Twenty-four hours post-op from a nerve decompression surgery for migraines and the patient was miserable with intense pain. The nurse had been paging the residents all day without any response. Giving the maximum amount of medications every three hours along with breakthrough pain dosing had proven to be inadequate. Aside from one precious hour of sleep during the night, the patient hadn’t even rested since coming out of the operating room.
By the way, I’m that patient. This was my big step into the unknown, because I felt like there was something there that was going to be positive. This surgery could be life altering. But, I had to get past the immediate post-op recovery before we could determine if this had been worth it. Botox wasn’t doing its job sufficiently anymore. Occipital neuralgia had added into the nightmare of pain as well. I had taken a leap of faith.
There is something about hurting so badly or feeling so miserable, that it seems like any capability of rational thought process is turned off. We go into survival mode, it’s a protective mechanism that our bodies have preserved through thousands of years of evolution. The only thoughts were pain, hurt, tired and an intense desire to rest.
I have endured numerous hospitalizations for migraines over the course of fourteen years. I know what pain is. Before even figuring out which way was up, I had to figure out how we were going to control my pain, which wasn’t migraines! I already had won on that front. This was pure surgical pain and something that I couldn’t make anyone else feel.
Throughout the twelve-hour shift with my nurse, we had brainstormed numerous strategies for how to get my pain controlled. All of them had gone unanswered with pages. A baby-faced resident came into my room late in the afternoon to see how things were going.
I forgot to mention that in the morning, the group of residents, with an attending MD, casually came into my room and had said that they would get me up and moving and I would be going home in the afternoon. This was all without ever asking how I was feeling about things.
In the afternoon, the resident had no idea what he was up against as he strode into my room. Aside from being exhausted, cranky and at my wit’s end with pain. He had no idea that I was a Registered Nurse also.
When asked how I was feeling, the words just gushed from my mouth. I told him about how much pain I was in and about the pages being unanswered throughout the day. Going a step further I told him about the plan that my nurse and I had come up with for trying to get the pain controlled. When he said that he wanted to lower the dose of one of the medications, I stopped him before he even got the entire sentence out. I said a range would be appropriate so that we could adjust and not need to page them each hour. It would save time for them and the nursing staff, whose hands would be tied if there was a single dose that was inadequate.
Trying to describe the pain and talking about that it isn’t a “one size fits all” kind of sensation, nor is the medication required to control it. Each person is different and that needs to be considered. I also told him that my blood pressure medication had been ordered incorrectly and that needed to be fixed. After going over ALL the dosages, medications and issues for the day, I shooed him out of the room so that he could enter orders before he forgot them.
While this encounter may sound harsh, it was the only time that day that I was finally empowered. Patients shouldn’t have to accept inadequate care. My nursing background did give me another leg to stand on as well. My surgeon came in later that evening and said that we definitely needed the modified treatment plan and to take whatever was needed to get comfortable.
This situation did have an adequate resolve. My pain got controlled, blood pressure medication was ordered, I got to rest and amid everything, also taught somebody about the art of medicine.
The next morning a case manager was sitting in my room chatting and the resident came in to check on me. I apologized to him for perhaps coming off a bit harsh the prior day. However, I also reminded him that when a patient is in a bed, we are already in a vulnerable state. It is up to the health care team to advocate for us.
As he walked out, I mentioned that he and his fellow residents should take these events as a learning moment for how they will each practice medicine moving forward. Even as they are treating patients, they should be learning something from every single person and that should continually mold them.