Saturday, September 25, 2010
My hospital shift today included an encounter that taught me a few lessons.
Patient X, when I introduce myself as the chaplain, starts complaining about pain. On the one hand, Patient X has a visibly painful condition; on the other hand, Patient X says "My pain's a ten" in such a calm and lucid way that I'm suspicious. On the one hand, people having level-ten pain are usually writhing and howling, not forming coherent sentences, and Patient X has asked for a specific painkiller that's frequently abused. On the other hand, drug seekers are also very good at writhing and howling, either because they're really in that much pain or because they're putting on an act.
The signals don't add up.
So I tell Patient X I'll check with Dr. Y, who snorts and says, "Yeah, we gave Patient X some of that drug and said we weren't handing out any more." Since Patient X has also asked me for a prayer, I go back and pray at the bedside. Patient X doesn't ask what the doctor said. I'm halfway tempted not to pass along the doctor's response, because I know from experience that being the middlewoman between drug seekers and ER docs can -- and usually does -- turn into a really nasty game of "he said she said," with both sides trying to shoot the messenger. But I told Patient X I'd ask the doctor, so, out of an obscure sense of duty, I repeat, as gently as I can, what the doctor said.
"I didn't get any meds! I didn't! I'd remember if I'd gotten some! And look, I don't have an IV!"
This is true. Patient X doesn't have an IV. On the one hand, patients of whom the staff are suspicious sometimes don't get IVs so the the staff can try to send them on their way more quickly; on the other hand, how were the pain meds administered without one?
So, unhappily, I trudge back to Dr. Y. I don't have much history with this doctor, and this isn't the kind of history I want. One of my challenges at the hospital is to try to maintain working relationships with people prone to dismiss me as a bleeding-heart liberal, someone so laughably naive that she believes drug seekers. So I'm quaking as I say, "Um, Dr. Y? I'm really sorry to ask about this again, but Patient X denies having gotten any meds, and there isn't an IV."
Eye-roll from Dr. Y. "That's because we gave it by injection. But okay, let me just doublecheck." Dr. Y sighs, flicks through several computer screens, squints, and then says, "Hey, you're right! We didn't give those meds!"
"Oh," I say, awash in relief. It looks like the messenger's going to stay alive this time. "Well, I'm glad I checked."
The patient and doctor both thanked me (how unusual that is in these situations, I probably don't have to tell you). I'm sure the oversight would have been caught and fixed fairly quickly without my intervention, but it brought home for me the importance of taking patients at face value, even when they're pushing my buttons, and of being persistent on their behalf, even when I'm almost as scared of their doctors as they are.
Still, I hope I don't wind up as the middlewoman again any time soon.