,
A Reader
First, I don't believe I ever wrote that I would leave someone in the waiting room because they were seeking pain control. However, someone with pain might have to wait in the waiting room a long time if we're busy and if they don't have a life or limb threatening condition. That's just the way it is. And if that person acts out or is rude or abusive to the staff, then they might wait longer than they would otherwise. That's just the way it is too.
Second, you should understand that ER docs don't take orders from Neurologists or pain doctors who aren't on staff, particularly in letter form. If you have a letter which either recommends specific heavy-duty narcotic treatment or is an open-ended "give him whatever he needs for pain" then you might be better off not flashing it around to everyone and expecting us to follow it like it were etched in stone, because it's just as likely to have the opposite effect. A letter that details your medical condition and some of your test results would be better received. There are plenty of unsavory doctors who write the first type of letter, and we hate them.
Third, I wonder what your goal of coming to the ER is. At best, you might get a shot or two providing a maximum 4-6 hours of relief, then you're right back where you started. If you come to a new ER with certain types of pain, they're likely to order lots of expensive tests to work you up for dangerous conditions, which will cost you a bundle and delay your pain therapy. You already have Actiq, and no ER doc is going to prescribe anything stronger than that for you to take at home. You might be better off trying to arrange better pain management from your personal physician.
How to present yourself if you do decide to come to the ER? Just be polite, be patient, be honest, and don't try to BS anyone. If you do those things (as it seems that you already are) and you still aren't able to receive appropriate treatment, then you should write a calm and rational letter to the hospital administrators explaining your dissatisfaction with your treatment. I don't think complaining to the administrators at the time of service helps much, and the letters honestly probably don't help much either, but if the hospital gets enough letters from different people then they might make a difference eventually.
Unfortunately for people who suffer from chronic pain and seek care in the ER, their condition is not (usually) a true emergency, and their management is purely dependent on the mercy of the individual physician they draw that visit. Some docs are assholes, but even the ones who aren't are often cranky, tired, busy, or stressed out from time to time. The bottom line is that we are under no obligation to give anyone narcotics ever, so once an emergency medical condition has been ruled out, then all we really have to give anyone is our advice. Anything more than that is personal preference and medical judgment, which is quite variable (as you have undoubtedly discovered).
Good luck with your condition, I hope you get some relief.
-scalpel
posted by scalpel at 1:36 PM
62 Comments:
This is the saddest thing I've read in a long long while. It makes me wonder whether you guys really want to help. But thanks for the honesty. I guess I just might kill myself should I ever find myself in the same situation as your reader. I'm pretty sure that doesn't impress you or scare you much anyway.
Why would it impress me or scare me at all?
Chronic pain, remember, by definition is not an emergency.
Here is the dictionary definition of "emergency":
1. A serious situation or occurrence that happens unexpectedly and demands immediate action.
If you have chronic pain, your pain is not unexpected; even if you have "flares", they are not unexpected either if they are part of your "syndrome". A fibromyalgia flare or whatever does not demand immediate action, especially when one already has access to a myriad of controlled substances and a specialist who apparently knows exactly what to do for you.
admitments
I'm rarely too busy for patients. And if I am, I've got plenty of room, and I've never, ever had a complaint from them about waiting to see me.
admitments - perhaps you would be better off being seen for your suicidal thoughts.....
Why is it that every single time someone asks you for your professional opinion that nurse K feels the need to answewr as though she were the doctor and not you?
She just clarified what I already wrote. I don't mind at all; in fact I appreciate her excellence.
Part of the problem I have is why would someone who has a specialist who is already seeing them for their condition need to go to the ER fro treatment? Seriously - flare or not, WTF is that? All you're clearly wanting is to be given drugs and you're using the ER as a drug dealer, just like a migraineur who "ran out" of their meds. If that's truly the case, deal with the situation, take better care to get your meds filled, and see your doc who knows about you more than the poor ER staff.
I don't see how, in this post or any previous one, or on any other blog, that the doctors ever indicate they don't "really want to help."
What they DO indicate is that they have a lot of people to deal with and treat, and they pretty much HAVE to take them in order of severity.
There's absolutely nothing that can be done about that, it's the nature of the emergency room. It's like complaining about gravity!
The only way to improve response time for non-critical patients would be to add doctors/nurses/rooms -- and that is out of their hands.
Complicating this equation, and slowing the process down, are the various people who are after drugs for invalid reasons.
I'm just glad I don't have chronic pain.
Well, I do but nothing that would send me to the ER.
Is the truth that we just can't relieve some pain no matter what meds are available?
I'm wondering if it's the science that's lacking and not the care.
M
I had a vasospastic migraine at my work, and got sent to the ED. I guess I must have looked pretty pathetic, because the Doctor gave me Demerol and Vistaril, even though I told him they only lasted around 4 hours and all I needed was something for the vomiting. I deeply appreciated their help. Damn that stuff works. I'd been worked up in the past (CT, LP, etc...), and had these migraines for years. I NEVER dreamed of tying up an ED for something I knew wasn't truly an emergency. (Inderal finally fixed them after I blushingly told my GP that orgasm was a trigger - among others... I wasn't having sex at work!.)
Sometime later I had a date with a drunk Dodge Ram and got a comminuted humerus fracture for my trouble. THAT time I was not shy about pain meds.
Everyone should have to work in a hospital at some time in their lives.
Scalpel, I think you rock.
~Faithfully, Shari Ann
MedStudentGod (MSG) said...
