Pain, I Can't Get Enough
One of my interns, Justin, has a patient that he literally can't stand. She is 43 and a chronic pain patient. Her chief complaint was "needing to see a gastroenterologist." She reports she carries diagnoses of both SLE (lupus( and Sjogren's Syndrome, though she seemingly has no symptoms (and all serologies have come up negative), and we are only one of many hospitals she had stopped at. She's had multiple abdominal surgeries, and she's been on opioids for awhile. When she first showed up, she was happy as a clam, walking about in her room, visiting the nurses' station. She looked like she owned the place. Because she had abdominal pain, we did an abdominal CT and found a small, loculated subdiaphramatic fluid accumulation on her left side, as well as some small cysts on her pancreas (she has had chronic pancreatitis in the past). In all likelihood, these are probably both benign findings. But ever since the patient found out, she's been crying up a storm. The pain! Oh, the pain! Finally, a reason for her suffering. Now my intern can't stand talking to her. Yesterday, I actually paged him in the middle of him trying to round on her so he had an excuse not to get drawn into a 20 minute conversation that always leads to her crying. We've already had psych come see her - which didn't go so well. But that was before she found out about her CT findings, and now she's ok with consulting them again because her anxiety is worse, though she still says pain is her major problem.
Today I thought I would pick up the patient just to cut Justin some slack, but it turned out he had the day off. I visited her a couple of times today, and of course the waterworks were on display. I was a little annoyed, but mostly, I just felt bad for her. That's the thing about chronic pain patients, at least what I've found. Honestly, I think a lot of it is psychological. And sometimes you get irritated, because you want them to snap out of it and realize there's nothing wrong with them. You want to, but you can't, because they honestly are in pain. Even if there is nothing wrong with them, and there is no reason to have pain, they have pain.
To make matters worse, GI and Surgery are lobbing her care back and forth between each other. No one seems to want to do anything about this subdiaphragmatic fluid (which is probably nothing, but could be something). You should read the notes the services leave in her chart. GI says they are awaiting surgery to drain her fluid. Surgery then writes they recommend the drainage, will await GI's results. Then GI writes again, deferring to Surgery. Surgery's note, the latest, says that "the loculation of the fluid makes surgical intervention unlikely to be successful, and defers to GI." In the meantime, the patient thinks this fluid is causing her suffering, when it might not. No one seems to want to do anything for this lady, and meanwhile she's suffering, even if this fluid isn't the cause of her pain, she thinks it is, and now she thinks nobody is doing anything for her. It's a bad situation.
I saw her again before I left today, and again, she cried. Then her nurse came up to me and brought up a pain management consult. That seemed like a worthwhile idea. I paged them and left my pager number, and Dr. Sternberg returned my page at about 5:30, when I was already back at the dorm. I called him up on my cell phone, and he must have talked to me for about 20 minutes on treating chronic pain and different mechanisms and modes of treatment, and what his recommendations were for this particular patient. He offered to come see the patient personally next weekend if his recommendations didn't seem to work for her. But is was just nice to finally see somebody care.
In other news, we have our 4th-year scheduling session in Gainesville Sunday the 22nd. It's from noon to five (yes, it literally takes that long). That's actually on my day off, because I'm still going into work up here in Jax Saturday morning. Right now, it's only me and one other student up here. Everyone else either finished half a rotation and gets the weekend off, or their team let them go home for the weekend. Not me, though. Future post about my fourth year schedule (which will be awesome) after Sunday.
Also in other news,
Today I thought I would pick up the patient just to cut Justin some slack, but it turned out he had the day off. I visited her a couple of times today, and of course the waterworks were on display. I was a little annoyed, but mostly, I just felt bad for her. That's the thing about chronic pain patients, at least what I've found. Honestly, I think a lot of it is psychological. And sometimes you get irritated, because you want them to snap out of it and realize there's nothing wrong with them. You want to, but you can't, because they honestly are in pain. Even if there is nothing wrong with them, and there is no reason to have pain, they have pain.
To make matters worse, GI and Surgery are lobbing her care back and forth between each other. No one seems to want to do anything about this subdiaphragmatic fluid (which is probably nothing, but could be something). You should read the notes the services leave in her chart. GI says they are awaiting surgery to drain her fluid. Surgery then writes they recommend the drainage, will await GI's results. Then GI writes again, deferring to Surgery. Surgery's note, the latest, says that "the loculation of the fluid makes surgical intervention unlikely to be successful, and defers to GI." In the meantime, the patient thinks this fluid is causing her suffering, when it might not. No one seems to want to do anything for this lady, and meanwhile she's suffering, even if this fluid isn't the cause of her pain, she thinks it is, and now she thinks nobody is doing anything for her. It's a bad situation.
I saw her again before I left today, and again, she cried. Then her nurse came up to me and brought up a pain management consult. That seemed like a worthwhile idea. I paged them and left my pager number, and Dr. Sternberg returned my page at about 5:30, when I was already back at the dorm. I called him up on my cell phone, and he must have talked to me for about 20 minutes on treating chronic pain and different mechanisms and modes of treatment, and what his recommendations were for this particular patient. He offered to come see the patient personally next weekend if his recommendations didn't seem to work for her. But is was just nice to finally see somebody care.
In other news, we have our 4th-year scheduling session in Gainesville Sunday the 22nd. It's from noon to five (yes, it literally takes that long). That's actually on my day off, because I'm still going into work up here in Jax Saturday morning. Right now, it's only me and one other student up here. Everyone else either finished half a rotation and gets the weekend off, or their team let them go home for the weekend. Not me, though. Future post about my fourth year schedule (which will be awesome) after Sunday.
Also in other news,