here we go again with THAT pain
i am mad and i want to blame somebody. or something.
i want to blame her.
why did she do this to herself? why start with something like Percocet and end up with the list of medications, mostly with sedative effects, beyond what is considerably normal? how can she fill up her mouth with doritos, wash it down with soda and eat more cookies and then complain she is extremely nauseated and demand the Phenergan with her Dilaudid?
her total PO doses DAILY: Ativan 4 mg. Dilaudid 48 mg. Zofran 12 mg. Phenergan 50 mg. Meclizine 100 mg. Zanaflex 32 mg. Benadryl 50 mg. she also gets a total of Dilaudid 4.5 mg IV and Zofran 12 mg IV prior to wound dressing changes.
imagine working seven nights straight and on the eighth day, you are not supposed to sleep the whole day because you still have to watch a sick, very irritable baby. that’s how she was everytime she was awake. fogged, drugged, mumbling, redundant. she can hardly keep her eyes open, and was always groggy, that seeing her surrounded with half a cookie hanging out her mouth was not unusual.
still, the few minutes that she was awake, all she talked about was how unfair and inhuman it was of the doctors to decrease the dose of her pain medication, and how stupid it was of them to switch the Dilaudid and the Phenergan to PO.
i want to shake and wake her up. because i think she is in trouble. and because i think her husband needs a wife who is not overtaken by the power of drugs. and because i think it is still the right time, that she can still get that help.
i want to blame the doctors.
why did they allow her to have that power? why didn’t they stand up and say the obvious? was it because it was easier to write that prescription than confront her with the reality that she can officially be called an addict and she needed to face her demons? was it really their concern for the patient’s pain that compelled them to continue increasing her pain meds dose till she got to this point when she constantly desired to live within that fog? or was it the opposite?
i want to blame the availability of resources/money and the system.
first of all, the reason why i have never seen somebody like this in a third world county like the philippines, is basically because nobody can afford it. here, i am so tired or feeling bad for these patients. they test my patience, they push me to the limits, yet, they break my heart. i had one patient burst into tears to me before. she confessed being addicted and without flinching, blamed the system. you know, how easy it is to get away with more more more. so much easier than admitting, or being told, that she needed rehabiliation, not for her constant pain, but for the high she seeked from the pain relievers.
i don’t know. i have thought of everything i can do to fix something like this. i always thought i can change even a little thing. i have seen so many people who never intended to be dependent on something, and i wish i can just take them out of it snap my fingers so they can start anew. it is getting so frustrating. and depressing.
the saddest part is, i know now that i can never help them.
that it’s just me and my wishful thinking.
i can’t even decide on who to blame.
what made me think i have what it takes to make a difference in these people’s lives?
it’s just an unfunny joke.
ALL of it.


I hear you. I have seen many physicians who would rather enable the patients habit than help them face it just because it was the easy way out.
On the other hand, I have also helped many patients go through DT’s and withdrawl, vowing they would never do the drugs or take another drink again, only to have them break their promise in less than 24 hours of leaving the facility.
Comment by PD Warrior — February 25, 2008 @ 3:55 pm
I agree. It is sad. I have a loved one in the same boat and don’t whether to blame her or her doctor. It is sad.
Comment by crazyrn2be — February 25, 2008 @ 5:41 pm
It is a horrible situation,I don’t know what to do about it either. I know I’m tired/frustrated with overmedicating them. It is very sad.
Comment by CindeRNr — February 25, 2008 @ 8:05 pm
I agree with everything you said. It’s such a frustrating situation.
Comment by Melissa — February 26, 2008 @ 12:31 am
Yeah it can be frustrating at times seeing people do this to themselves. Even if you want to help by knocking them out of their senses you can’t just do anything. Sigh
Comment by Ferdz — February 26, 2008 @ 10:10 pm
i think we feel frustrated because we know why things are happening. we learned all of these in nursing / med school. i myself have been sarcastic with patients because of what i think is their stupidity causing their illness and then expecting doctors / nurses to work miracles.
but sometimes i realize that maybe what is very obvious to me might not be as obvious to them.. or the circumstances that started the drug dependence might be pretty tolerable for me but intolerable for them.
mostly i think it’s just ignorance of the laws of health.
Comment by Rygel — February 27, 2008 @ 7:29 am
ah. dilemmas we nurses must go through… really makes you go crazy.
Comment by lei — February 27, 2008 @ 7:56 am
it is a sad situation and one that is and will be repeated many times over
Comment by melissa — February 27, 2008 @ 9:04 am
I’ve taken care of that same patient!
I totally understand how hard it is to give them the drugs when they like that. As we were taught in school, pain is what the patient says it is. I usually document wayyy too much when it comes to patients like these, just to cover my rear if something should ever happen in the future.
Comment by CrazyRN (Brooke) — February 27, 2008 @ 4:07 pm
I disagree that you don’t make a difference. Every conversation has an impact…even though you may not see it for years. This is the challenging struggle every teacher faces when dealing with an upset child. You never know, you could be the person to say the words that will one day make a difference. Mental health issues are medical issues and vice versa. Seeking blame is a time consuming, useless activity. Ultimately, when patients are in our care, and I mean in the care of the medical community, we are responsible for accurate assessment and treatment recommendations. Here’s a comment from Norman Cousins I’ve found helpful when I felt discouraged. “A person with a real ideal has no time for cynicism.”
Onehealthpro
Comment by Onehealthpro — February 28, 2008 @ 5:58 am
[…] may put up a good read today.Here’s a quick excerpt:still, the few minutes that she was awake, all she talked about was how unfair and inhuman it was of the doctors to decrease the dose of her pain medication, and how stupid it was of them to switch the Dilaudid and the Phenergan to PO. … […]
Pingback by oriental medicine blog » Blog Archive » here we go again with THAT pain — February 28, 2008 @ 9:11 pm
The addictive substances themselves, whether they are pills, opiates, alcoholic beverages, or whatever, don’t always win.
Comment by shrimplate — February 29, 2008 @ 7:07 pm
I have seen this situation and I’m so happy you are talking about it no matter how difficult the conversation is.
Comment by Jake — March 3, 2008 @ 7:19 am
As I read along, I could swear you were referring to one of my patients! Almost the exact scenario. There are many scenarios very similar in the patient population.
The thing is, there is no one to blame. Not even the patient. I’ve come to believe that people dictate their destinys, and they will do what brings them comfort, no matter what the cost in terms of physical and/or psychological health.
No judgement from me. Is it what it is.
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