Part of the problem I have is why would someone who has a specialist who is already seeing them for their condition need to go to the ER fro treatment? Seriously - flare or not, WTF is that? All you're clearly wanting is to be given drugs and you're using the ER as a drug dealer, just like a migraineur who "ran out" of their meds. If that's truly the case, deal with the situation, take better care to get your meds filled, and see your doc who knows about you more than the poor ER staff.
It was my letter that the doc posted, so I'll respond to this.
I don't want pain meds, I HAVE pain meds. I want something to make the pain recede for a bit. The part of the letter that you didn't read stated that I took my pain med (Actiq 600mcg PRN every 4 hours) prescription with me for the doctor to see that I really do have an Rx for it, when it was last filled, how many suckers it was filled with and how many suckers I have left (I had 8 out of 12 left on my last visit).
Upon whose advice did I go to the ER? My Neurologist's advice. I did not go on a whim.
It's stated in my pain contract with him that I am to go to the ER if he is unavailable to help me, and out of the two times that I have gone to the ER for help, the first time he was out of state and the second time he told me over the phone to go to the ER and have the reports from there forwarded to him.
And just so we are clear, I just finished two days of testing at Cleveland Clinic in Cleveland, Ohio last week. After conducting an EMG/NCV (my first one at CCF, my fourth one overall), they documented in writing "gross neuropathy with unknown etiology." Their written advice? Aggressive treatment with pain meds and use of the ER to treat breakthrough pain. I went to the ER on the advice of my Neurologist, who is Chairman of the Neurology Department and a specialist in movement disorders for a large university that runs their own teaching hospitals in my state.
My letter to the doc here was not a complaint letter about a lack of caring in the medical community. I didn't whine or try to weasel advice out of him (her?). It was asking him for his advice about how I can present myself , if needed, to my ER department for help with chronic pain when the situation is warranted, and show them that I am being honest about why I am there (to break my pain cycle), that I am not a drug seeker because I would have just stayed home at ingested my Actiq if I wanted a drug of some sort, and that I feel I have no where else to turn for help at that particular time.
BTW, I do have a therapist that I see regularly to watch me for signs of depression and mental illness, none of which she sees in me according to her regular reports to my Neurologist (just in case you were wondering).
nurse k said...A fibromyalgia flare or whatever does not demand immediate action, especially when one already has access to a myriad of controlled substances and a specialist who apparently knows exactly what to do for you.
Thank you for diagnosing me from a couple snippets of a letter. I am not discounting your medical knowledge or experience, just expressing my frustration that you have been forced to become so cynical in your career. I think I love you.
I posted this comment at Nurse K's site, but I'll repeat it here:
Part of the problem is the relative scarcity of truly good pain specialists. A fairly large subset of them are just pill-pushers who have a limited desire (or ability) to actually manage their patients' pain. Others specialize in more exotic injections of limited benefit because they can charge more for the procedure then just writing scripts. So there are many mismanaged patients who simply don't know what to do when they are still in pain. There definitely can be flareups of chronic pain, but proper management can reduce the frequency of those flareups and perhaps allow them to be managed at home.
I don't begrudge these patients the occasional ER visit. I only ask them to have reasonable expectations about what we can do for them in the ER, and to be patient and polite during their visit.
I went to the ER on the advice of my Neurologist
Remember, just saying "my doctor sent me in" doesn't mean anything. Half the people in my lobby at any given moment were sent in by their clinic or some nurse on a triage line or came in because their doctor didn't return a phone call or was out of town, etc.
If your doctor feels strongly that you need something in particular that can only be delivered in an emergency dept, he should call and speak with one of our physicians and give them a heads up that you're coming and what he thinks should be done. That's less shady than showing up and asking for more meds yourself.
I think the issue here is one of consent ... the Cleveland Clinic or your Neurology chair cannot consent on the behalf of any random ED to the participation of that ED in your pain management program.
So, actually, your treating docs are setting you up for failure by creating an "ED clause" in your pain management program, without actually clearing your pain plan ahead of time with their ED department and getting their ED to agree.
It's no more realistic to expect the ED to do what you tell them your neurologist recommended they do than it would be realistic for me to expect your neurologist to go along with me if I showed up at his office and told him to give me 20 Xanax because the ED doc told me I have tinnitus and Xanax will help. Your neurologist would have to work me up himself, and then make a judgment based on his work-up. That's what doctors do- that's what we *want* doctors to do.
Your belief that the ED will be of any use in a pain crisis is not realistic, regardless of your behavior. Politeness and patience, while always admirable, are not going to get you what you seek.
So, what are more realistic options for the pain crisis care you are seeking? Talk with your doc. Ask him to set up a plan where if you go to the ED of his teaching hospital (and *only* that ED, because that's the only one where he has the power to make this plan work), the ED will automatically page the neurology resident who will come evaluate you in the ED and admit you to the neurology service if needed, where you can receive treatment according to your pain management protocol. As Chair of Neurology, he has the power to make that happen. He may not have the *will* to make it happen, as it is more work and cost for *him and his service* rather than more work for the *ED,* but that's a different problem ...
And, very cool to see you back in the blogosphere Nurse K!
Part of the problem is the relative scarcity of truly good pain specialists.
This has been my experience so far, unfortunately.
I do agree that the ER is not the best venue for treating ongoing pain, but I think many people find themselves scared and desperate and with no place else to turn for help.
I'm a patient who sees a neurologist for a painful condition, and I don't understand the treatment plan that calls for ED to be part of the plan. Why isn't the neurologist able to handle unexpected flares? Is it because he's Chair of the department at a teaching hospital, so he can't be bothered with dealing with patients after hours?
