Monday, 9 August 2010

Show me where it hurts

"Doctor! Doctor!"

I sigh and without even turning 'round say loudly "I'm a nurse"

"Oh! Right! 'Course you are! Well, I mean, I'm in pain, is there anything I can have? I mean, doctors wouldn't know about that, would they?"

Charleen's unintentional Uriah Heep impression doesn't warm the cockles of my heart. She came to us ?Pancreatitis ?EtOH abuse, known ex-IVDU. Now I am not the kind to refuse analgesia to anyone - pain is pain, you can't judge another person's pain, period - but there is something frankly funny about someone who can sleep all morning after their a.m. methadone and then be unfortunate enough to wake with "terrible pain" in their abdomen and an accompanying limp that seems to have manifest itself. Luckily for Charleen, she IS able to have some Oxynorm. It is as much as I can do, not to roll my eyes to show my lack of surprise.

As I say, pain is pain. I do not tarry to get someone pain-killers, even the more suspect actors amongst our current crop of patients. I do, however, find it rather tiring when people make these grandiose shows of how they are in pain and can't I do something, please, and oh it must have been 2 hours/ 4 hours/ 6 hours since their last dose of oxynorm/ morphine/ diamorphine etc. etc. Just tell me you're in pain. We both know that you've been watching the clock, that you know *exactly* when your last dose was and, yes, that paracetamol will in no way improve the terrible and sudden pain you are in.

Pain is, as my lecturers might have said, a vital sign and the symptoms of which vary from person to person, aetiology to aetiology. Maybe you really are in pain, maybe that potent opioid is just a bit moreish, honestly, I don't care if it's the latter. It just means that I have to go hunt down the CD key, another RN and interrupt whatever it is that I'm doing, so you may have to wait a bit.

I don't want to come across as some cold-hearted bastard, I do really have a personal interest in pain - if I'd stayed in nursing it would be something I could see myself specialising in. Junior doctors don't really understand how to prescribe analgesia in my experience and more often than not don't understand that morphine is not going to solve all kinds of pain - and isn't without its side-effects. This often leads to people being left in pain, whilst I apologise profusely and bleep the doctor to get something more written up. I'd ask of all doctors, when writing the drug chart up, if you can please give me some diclofenac or codeine or dihydrocodeine or tramadol on the prn side, if only so I don't have to see one of my patients in pain and me helpless to do anything about it. I know that some people are not suitable candidates for more potent pain-killers (liver damage, head trauma, renal insufficiency, whatever) but that doesn't mean they have to run the risk of being left in pain.

 I hope I remember all this in years to come, if only so I don't (as has happened to me in the past) shuffle up to an RN and ask, plaintively, how tramadol should be prescribed.

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