Wednesday, March 22, 2006

All Alkaloids End With "ine"

What is pain? How does it work? Downy duck if I know. And I even suppose that I don't care much.

Having said that...

I am rather generous with pain medications. I've worked with enough really hurting people to realize that an amount of pain medication that would probably kill you or me or your average Bengal tiger in a trap does not always relieve the pain of someone like that little old lady in the halo. You know, the one who went through eight 30-milligram Dilaudid PCA cartridges in one twelve-hour shift when I worked with her a few weeks ago?

Chest pain. Tell me about it. I basically don't even bother with sublingual nitroglycerin anymore. Bad habit, you think? Maybe me too.

But if your mother had chest pain rated at an 8-out-of-10 and I gave her a sublingual 0.4mg dose of nitro and took her blood pressure and it was 180 systolic, and then I went and fixed another patient a cup of tea and changed out the bed of a bowel-prepping 95-year-old demented nursing home resident who just luckily came to stay with us, and then came back to your mommy and her chest pain was now a 9 and her pressure was still 180 and I gave her another nitro, you would be very happy, no?

Because I was following protocol.

So I then go answer a call light and take a 50-year-old retired NBA star to the bathroom because he's "afraid to go by himself" and eventually get around to your mommy again, after fielding a few phone calls from out-of-state distant relatives who don't even bother to identify themselves but want to know everything about their dear uncle's condition because they're from Connecticut and they can't get there but federal healthcare information privacy act legislation prevents me from acknowledging that dearest uncle is even a client of ours and they insist that I tell them anyways and I politely apologize and they further insist that I get my manager and then I "accidentally" lose their call so I can see how your mother's doing with her chest pain.

Yes, I do that.

No, I'm not proud.

But there's only so much time in the day.

She looks OK on the monitor, sinus rhythm in the 90's and her pressure's down into the 140's and you're holding her hand but her pain's still a "5" so I go get a couple milligrams of intravenous morphine for her, administer it over a little bit, like a couple television commercials (one of those daytime "judge" shows is on the room TV) and it makes the pain almost entirely go away and your mother says she'd like to take a little nap, but she has a headache (from the nitroglycerin,) so could I get her something for that?

So I get some tea and tylenol and and fifteen minutes later she's sinus rhythm in the 80's and her pressure's 136/80 and the stupid judge just gave the ex-boyfriend his car back when he was plainly being a jerk about the barbecue sauce on his girlfriend's new white shag carpet and her other boyfriend stole the car to pay for the carpet cleaner and was going to give it back anyways, after he got back from Austin because he had to visit his other girlfriend who was sick there. You know, that story.

Sometimes I just go get the morphine first and skip the nitroglycerin completely, and the patient says "thank you" and they get a few moments of precious relief before they go off to the cardiac catheterization lab to get a few stents placed.

There's enough pain in the world. We do not need more. Morphine's cheap and I've got a ton of it in the Pyxis down the hall.

Oh wait... we don't have a Pyxis anymore. Some other thing. Whatever. Some pricey medicine dispensing machine.


may said...

i'm guessing, accu-dose? it replaced our pyxis too. what's was wrong with the pyxis anyway?

shrimplate said...

OmniCell, the same company that makes the machines that keep the toothbrushes and catheters locked up.

I don't know why they replaced all the Pyxis machines. Must've cost literally millions o' bucks.