My experience dealing with my chronic condition is that I've gotten more attentive care seeing private neurologists located in the suburbs, compared to seeing specialists at large teaching hospitals, who by and large seemed disinterested and too prone to slough off their work onto overworked residents.
Giving you instructions to go to the ED when you are at your worst is a recipe for failure. It's like the neurologists are saying that they'll treat you, but only during office hours, when it's most convenient for them.
What has helped me out the most, in my quest to get better control of my condition, was joining a neuropathy support group, where I was able to hear directly from other patients what their experiences were with various doctors and treatments. This has been the major reason that I was able to get myself off of the teaching hospital merry-go-round, where I literally was going in circles and getting nowhere.
Interesting post and comments!
Someone who's gotten to the point of actually having a pain contract has likely gone through many doctors, dozens of office visits, and the expense, discomfort, despair and time cost of batteries of diagnostic tests. They've got drugs. They know what doesn't work. They've got diagnoses. They've got PAIN and they've lived with it. And now, late on some evening, it just gets UNBEARABLE. You know? Ever been there? Admitments talks about suicide being an option. Ever been there? Ever hurt that much for so long? And now, late on some evening it gets even worse. And they go somewhere, the only place where there are doctors on duty. Make sense?
No. Nurse K says "You Fail". You've obviously made some mistake. You settled for the wrong doctor. You've been to 35 doctors but you should have held out for doctor number 36. Shame on you. Chronic pain is not an emergency. What were you thinking?
Scapel,
You need to get out of the er.You are too much of a risk to be giving care there and way to uninformed.
How I wish someone would bang you upside the head with a frying pan every day when you get up and at least 5-10 times throughout the day when you least expect it.That pain still would not come close to what a chronic migraineur goes through that has a high level migraine constantly.
Then,you need to be sick and dizzy every time you move your head so that you throw up so bad that you are dry heaving.Then your head needs to feel like it's going to burst because the pain level was so high to begin with,now with dry heaving,you try to scream and throw up at the same time.
Then you need to go to the er and not be able to speak and say how much pain you're in.Then you need to go into convulsions because the pain is so bad.Then you need a doctor,identical to you,come up,grab you by the arms and tell you to stop that.
At that point they need to put you in the brightest room they have,I know,the one where they put on casts.And after you get set in a fetal postion,the nurse comes in and says they need the room,and they move you.Only when you go to get up,the room spins and down you go.Your head is killing you,you want help,you want to speak,but can't.They throw you in a wheelchair,half way conscious.
They stick you in another room and some time later,they wander in and say oh,a headache,we'll give you a shot.Your wife is now there and asks what if the shot doesn't work,because you usually get an iv.The doctor says,oh,the shot takes at least an hour to work and we need this bed for sick people.So they drug you up.Your pain is still at the same level,but you can't speak because they've drugged you into shutting up.So the invisible frying pan,that somehow never leaves a mark keeps banging at your head.
But nobody cares,even though it is a fact that a status migraine can cause stroke,even though so much research shows migraine is a real disease,doctors like you don't care.
I hope you become a migrainuer.I hope you get it so bad that it never stops.I hope it goes to the highest level so that you want to put a gun to your head to make it stop and that no one cares.And that they tell you that you don't matter.
I hope it for you and everyone with the same attitude that you have.I hope that it happens to you soon.I hope your life becomes a living hell,so that all you want to do is die.No one deserves it more.You are ignorant.You deserve the pain.And you deserve it now and for you to never get releif no matter what treatment you seek.
You are an educated idiot.There is so much information out there about migraine.But you don't want to be informed.You want to sit on a throne and judge.I hope the throne that becomes your closest friend is a toilet that you're dry heaving into.
You've made yourself judge,jury,and hangman.I hope I see you hanging right there with the rest of us.
You've earned every bit of whiny "frying pan pain" you have ever had for wishing discomfort and misfortune on others. That's the difference between me and you, and why I'm "in the ER" and why you are in the waiting room at the end of the line behind the truly sick and injured people.
Get a clue, fucktard.
How are you able to be so polite to these anonymous posters? This one reminds me of your old friend Payne
Hey Joints,
What would Scapel know about being polite,doesn't matter if you give your name,he's still an ass and so are you.I wish for you the same as I wish for him.
He thinks because he's a doctor he's a god.If he hates the er patients so much,he needs to get out.And if you are in any way working with er patients blow it out your ass.
You've earned every bit of whiny "frying pan pain" you have ever had for wishing discomfort and misfortune on others. That's the difference between me and you, and why I'm "in the ER" and why you are in the waiting room at the end of the line behind the truly sick and injured people.
Wow,that hurt.You really are a dumb ass.Take your degree and wipe your ass with it.Wishing discomfort,no,I don't wish you discomfort,I want you to suffer the tortures of hell.I want you to feel what you try to make people feel with just your words,let alone your ignorance.You are a disgrace to the human race.
I may wish this on you,but you bring it to people.And by the way,how the hell do you know what I do?You are a coward.
If I diserve this for wishing,imagine what you deserve you scumbag.
Oh my,big shot."That's the difference between me and you, and why I'm "in the ER" and why you are in the waiting room at the end of the line behind the truly sick and injured people." Truly sick,that would be you.The thought of you treating any paitient for anything is disgusting.
You are a self centered moron.And nurse k,chronic pain by definition is not an emergency.Define this.Stick your head in a doorway.Now,slam the door on your head about 20 times.How do you feel.Better yet,do it to scapel and don't treat him.
