The more I think about it, the more my recent hospital stay bothers me: in the ER, all they wanted to do was give me pain medications and send me on my way. But more on that later.
After triage, they sent me to the ER bays where my first point-of-contact was a nice nurse who took my vitals and got me the world's crappiest ice pack (but points to her for asking if there was anything she could do to alleviate the pain). After that, it was a physician's assistant who told me that she wanted to do a steroid injection as well as some Percocet. I told her that at my most recent appointment with my doctor, he said he didn't want me on steroids (such as the epidurals that I've had in the past for both my neck and my lower back) and that I would like an ortho consult. She gives me Percocet (even after I told her that Percocet/Vicodin don't help me) and then brings in the ER attending doctor who sasses me for questioning the care(?) that I'm getting. He's the doctor, and I must defer to his all-knowing wisdom. Nothing makes me angrier than this arrogance. So, I sassed him right back and asked him when he did his ortho residency. I think that shamed him enough into flipping through the file that I brought with my most recent MRIs and radiology reports.
The ER attending told me that taking an MRI or x-ray for a known condition (my back issues) wouldn't change their assessment or their care. So long as my legs weren't numb (a spectrum from nerve compression to paralysis), their plan wasn't going to change -- they wanted to give me pain medications and send me home. I could have herniated three discs and had disc bits floating around in my epidural space pressing against my spinal cord and they wouldn't have cared. It didn't matter to them that I've had a history of managing the injury and the pain and that for me to even come into a hospital meant something had escalated.
He leaves and I take that time to call the orthopedic resident on-call (yay internets on phones!). He comes down within 20 minutes (Dr. Dan is very cute! (but don't tell him that!)) and the first thing the resident tells me is that he texted his boss: my doctor. My doctor wants me to get an MRI and to admit me to address the pain. Finally, someone was listening to me. I apologize to the nurse and the PA for being such a persistent pain in the ass.
I get my MRI and then was taken to the orthopedic floor of the hospital. The ortho nurse listened to me when I told her that I was a needphobe, and she gave me an anti-anxiety med along with the Dilaudid. Sadly, the Dilaudid and I didn't get along, I vomited, and we learned no Dilaudid without an anti-nausea medicine. And I think I also got more Percocet. There were a few miscommunications along the way: no one told me that they were planning to keep me overnight until it was 8pm; a nurse told me that I could order dinner up until 9pm but food service stopped at 6:30 (yay! narcotics on an empty stomach!); notes not making it into my life and/or people saying they were going to set up appointments for me and that never happened. I think I went through 20 of those crappy ice packs. Maybe more.
Even though I had been given a morphine derivative, I was still awake for most of the night. Sometime around 6 the next morning, Dr. Dan stops by before he's set to spend the day in the operating room with Dr. O'Brien -- the radiology report is back! I didn't herniate the disc, but (based on my reading of my radiology reports) my discs and/or vertebrae have shifted. Dr. Dan tells me that I'm not a surgical candidate at this time (the plan is for another disc replacement, not a multi-level fusion). I don't want to be sliced and diced, but this is still hard news to take. He's saying that it's all about pain management until I am a candidate (whenever that is). Joy.
So the discharge nurse and I have a chat about pain management. What works for me? Well.... ice. If you know me, you know I love my ice pack (which makes having a broken fridge that more awesome). I try to lay off the pain meds (they do nothing for me in the prescribed doses and I don't want to increase the dosage and become a zombie), however I've found NSAIDs and muscle relaxers to help. Trying to find a comfortable way to sleep is one of the hardest parts of my back pain and NSAIDs/muscle relaxers make that possible. Sleep is where most of the healing/repair takes place.
So what do I get sent home with?
-- 2 prescriptions to help counteract the effects of narcotics on my gastrointestinal tract
-- 7 Meloxicam (NSAID) pills (1/day)
-- 10 Flexeril (muscle relaxer) (2/day)
-- 40 Percocet (narcotic pain pill) (1 every 6 hours)
"The good physician treats the disease; the great physician treats the patient who has the disease."
It saddens me that "pain management" is this catch phrase that translates into numbing someone to the pain they're feeling instead of helping them alleviate it (as well as translating into a very lucrative medical field). A patch job versus repair. I wish there was a way to condense the last 16 years into a way of showing doctors that I'm fighting for myself with all I've got, but that for right now I need their help and compassion. So much of managing chronic pain is just finding treatment from a doctor who doesn't assume that you're weak. So much of managing chronic pain is reminding the patient that they are being heard and the doctor is on the patient's side.
(And the thing that I'm afraid to say, because I don't know how it'll be received:) So much of managing chronic pain is reinforcing the narrative of hope -- that one day the patient will have less or no pain. Ask anyone who has had chronic pain before, and that very statement can send them to a very dark place. Chronic pain without hope can send people into alcoholism, addiction to pain killers, and even to suicide.
I'm not there. I've not lost hope -- but as I get older and feel less like I own my on body or my own future, I wonder about these things. How much hope should I have about falling in love when I'm worried about just regular falling? How much hope should I have about being a mom when I'm not allowed to carry anything over 5 lbs? How much hope should I have about anything when it takes all my focus and determination to just put on underwear? I'm not trying to be hyperbolic or melodramatic. The people who have had chronic illnesses/diseases or who have a disability that affects them every day of their life know where I'm coming from.
Life's not always rose colored glasses.
Sometimes the asshole doctor in the ER gets his wishes and you get sent home feeling as bad as you did when you came in.