5 – Pain management Part II

Once settled into my hospital room, I found myself hooked up to the now familiar but inadequate PCA morphine pump. I thought we had clearly established the advantages of mainlining Dilaudid over a morphine drip way back in the recovery room. This couldn’t possibly be happening.



The little button attached to the PCA lit up at regular intervals indicating that I could push the button for my next dose. Knowing that all available peace and goodwill on earth were currently flowing from the morphine pump, I developed an instant and deep seated fixation on the button. This prevented me from doing anything remotely useful such as transcribing Braille or making cold calls for the Democratic National Committee. I started playing clever little games with the button such as trying to push the button milliseconds before the light came on to see what the reward would be. Sometimes I’d push the button in rapid fire succession and other times I’d just push it really, really hard. Perhaps I’d fool the machine and get an extra dose. Sounds crazy, but in my mind, it was definitely worth trying. I sat there contemplating how it was possible that once again I was feeling unbearable pain yet my only response was to push a little button at regular intervals for a less than adequate reward.

For a brief period, I became a lab rat pushing the button… pushing the button… pushing the button while the doctors and nurses stared down into my cage. “He is a persistent little bugger! I wonder how long he’ll continue in this manner before he develops alternative strategies?” asked a nurse. A doctor replied, “oh, I’ve seen the brain injured subjects push the button until they wear their little paws to the bone. I hope this one tires before that happens.”  I awoke to the sound of the PCA emitting a longer than usual beep and then I realized my knee was about to combust and my pain scale was at an 8 – or was it a 9? I was so confused. One thing I was fairly sure about was that those titanium screws in my Patella were working themselves through the bone and scraping against my tendons. I buzzed the nurse who finished up her dinner, went to the bathroom, washed her hands (thank God!), went out to the vending machine, finished her charting, chatted with Rosie who I had caught, just moments before, eyeing my untouched pudding, and then rushed breathlessly into my room. I cried out, "my PCA is broken, I swear to God, it's really broken, it doesn't work, it hurts, it hurts!" She looked at the morphine pump and told me it was working fine and left the room before I could muster another volley of complaints.


I sat there stunned but the nurse did eventually come back to look at the PCA again. “Well,” she said, “you have maxed out your morphine drip. Looks like you won’t get any more for an hour.” I thought she was joking and then realized that not only was she serious, she wasn’t presenting any possible alternate solutions such as acupuncture or music therapy and furthermore, it appeared that the punishment for morphine gluttony was deprivation for an entire hour. The nurse walked out of the room.


I buzzed the nurse once again. This time I convinced her that I needed something stronger than the morphine drip and the alternative she was presenting, no pain meds at all, was not acceptable. She called the doctor who thought that a 12 hour slow release pain med might do the trick. In the meantime, she gave me two Percocets in the hopes of keeping me off the buzzer. I took the Percocet and then settled back to watch the clock. After three hours and fifty nine minutes, I buzzed the nurse and asked for the 12 hour extended release pain med. “Oh no”, said the nurse, “the doctor has that scheduled for nine o’clock and it’s only seven. You will have to wait for two hours.”


“OK,” I said, “I started by asking for better pain management than the PCA provided and you told me that I would have to wait for one hour with no pain meds. Now you tell me that I have to wait two hours for a better pain med. The more I ask for pain meds the less I get. Is there some logic operating here that I’m missing?” That is what I wanted to say. What I really did was beg, cry, and plead and finally closed the deal with an offering of chocolates. The nurse agreed to ask the doctor if he could move the administration of my meds up two hours as she walked out of my room with an entire box of Belgian chocolates. The rest of my hospital stay was tolerable – which is all I really wanted.


Lessons learned:


• Nurses work with people in pain all day every day. They are not easily impressed by your sorry tales of woe and, depending on the seriousness of your condition, they are not easily convinced that you are able to trade sex for pain meds.


• When a nurse leaves your room, don’t assume she just got interrupted and will be right back. They do that when they don’t want to hear you whine anymore.


• Doctors hold the drugs – not nurses. Figure out ways to get the doctor on the phone or in the room. They are very busy so if you start on a long-winded explanation of why you need more pain meds, they will very quickly break down, scribble a script and leave. They feel good, you feel good – truly a win-win situation.


• If the hospital staff gives you control of your own drug administration, you can safely assume the drugs are absolutely and unequivocally ineffective. Why else would they give them to you to self administer? The reason that PCA has become popular is that doctors know most people will not yell at themselves when the drugs they are giving to themselves are not the least bit effective.


• Even though there are no signs prohibiting it, don’t try and take apart or increase the throughput of the PCA. The resulting long tone and flat lines on the display are not signs that the gates are open and the drugs are flowing… and those machines are expensive!


• Try not to talk about getting more effective pain medication too much or people will think you are becoming dependent.


• One of the best ways to show your support for friends and family members who are recovering from surgery is to bring small meals and small envelopes with left over pain meds you may have found in your medicine cabinet. Don’t worry about expiration dates. This lets the hospital off the hook and lets the doctors focus on more important things like golf.