Migraine is a disease.It's not just chronic pain.
As I read scapel's idiotic writings,I'd say he's a disease that needs to be gotten rid of.
It's bad enough to put up with the pain,throw up for hours then have to face a pain in the ass like scapel.It's doctors like him that make people go home and slit their wrists due to the mistreatment he enjoys giving out.
He needs to be banned from coming near any patient ever.What a dumb ass.
The torturous hell you suffer is of your own creation. Only when you realize that will you be healed.
Speaking of bans, name-calling trolls will be banned from my blog and automatically redirected to this site.
Heh.
Scalpel,
I wanted to thank you for this. I am a chronic pain patient who has noticed that all too often doctors do not want to carry certain meds in their clinic (so they send you to the ER when they think a high dose dilaudid shot would help) or only see a certain number of patients per day (so they send you to the ER when their appointment slots are full) or are undereducated but trying to do some good (but again, don't know what to do so send the patient to the ER).
I am very thankful for the good pain docs. I am very thankful for the ER docs that are willing to take the extra step that probably the Pain Management doc should have taken (calling and paging the Pain Med Doc to figure out a plan).
I am sure you have been burned more than once by drug seekers, but you still seem caring and compassionate and willing to do what you think is best for your patients.
Thank You!
Why in the world would you need to come to the ER if you have Fentanyl lollipops? Fentanyl is more potent than Dilaudid. And how is it that all these people who have such severe unrelenting headaches manage to spend so much time in front of a computer screen?
ERNursey took the lollipop out of my mouth! Fentanyl 'pops are used for breakthrough pain so what do they expect in the ER, sufentanyl? A "you're gonna go to sleep no matter what" cocktail? MRI-guided injection of lidocaine to the brain stem? I mean WTF?
Pain is considered a vital sign, but it's the last sign to consider for a reason.
WOW!!! Am I greatful for my ER staff. I suffer from frequent migraines. Most of them can be controlled at home. I have a great team of educated and compassionate doctors including a neuro, PCP, ob/gyn and yes, a great pain management doctor (who is on staff but I had no idea this was a requirement.) This team has taken me from daily migraines (and no not rebound headaches but daily migraines) to less frequent migraines.
I still get them and sometimes none of the meds I have at home will touch it. I wait. Sometimes too long. Usually because I am throwing up so much that I cannot leave the bathroom. Doc tells me to go to the ER because after all these years even he knows the only thing that works is IV Fluids and meds.
At some point my husband carries me to the car and drives me to the ER. All of the nurses are very understanding and compassionate. If there is no bed they lead me to a "secret spot" where I can actually lay down and there is a bathroom very close by. I try to answer the questions, hubby tries to talk for me.
The usual IV's, fluids, anti-nausea meds, ativan, pain meds, sometimes different ones because what worked last time may not work this time but they keep trying. I don't get to go home until the damn thing is gone. Finally I can see, I can talk, I can hold down a sip of water.
It is over. I live in fear of the next one. They only hit a few times a year but I live in fear. I would not wish this hellish pain on my worst enemy. It is blinding and unrelenting. Nope, no one should have to suffer this way. Thankfully the staff at my ER feel the same way.
I never realized this experience was not the norm. I now volunteer at the same ER who has saved our lives more than enough times. I see that they treat everyone with dignity, compassion and respect.
I do understand where both Scalpel & Nurse K are coming from. I cannot imagine the ordeal of dealing with drug seekers, risking your careers for that one wrong judgement call. I am sorry that dealing with these types of patients has resulted in them coming across as less compassionate and understanding. I hope that this is just something that spills out in their blogs as they vent and not a preview of how I would be greeted at their ER's.
Reading some of these doc & nurse blogs that yes, are just "letting off steam" has been quite enlightening. Most surprising has been the nursing blogs. My grandmother was a nurse. She continued to volunteer until she passed away. I never heard her talk about her patients the way some of these bloggers do. Again this just has to be what is coming accross on these blogs. NOT how they act in real life? Please tell me it ain't so.....
Quote:
"And how is it that all these people who have such severe unrelenting headaches manage to spend so much time in front of a computer screen?"
It's not severe all the time. I do normal things when my pain is mild, even semi-normal things when it's moderate. Pain fluctuates. And not all migraineurs are light sensitive. The light of a computer screen or a tv doesn't bother me. Sound, touch, and smell do. We're all different. But you're an educated healthcare provider, so you already knew that...........
***NEWSFLASH***
You have to WANT to get better.
Many patients have dysfunctions that are part of their pathology. The fact that some commenters are indeed quite ill, does not mean that illness allows them to see that it is a "mind" not a "body" problem. I don't think a turf is the answer, because they will be a thorn in the side of the only doc willing to take care of them. And I can't tell you how often that is "your truly".
http://executivephysician.blogspot.com/2007/12/chronic-pain-malingering-and-difficult.html
Although Scalpel, I do believe you when you get patients no , not patients, but druggies in the ER, not only do they take up valuable time and away from the needy patients who don't have family with them there are scared hurting, and needing your support not just meds but words of comfort etc, then thats where I would draw the line too if I were a doc in the ER,they need to get help from a place where they can be properley treated for their addiction, not the ER, that would make my blood boil, and for that I would do what you would do !! I suffer from chronic pain, and yes it is difficult, but I would only go to the ER if something occurs where I really do need to get some relief, and have exhausted all other measures, but again, I would be more than happy to wait my turn (you caring for the serious patrients first, and once stable that it be my turn to get some relief ! good luck in your job!!
