The War on Patients

Abstract

Several years ago, I retired from my corporate job to enjoy a much-anticipated time of getting up late and not having goals. Eventually, I realized that spending my days on the couch was not enough. I began volunteering at a local hospital and liked it so much that I decided to become a nurse’s aide. I went back to school and embarked on a completely new journey. I have worked in this rewarding field for several years now and have become aware of the life-altering effects of chronic pain. There seems to be an unwillingness to treat it properly with effective medications. The overriding concern appears to be the low possibility of addiction. Patients like this are not looking to get “high.” People in pain self-restrict movement somuch that it can shorten their lifespan. To bring this to life, I would like to tell the story of Dottie... In front of me was a tiny lady, in a wheelchair, so bent from osteoporosis that her spine was curved like a bow. Her rheumy eyes peered up at me as she whispered a good morning. I replied, “Hello ma’am, my name is Pina, what’s yours?” “Dottie.” “Hi Dottie, it’s time to get dressed for the day, what would you like to wear?” I noticed her painful grimace as I maneuvered her arms into a pink cardigan. According to her chart, she had neuropathy, arthritis, and fibromyalgia. She was due for hydrocodone-acetaminophen (Lortab), an opiate, at 11 AM, still 2 hours away. Once she was dressed, I started to say “see you later...” but stopped short when I saw tears rolling down her wrinkled cheeks. “Oh my gosh, are you okay?” She cried “Why is God doing this? I’ve always been a very religious woman.” “I don’t know the answer to that, Dottie...” She moaned “It burns, it burns, nobody knows what it feels like. They don’t believe me.” “How about if you tell me what it feels like?” “Like hundreds of needles jabbing into me.” “That must be so awful,” I said. She stared at me blankly, her eyes still blue under a fluff of white hair. I noticed Dottie kept a little notebook in which she meticulously noted her prescriptions and the time she took them. She would not touch her hydrocodone-acetaminophen before 11 AM no matter how badly she felt. When I returned for her lunch order, she was sitting in her recliner, watching Gunsmoke. She had put on lipstick and earrings, a good sign. “Howdo you feel, Dottie?” I asked. “Hello, dear.My pill took a little while to kick in, but better.” “Oh good, what do you want to eat today?” I felt like I was the waitress in When Harry Met Sally as she launched into her extremely detailed order. After she ate, I said, “Okay Dottie, I’ll be back a bit later to do some exercises with you.” She looked scared. “Doesn’t it count that I move around in my wheelchair?” “Yes, that’s very good but it’s important that you move as much as you can every day.” She grimaced. “We’ll do it together, it’ll be fun, you’ll see.” It was 2:30 PM before I could return, and Dottie looked a bit depressed. Her expression was tight. I showed her the sheet of wheelchair exercises. “Okay, let’s try the first one. She cautiously lifted and lowered her right leg as I counted “one, two, three, four,” stopping at five. “You did it! Good job! Okay, let’s do your left leg now.” She was obviously pleased with herself but at the same time I could see she was hurting. “How do you feel?” I asked. “Well, the pill wears off about halfway through. I can’t take the next dose until 5:00.” “Hmmm, your doses are six hours apart?” “Yes, and Dr Patel won’t let me take them closer together.” I made a mental note. When I came back at 5:30 PM, she was not in her recliner. I found her in her wheelchair next to the bed, tears streaming down her face. “It hurts everywhere, my hands are so bad,” she sobbed. Her hands were curved like claws on her lap as she stared down at them. “Nobody knows how I feel. My children don’t believe me...” “Yes, they do, Dottie, sure they do. Did you take your next dose?” “I did, but it takes a while to work,” she wailed. I comforted her as best I could and asked what she wanted for dinner. I smiled to myself as she replied, “I’d like the roast chicken but tell them to baste it more, it’s not tender enough. I want a baked potato, but the skin should be firm and the insides fluffy. Tell them to cut out the eyes. You know, Pina, those girls in the kitchen don’t seem to have the faintest notion of how to do things. I taught my daughter the right way.” “I’m sure you did a great job,” I replied. “Everyone is so sloppy nowadays, I don’t think they even iron.” Shocking, I thought. The next day, I asked my supervisor, a registered nurse named Nancy, if she could take more frequent doses. “She only experiences relief for about 2 of the 6 hours,” I explained. Nancy later told me it was no go. “Shoot,” I thought. Hydrocodone-acetaminophen was the only medication that truly gave her respite, much more than lidocaine (Lidoderm) patches or gabapentin (Neurontin). By not moving enough, she risked contractures, a shortening of muscle that leads to patients who are literally frozen in place. “I know it’s wrong but sometimes I want to die,” she would say. “No, you don’t, you’re so strong,” I replied. “You really think so?” “Sure, a lot of people would give up from this, but you just keep chugging along.” She seemed to brighten up a bit. “Well, I don’t have a choice, do I?” she said, with some spirit. DOI: 10.1111/jgs.16065