After I graduated from nursing school, I took a job working nights on a Medical/Surgical floor. This is about the night I learned to keep the phone away from unpredictable patients.
This patient, “Mona”, had had surgery that day. I don’t remember of which variety, but she was hooked up to a Morphine PCA – a Patient Controlled Analgesia pump. This pump has a large syringe of morphine in it and a little button for the patient to press so they can deliver themselves pain medicine when they need it. It’s programmed by the nurse according to the doctor’s orders and there is a lockout feature. If you tell the patient that the pump will only deliver medicine every 10 minutes, but they press it every minute, they’re still only going to actually get an infusion of drug every 10 minutes. The pump is a bit sneaky though… it doesn’t sound any different. Every time you press the button, it gives the same exact beep, regardless of whether it infuses the morphine or not. At any time, we can look up the number of times a patient “attempted” to dose themselves, and how many times they were actually successful.
At about 1 or 2am, Mona decided that she wasn’t getting enough pain medicine. Her chart alluded to some drug-seeking behavior, but I feel that pain is a subjective thing, and she did have surgery that day after all. I checked the pump settings against the MD order; all was correct. I checked her orders to see if I could give her anything extra for “breakthrough” pain, but all I found was a sleeping pill. I told her this and she said that that simply wasn’t going to cut it.
I then bit the bullet and called the MD to ask about additional pain medicine. He said that this was the 3rd time he’d been called about the same patient, he wrote right in the chart for all to see that she has drug-seeking tendencies and he felt that he ordered more than plenty of pain medicine for the type of surgery that she’d had that day. Me, being new and completely cowed by anyone with an “MD” after their name (Oh, how times have changed!!), mumbled something about it’s just not working for her. He said not to call him anymore and hung up.
“Ugh,” I thought. I went back to her room and told her about the conversation I’d had with him, leaving out the part about how he thought she was a druggie. She was pretty angry and started trying to manipulate me into calling him back and was generally getting herself really worked up. It was right about then that I started thinking that maybe the doc was right… she was pretty animated for someone claiming to be in so much pain. We finally settled on the sleeping pill.
I made my way back to the nurse’s station and as I was getting the pill out of the med room, the phone rang…. it was for me. I got on the phone only to hear a very irritated surgeon ranting about this woman and her pain medicine! I was completely confused and asked him what he was talking about. He said that he’d just received a call from my patient saying that she was not being treated for pain, and what kind of doctor was he, not letting her get any sleep at night?
I had no idea what to say to that, other than, “She called you? Just now?” He said she certainly did, and why did I not have the PCA hooked up to her? I assured him I did, and that she had almost 100 “attempts” for the past few hours alone.
Silence. Then: “Fine. Give her a 4mg bolus, increase her usual dosage another 2 mg and get that phone away from her!“
That certainly made for a lovely late-night story to tell the other gals :-) Especially after my patient fell right to sleep after finally getting her pain controlled. Whew!