I had one migraine, after the chiro "cracked my neck" it happened within a half hour. lasted for 4 days, then when I had had enough I couldn't take it no more I went to the ER, I was throwing up , and I seemed to be melting off my chair, well they took me in right away, did a cat scan, had to wait semmed like hours for the results came back ( make sure no annurisum) before they gave me a shot thru the IV, after 3 shots, it finally retracted(I could still feel the pounding but it wasn't as painful but it was still there, after 4 days of this, there was no way for it to just disappea, I finally was able to pass out (exhausted from the pain) and they let me sleep a good few hours before they asked me if I was feeling better enough to go home ! I said Yes, and Thank You, I have never had a migraine like that one ever, and thank the good Lord I havn't had one since, I no longer see a chiro!!! now would you have treated me as those ER docs did?? just curious? Thanks for your time on this.
Well, worked in the medical field for 16 years. I don't mince words.
Scalpel, time for a new job friend, not everyone is bad but I'll relay a story that may warm your heart because it is like something you *sound* like you'd do. Got referred to a neuro doc for migraines. I tried Inderal, everything. Nothing worked. He told me to be a 'man' about it and quit seeking pain meds. I never asked his ass for any to begin with because I think all of you all have an attitude problem, nearly. So, forward the clock two years and he's under my care for HIV/AIDS and a horrible chylothorax and loculated air. He has a splitting headache and screamed at me to get his F'n Percocet back to him. Well, two years prior he told me to take a Bufferin, so I said take a Bufferin and left him there. He is now deceased. I thought you'd like that.
Look, I got burned out and left. Worked ER at a level one trauma for 16 years, you need to go man. Go do your plastics plant thing.
Best of luck,
Tim
If I ever get desperate enough to take vocational advice from burnt out ex-respiratory therapists who don't even know me, then it will definitely be time to do something else.
I figure that level of senility is at least 20 years away.
Merry Christmas!
Really? God man, I wish I were as cool as you.
Welp, you just keep delivering that good care you give, cuz you're the best.
You don't 'know' the people you deal with either, which, I understand is part of the problem, seriously, I do. I can see the problems it presents. But your attitude determines your altitude and yours is poor, troop. Piss poor. I'm just telling you how it is, that's all. Don't get all wet in the britches. You tell me all I need to know about you when you and your posters use words like 'punitive' in relation to your patients and patient care.
You confirm I treated your collegue in the correct manner.
You have a Merry Christmas too :)
Scalpel !! you didn't answer my question?? ( the migrainer in the above post ) would you have treated me in the same manner as they did?? I am still curious, Thanks for your time!!
oh never mind! I saw your other post and indeed noted your answer, and that would be YES!!!
I go to the ER with migraines when the drugs that my regular doctors have given me do not work. When in the throes of a migraine I cannot take in any food or fluids and the bad ones can last days. I think not being able to hold down fluids for over 24 hours is reason enough to go to the ER. Quite often I wish they would just give me a saline drip so that dehydration doesn't cause the migraine to continue.
If I have run out of meds it's because I often get a run of migraines, with many happening with short breaks in between. If this happens over a holiday weekend, then my regular doctor is unavailable. My regular doctors also won't give me higher quantities of meds. So I cannot see how running out of meds in that situation is my fault.
Nurse whatever - you obviously have no idea what FM is really like. At my worse pain (way worse than a broken bone, the only "emergency" I have had to compare it to), I have nearly killed myself because I couldn't cope with the pain. And no, I do not suffer from clinical depression. I have certainly passed out from it and lost control from it. I am lucky in that my FM is now managed by a specialist. But they are few and far between and for many years I was under the care of docs that I now realise I should have sued for malpractice.
I no longer go to the ER unless I know that there is definitely something they can do and that I am in such a bad case that I can't do without whatever that is. I have had so many bad experiences at the ER with incompetent and uncaring staff (often nurses) that I wouldn't wish a visit there on anyone.
Having said all that, I didn't have an issue with the original post. Maybe I should be commenting to nurse k not scalpel?
Gosh. I do hope this is the US system that you are all talking about. What a sorry excuse for a medical profession. I am a chronic pain sufferer and it I fully understand the depths of agony that can arise from it. If your medical staff did not sell themselves so often to the rich and famous, catering to their every little nose bleed then perhaps they would have time for these poor unfortunates who have such pain issues. Open a suitcase of money in America and any doctor will love you but the poor can die in agony. Great medical profession, NOT.
Scalpel you would not last five minutes in the UK. They would strike you off for having no concept of what it is to be 'sick'. I cannot get over what you are saying to the guy with the migraine. You should really be locked up and the key thrown away and maybe for good measure injected with something really nasty. A disgrace. It makes me wonder if you are really a qualified medical guy. Sounds like you are pretty stupid whatever your qualifications.
Injected with something really nasty?
So striking me off the medical rolls of your inferior country and sentencing me to a life prison term wouldn't be enough punishment for someone like me, eh? You want me to have a nasty injection too.
Just don't make me eat your nasty black pudding. A man can only take so much.
