Rx for suffering
Posted by: KrisVSunday, November 2nd, 2008
I’ve been away from this blog for a while as my daughter recuperated from surgery. Over the course of her hospital stay, we encountered some weirdness, and I’m curious as to whether I am merely sleep-deprived and stressed, or whether this was really irrational. This is the group to ask.
My daughter’s surgery was predicted to result in significant pain for at least a week, and in fact the plan was to keep her in the hospital until her pain was well-managed. The surgeon explained her options before surgery, and assured her that she should speak up if she were in pain so that she could get relief.
As she came from the recovery room and started to wake, she didn’t immediately ask for additional medication, or accept it when offered. However, about 3 hours after the surgery, she said her pain was increasing and she wanted some relief. Here’s where the weirdness started. The nurse we called first tried to talk her out of it, and then tried to insist she take the weakest of available options because “you’re not going to be able to go home the IV, so you might as well start with the oral meds now.” This was at least 24 hours before we were scheduled to leave. And as long as this nurse in charge of care, every time my daugher asked for pain relief, he came in with a lecture. For instance, he told my daughter (in direct contradiction of her doctor’s orders) that she should try not to take her prescribed narcotics once she got home, and instead just take Advil. Twice he told us he was only giving her half the prescribed dose because he felt she shouldn’t have the full dose unless she “reallY’ needed it.
I would have thought it was just him, but then I went to the pharmacy to fill her prescription, and the pharmacist similarly argued with me that she did not need the volume of medicine prescribed. (She was supposed to take 15 ml every 4 hours for 4-5 days, and the pharmacist told me that the prescribed 400 ml was way too much so he would only give me 300 ml. Try the math.)
So what the heck is this about? The belief in the nobility of suffering–that she would have been more virtuous to “tough it out”? The belief that a 14-year-old would become drug dependent in 5 days with parent-supervised medication? Either way, it seems completely crazy to me, but as I said, I haven’t slept a lot lately. If you’ve got a way to make it make sense to me, please let me know.
(By the way, my daughter is doing pretty well now, though it will be a few weeks before she’s back to normal.)
November 3rd, 2008 at 9:36 am
According to my hubby who works as an occupational therapist in a hospital environment (and who just this summer had painful knee surgery with heavy pain management) indicates that you just got unlucky. The pharmacist and nurse are both operating on older “best practice” thinking for pain management, largely driven (as you guessed) by fear of drug dependency. Current thinking in medicine is all about keeping the patient comfortable, as it has been shown to result in faster, easier recoveries because it reduces the stress from pain. Since your doc was in favor of pain control, a quick phone call to him to rip the nurse/pharmacist a new one would have been in order, ESPECIALLY with regards to his prescription not being filled as written.
November 3rd, 2008 at 11:22 am
What happened you your daughter was frankly wrong and medically unsound. If your DOCTOR has prescribed a pain control plan that includes a certain dose of meds, then that is what you should follow and, more importantly, what the medical staff are required to follow. They are not doctors, and thus have no say in the treatment process. Their duty is to follow the doctors orders. As mentioned by Stacy above, a call to your doctor would have gotten the orderly in big trouble, if not fired, for second guess the doctors orders. Big no-no on their part.
As for the pharmacist, it depends on the laws in your state, but they are required for the most part to fill a lawful prescription regardless of their opinion. I would find out the laws in your state and then call the company that employs the pharmacist if he/she violated those laws. If not, I would call the outlet that harbors the pharmacy and complain about his/her behavior.
November 6th, 2008 at 1:59 pm
Wow, did this tick me off. I’m not sure I would have been as cool as you seemed to be in the face of such second-guessing.
The only thing I ever say when someone counters our doctor’s order is “Take it up with the doctor. In the meantime, do what she says.” The first thing that popped into my head to say to the nurse was “I’m bringing the doctor in here and I’d like you to repeat what you just said in front of him/her.”
Sorry you had to go through this, and I’m glad to hear your daughter is doing well.
November 9th, 2008 at 11:26 am
I am a nurse and wouldn’t do that. If, on the other hand, the order was a blatant med error, I would contact the doctor for verification. Pain is totally subjective and to attempt to talk people out of pain medication is ridiculous. The nurse is there to advocate for the patient.
I am sure you are busy with your daughter (who I hope is doing better now), but perhaps a letter to the doctor advising him of what happened might prevent future patients from this insanity.
November 10th, 2008 at 4:06 pm
I think that a lot of medical professionals still operate under the assumptions that children feel less pain than adults and that narcotics = addiction. Both are completely false. People of all ages have the right to be free of pain, if they choose it. Do follow the advice of the above posters, talk to your doctor about what happened. The particular nurse and pharmacist that were part of your daughter’s health care team are in serious need of evedence-based practice. Glad all is well.