Scapel and Nurse K: I remember the day I knew it was time to leave teaching and surely you must know it is time to leave the medical profession. Your cynicism is at best pathetic and at worse, dangerous. I can tell from your posts that you are listening to your patients, but you are not hearing them. It happens in every profession. Your lack of empathy (as mine towards my former students) is screaming of burnout. As a former chronic migraine patient (hysterectomy got rid of 75% of them), I can tell you that although I avoided emergency rooms like the plague, sometimes they are just unavoidable. When a migraine patient's medication is midrin or one of the others in the same group, it doesn't take much to break through those medicines. Frankly, I was delighted when Toradol came out, one shot, relief in 30 to 40 minutes, and out the door. It is unfornate that Toradol can't be taken in pill form. But every once in a while, even the Toradol can't break through the pain. Chronic pain patients are not addicts, the research is quite clear on that. I'm not sure where you are getting your information. There is addiction - taking pain medication for the high, physical dependence - consequence of taking pain medication for a long period of time and pseudo drug-seeking in patients who are being undertreated. Perhaps your anger and cynicism should be directed towards the DEA which has caused the untreatment of pain in this country since 2002. I would suggest educating yourself through the American Pain Foundation and the Chronic Pain Network. I leave you with two thoughts: If I would a six-years-old with a migraine (my son started getting them at age 4), you would be running to get pain relief for him. Second thought - I complained for months to any doctor that would listen of worsening headaches, dizziness, blind spots, etc. and would given such things as ibuprofen, handouts on migraines and handouts on dizzy special. End result - retinal artery stroke that has blinded my - caused my chronic migraines. To say that doctors missed the boat is an understatement. I had all the symptoms, no one was listening. Because of a very empathetic neurologist, I did not sue the internal medicine doctor who missed the mounting symptoms. Not the first time I have been diagnosed - I am a zebra. Hope I have the pleasure of your misdiagnosis sometime, because I will go after you in civil court. I wonder what your attorney what think about all the evidence you post on this blog - perfect amunition for court. Good job and way to express your refusal to treat. Terrific stuff for court.
Good Luck, You'll need it.
Chronic pain patient and medical malpractice paralegal.
You hope I misdiagnose you so you can sue me?
Get some psychiatric help, then go fuck yourself.
That was quite the educated comeback. Psychiatry and then go fuck myself? Truly that was the best you could come up with? Did we hit a nerve? I showed this blog and your response to our law firm's team of psychiatrists. Their diagnosis - (as you and Nurse K are so fond of doing without all the facts)_ Narcissistic Personality Disorder. Terrific, you are a Plaintiff attorney's dream defendant. Good luck to ya because your worst nightmare will catch up with you.
"Just don't make me eat your nasty black pudding. A man can only take so much."
LMAO!!! That was just golden, Pony Boy!
My story will hopefully give hope to some of the CP patients who are unfairly labeled "head cases."
About 5 years ago, I started having bouts of severe runs and ungodly abdominal pain. No one could find anything wrong after two colonoscopies and numerous CT's. My primary care doc decided I just had IBS and gave me Bentyl, which did nothing for the runs or the pain. He refused to prescribe pain meds except for NSAIDs even though I was allergic to them. (He said he had a strict "no-narcotics" policy...he "hasn't ever prescribed a narcotic in his life, and he wasn't about to start with me"), I was in and out of the ER 17 times in one year at one point. The ER doctors called me a malingerer, drug-seeker, etc. One particular ER doctor did a rectal exam in a very rough, painful way for three minutes solid, and then told me to "remember this experience the next time I thought about sniffing around his ER for narcotics!" My PCP sent me to a shrink because "this pain stuff is all in you head and it's controlling your life. There's no pain medicine that can treat what's wrong with you."
In 5 years I had seen literally 15 specialists. One attack landed me in the ER after I started screaming in pain at a bus stop and a bystander evidently witnessed me threatening to kill a "ghost trying to eat my soul." This scared the crap out of me because my father had the same crap happen to him...it drove him to commit suicide. Needless to say that I was admitted.
I was given a PCA for two days, and they were about to just send me home when a young hospitalist looked at my chart and said to me, "I have never seen this disease before except in medical journals, but I think I may know what's wrong with you." He did a 24-hour urine save, and kept me in the hospital for another day, giving me whatever pain medicine it took to control my pain; he got it down to a tolerable level after adjusting the PCA thingie.
The next day, he came into my room, asked me about my pain and then asked if he could bring in some med students. I agreed, and wham! There must have been 15 people in there. It was then that he told me what he did with the urine. It sounds like he basically held my pee under a blacklight in a dark room and it lit up like a firefly's butt. He gave me a preliminary diagnosis of Acute Intermittent Porphyria. He then had the nurse draw a TON of blood, and the tests confirmed it. I stayed in the hospital for a week hooked up to the PCA and got Panhematin via IV and was put on a high carb diet. When I got better, I was discharged with a referral to a pain clinic (I'd been BEGGING my PCP for a pain referral for years, but he wouldn't hear of it since it was "all in my head.")
I recently sent the abusive ER doctor (and the hospital's patient advocate) copies of my test results along with a demand for an apology. Wanna place bets on whether or not the guy will nut up and apologize? The patient advocate sent a letter of apology...I'm thinking the doctor won't be so gracious.
Anyway, jsut thought I'd pass this along in hopes that the chronic pain patients here realize that there are good doctors out there, and here's hoping that some of the doctors think twice before writing patients in pain off as "head cases" so easily.
ArmBar!
Redhawk, as a former athlete who now has a chronic pain condition, I really want to be on your side but posts like that make it really tough to root for you
Being ill in a third world country opens a whole new perspective - you realize that you are the one with the problem, and possibly no one can help you - anger and a sense of entitlement become simply distractions
Oh my. I wandered to this blog via a Google search on Chronic Pain Syndrome.
Scalpel,
Anyone on any blog can pose as anything. Are you really a doctor or just play one on TV? You're surely not self-contained to be an emotionally healthy one. You seem rather troubled and full of anger and self-loathing leaking outward. If you are indeed one, you seem dangerous to your patients.
So too, nurse k. Any nurse who needs to quote the dictionary to define the parameters of emergency and what is or isn't individually tolerable, is indicative of hardened soul who needs to do some serious, long-term inner examination. There's a mean-spiritedness from you and scalpel that oozes all over these pages.
For those of you with chronic pain - I know it well - the long-term physical horrors and all the emotional pain it causes - as does the invalidation of others. Remember this - you never have to prove yourselves to others...this endless cycle of external invalidation internalized inward, is one of the more hurtful emotional by-products of living with chronic pain and dealing with others who simply don't understand...and can't understand.
The Bufferin situation was sweet justice in that only in the actual experience of hell can an invalidator gain some enlightment.
I'm not a doctor but have run a chronic pain website on and off now for years and have a long history of extremes of pain improperly identified and diagnosed. Been through the hell and back many of you described - for me, decades worth. It's been long road to arrive at the improved point I am now...but everyday is a battle. So that's some background.
For those of you with neuropathic pain, please ask your pain specialists about neuro-oriented meds - meds that target the central nervous system and "wiring" that has run amoke from years of unrelenting pain attack. There's pain - the symptom - and pain, the disease. Central nerve pain is horrific and I bet many of the long-term pain survivors here, have it. It sounds like many of you here experience reams of the latter (pain the disease )and is why relief is so fleeting. Those narcotics don't do enough cause they're probably not treating the disordered and broken-wired central nervous system attacked all these years from ongoing pain elsewhere. I am concerned that some of you are overly medicated on those things that aren't helping and setting you deeper into a black whole.
Baclofen, Neurontin, Depakote, Lyrica, Zanaflex can help neuropathic and central nerve syndromes. Due research, talk to your docs. Different people need different types and different combos...different amounts. Some help, some bring bad side effects. Do research on rebound headache...very important for some of you. Ask your doctors about program of preventatives to reduce migraine incidence and veracity. Do research on central pain, chronic pain syndrome...and I can't emphasis enough - rebound headache - medication induced headaches and it's very vicious cycle of hell.
Do think and observe out of the box. For instance, for me, a bowel med, Levsin .375 is a daily, multi-dosed utter must - if not, migraines are non-stop. This med controls a bowel oriented neuro problem - without it, it triggers central nerve reaction that triggers migraine. I weave through that and edometriosis and back surgeries and other things - deciphering the interaction and what's triggering what is a long term journey of discovery.
For those of you with chronic pain reading this - please, please divest yourselves of nasty people who invalidate and denigrate and don't want to learn and grow with you in relationship and healing. Long term chronic pain and the suffering it creates, does all sorts of things to self esteem and relationships with others..and self atop all the other dysfunctions we humans carry. So it's not just physical healing but emotional as well and divesting of victim mentality and dramatization.
Good luck to all of you. I wish you all well.
You won't find many ER staff who are interested in "learn(ing) and grow(ing) with you in relationship and healing" and we don't usually have the time or the inclination to "decipher the interaction and what's triggering what."
You either have an emergency medical condition or you don't. That's all we really care about. Your psychiatrist can figure out the rest.
Scalpel:
When it's 2:00 in the morning; when none of the migraine meds prescribed by doctor have been working (including the narcotics); and I am in excruciating pain, then yes that is an emergency and I have every right to go to the ER and be treated. And the meds you give me to help me get through the next 4-6 hours may be just what I need to make it though the night so I can get to my doctor in the morning.
I really don't need you to just give me some -I have those at home and they are not working-that's why I'm at the ER.
I've had my arm dislocated and broken in two places (all at once). That hurt about 1000 times less than a migraine.
scalpel said...
Speaking of bans, name-calling trolls will be banned from my blog and automatically redirected to this site.
Heh.
Then a few posts later by Scalpel say ftard and go f yourself?
Do as I say not as I do I guess?
I understand you get cynical after dealing with that crap day to day, but some of this stuff is pretty harsh. It not her fault if she is instructed to go to the ER when she need immediate help when her regular DR isn't available. Not all of us are medial professionals. We do the best with what we are told by the (airquote)Experts (/airquote).
Granted people on both sides of this went way overboard, but hoping someday you can obtain some empathy regardless of the means it takes to get to that end seems warranted by how you have responded.
Then again..this is the crap you get when complete strangers gather and give their opinions, and quickly pass judgement on individuals you have created an opinion about by reading a few brief passages.
Dear Scalpel,
I am a chronic pain sufferer who has never understood someone asking, "I wonder what your goal of coming to the ER is. At best, you might get a shot or two providing a maximum 4-6 hours of relief, then you're right back where you started" This is the analogy I gave my mother when she posed the same question to me. I asked her, if you knew that someone was going to beat the hell out of you for say 12 hours and they gave you the choice of either being beat continously for that 12 hours or you could stop the beating for 4-6 hours. Which would you choose? To me a few hours of relief is better than having no relief at all. I realize that nothing is going to take my pain away completely, but a six is a lot better than a ten on that pain scale in my book.
Sometimes, for a patient finding that one Dr. who will aggresively treat you without pussing footing around is like trying to pull teeth. Just today, I went to a new Pain Management Doctor. I moved from New Mexico to Indiana and trying to get established with new doctors as a CPS patient has not been easy. I told the Dr. who is an anesthiologist that pills do not work well for me. Injections or IVs work a lot better. I explained that because of moving to a new state, I have had to visit the ER quite a bit and that my new PCP told me that he didn't know what to do for me. In my mind my PCP basically wanted to find me a Pain Specialist so I would be out of his hair. I also told the Pain Dr. that when I lived in New Mexico I had trigger point injections and subarachnoid injections done by my Pain Specialist that helped me more than anything. Several times, I made the argument that narcotic pills are not the best choice for me. I walked out of his office with a morphine prescription he gave me. As you stated, "a fairly large subset of them (Pain Specialists)are just pill-pushers who have a limited desire (or ability) to actually manage their patients' pain." I totally agree.
On a recent occasion, I had a very nice ER Doctor admit me in hopes that their local pain specialist would consult with me while in the hospital and maybe go ahead and do a nerve block or epidural. That pain specialist refused to see me and stated (from my medical records) that he couldn't help me.
In my case I don't know what else to do but go to the ER.
Furthermore,I do feel that sometimes other Doctors put too much responsibility on the backs of Pain Specialists. For Pete's sake, they don't have a crystal ball to foresee every patient's need. Sometimes what worked once might not work another time.
I wish they would give injectable medications to Chronic Pain patients, they do it for diabetics so why not. Maybe in some cases they do. Scalpel, your professional opinion here, please.
I do agree, as a chronic pain patient we do have to realize that we need to be patient and respectable of others who need immediate attention and not to ask for things that are not necessary, like another pillow for instance. If you are not happy with the care you received don't take a doctor's or nurse's time up arguing. Go through the proper channels to voice your complaint.
I do have one more point to make and then I'll shut up. I have always felt that chronic pain can kill. If a CP patient has been treated poorly by ER staff in the past and they feel they can't return there for help while they are in agonizing pain, how far will they go to make that pain stop? The bottom of a whiskey bottle with a side order of twenty morphine pills or perhaps a single spent bullet.
I used to work in an ER. Migraines (along with kidney stones and apparent MI's) got treated immediately. The nurses and docs knew and understood the level of pain these people were experiencing.
I have trigeminal neuralgia.
I went to the ER once in 30 years when I could not tolerate the pain and had nowhere to turn.
The MD's did not know what to do for me. Ultimately they gave me a shot of something. It did not help the pain as much as give me the time for it to settle back down to the, at that time, 'normal' permanent and constant level. (My pain was both typical TN sporadic and also constant.)It also helped that I was somewhere where help might be available. The nurses and the docs told me that the ER was the place for me at that specific time because of the uncontrollability of the pain. They were not unwelcoming or suspicious because I had a complaint of chronic, and that evening, uncontrollable pain.
CP patients should not go the ER as a normal part of ther pain regimen. Any good ER staff, however, knows that sometimes the pain gets out of hand and the ER is the place for them to go for the help they need. As someone else said 4-6 hours of relief is better than none. And, 4-6 hours may help to break the hold of the pain.
Thank you.
Carol Jay Levy, B.A., CH.t
author A PAINED LIFE, a chronic pain journey
member, cofounder with Linda Misek-Falkoff, PWPI, Persons With Pain International
member U.N. NGO group, Persons With Disabilities
Hello
I am in chronic pain and have been for many years.. I hurt my back in 2001 and had to have surgery on my lower back in 2002.. I had 5 back surgeries in 9 months.. I also have a Spinal Cord Stimulator in my hip that suppose to help with the leg pain but now all of my pain is in my back.. My last surgery was in 2003 and that was to have the hardware taken out of my lower spine..
Anyways I recently lost my insurance and now my doctor since they do not take patience with out insurance.. I had been taking Morphine 60mgs twice a day and Oxycodone 5mgs which I take two in the morning, one at noon and two at night. I have been taking this for at least two years now..
Anyways soon I will be out of pain meds and I am so scared of what is gonna happen to me.. I have been cutting back on the morphines to one a day and now my pain has pretty much have me in the bed to where I can hardly move.. Soon it will be the withdrawls.. I am a diabetic and the smell of food makes me gag.. I guess you can say I am already going though some withdrawls already..
Come time that I run out of meds, will I be ok? Will I have to go to an ER and will a doctor even see me for this?
Thank you in advance for your opinion..
Andrea
In this area, many pain specialists don't even accept insurance....they require cash payments. And neither ER docs nor most primary care docs prescribe Schedule II narcotics like morphine and oxycodone.
I'm sure the situation varies around the country, but that's how it works here.
Wow, as a nurse in the field for many years, I am disgusted at how the public, Joe BLow and his wife Mary, treat our physicians and nurses here on this blog! You type in and ask for advice, and you get it and you dont like it. Probably just like when you go into the doctors office and dont like the advice you get there! So many people are jealous of the doctors and nurses who have more knowledge than them. One person here thinks they are an expert because they ran a website??? Seriously???
I really hope and pray that the nurses and doctors on this page have more compassion for the patients they deal with everyday than what's expressed here, at least out of respect for the profession. It's alarming the way you speak of the patients you are under oath to help. Why practice medicene if not to help the sick and/or injured?
I have Lupus and Rheumatoid Arthritis that is controlled through a variety of drugs. If you know about these disesases, severe flares are not uncommon. Normally I can find ways to live through it but once I had one that was so involved movement was impossible and was taken to the ER by ambulance with breathing troubles. I was treated fairly and nicely. I thank GOD I have a decent ER that has the intelligence to know the difference between a weekend flaring emergency than to go to any one of you quacks that don't care about pain.......
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