|sort of what I was seeing last night|
Things were neither so dismal nor so nefarious as I thought they were last night and in the wee hours of yesterday morning. I was not being given even close to the correct dosage of pain medication I was prescribed, but it was not, as I feared, due to the staff siphoning meds off patients' allotted dosages in order to make a profit on the street off the purloined meds. It was, instead, a case of a medical staff member, known colloquially as a nurse, who misinterpreted the written and oral (I distinctly heard my doctor articulate the pharmaceutical instructions myself and understood them clearly as crystal despite still being in a state of not-quite-having-emerged-from-the-haze-of-anesthesia (sometimes described as "being in the land of blueberries"). Admittedly, I had a vested interest in the matter: my body, my pain, and my medication were the topics of the conversation, all of which is entirely beside the point. By way of reinforcing the utter lack of competence involved in misreading or otherwise failing to correctly interpret the given instructions, allow me to explain that my surgeon -- female and roughly thirty-three -- uses penmanship with such textbook -precision that when she writes prescriptions, they're often verified by phone from pharmacists who refuse to believe the prescriptions were written (or signed if the prescriptions themselves were printed by computer form) by anyone qualified legally or otherwise to write prescriptions. Pharmacists assume no doctors, or, for that matter, even nurse practitioners or physicians' assistants -- write the way she does. You know the look of the classic physician's signature -- appearing as though it could have just easily been scrawled by a twenty-two-month-old child. My gastro-woman's signature and cursive in general (she rarely uses manuscript, though I've seen her write in manuscript, and it's every bit as perfect) looks as though the printing were done not by hand but by a computer cursive font (maybe KG Only Human Regular or something similar) except even less obnoxiously ornate and more perfectly slanted. Anyone who would have misread what my surgeon wrote would also have misread the font used in the "Dick, Jane, and Sally" basal readers. The language used in the orders was standard as well as clearly penned. The surgeon wasn't using esoteric vocabulary for the purpose of impressing anyone. A certified nursing assistant should have, and in all likelihood would have understood and correctly followed it.
Unfortunately for me, it was not a certified nursing assistant charged with dispensing and administering my medication. It was, instead, beautiful, twenty-four-year-old Nurse Abigail, in her second week on the floor and fifth week on the job. No conspiracy was at work in sending my pain levels to the ceiling (you know the 1-10 scale paients are asked to self-rate their pain) and beyond if such is possible. I said it is possible. The floor charge nurse disagreed with me.
In cases of moderate-to-severe pain, it's imperative for the pain medication to precede the pain. Such is not the case with most conditions which might cause pain, but pain immediately following certain types of surgery is predictably severe enough that it isn't an abuse of painkillers to prescribe it in advance of pain reaching its worst.
I was at the added disadvantage of being small. Medical personnel are apprehensive concerning how any given patient will tolerate medication. Such is all the more the case when the patient is small, as I have been determined to be. it seems that despite how many times a person has undergone surgery and been given the post-surgical painkillers, the same level of caution applies. Hence, my painkillers never get the opportunity to get a jump on my pain. Then the cute little nurse-in-training (I know she has her full licensure, but she performed very much like a nurse still in training last night) gave me half of what was prescribed and half as frequently as prescribed. The reduction in painkillers only turned me into a raving, technology abusing psychotic. The limit on the antibiotics I had been prescribed for the slight perforation in my colon (courtesy of gastroenterologist #1, who would be facing malpractice charges in a court of law were his patient anyone other than a medical school student at facility affiliated with my medical school) caused my temperature to have to be monitored continually and caused an additional antibiotic to be thrown into my regimen. If anyone was at all concerned about the sometimes constipating effect of opium-based painkillers, he or she can forget all about it. The double-whammy of the mother of all antibiotics combined with the stepmother of all other antibiotics is making constipation sound like heaven.
My surgeon had to show up at 2:45 a.m. last night to clarify matters to the nursing staff and to write new orders. Matthew says the surgeon had to come in the middle of the night to shut me up, but the new orders to compensate for the failure to adhere to the original orders was why she had to appear. She otherwise could have called in any changes except that she had to examine me again, and if, as Matthew suggested, she had needed to come in to yell at me, she could have done so over the phone as well
The advantage of the double-antibiotic regime is that painkillers can be given to me to any degree that they are not toxic to me. Any constipating properties that did their thing would be a welcome intervention.
Despite his trash-talking of me, Matthew's appearance here was very much welcomed. (For one reason, there is a fourth-year med student, nicknamed "the c--t," who dislikes me with every fiber of her being. The floor charge nurse was threatening me with summoning "the c--t" if I did not calm down. Before I had to make the choice of cooperating or risking the appearance of "the c--t", my brother fortuitously appeared on the scene.) The lingering effects of pain and of benzos that they gave me to calm me down left me not exactly paranoid, but, just the same, fearing for my life. Matthew and Nurse Abigail conversed congenially throughout the night while ensuring that no one came to smother me with a pillow. (Matthew's "comfort" involved mostly reassuring me that killing me would be much more easily accomplished by inserting a tube of insulin into my IV. With all the confusion over medication, it could have been easily explained away.)
Tonight my dad is here in the bed next to mine. He is, as am I, an insomniac. He is working on something on his computer, though he will stop what he is doing to talk to me at any time that I want him to do so, which is not very often. I just want someone to check everything that goes in our out of my IV. I know what happened last night was an honest mistake which was, in theory, corrected, but what is, in reality, in place to keep another rookie nurse from making the same lame mistakes tonight?
There's another new nurse on duty tonight. Her name is Nurse Morgan. She's cute enough, but, if anything, looks even dizzier than did Nurse Abigail.
As for Nurse Abigail, she has the night off. So does my brother. The two of them are off together on some sort of a soiree. Matthew uses people who crash their cars into me on the freeways of California, or people who mis-administer my medication incorrectly, as a source of date material. I'm sure Freud would have an explanation for this, but for now, I'm letting it go.
The daughter of a close friend of mine is having shoulder surgery in just a few hours. Please join me in prayers, positive thoughts, or whatever, that everything goes perfectly in her procedure and that she emerges with a shoulder that works just as God originally intended for it to work before injury rendered its function and comfort to levels less than optimal. Let her parents be calm, and let her surgeon and anesthesiologist both bring their "A" games to the O.R. this morning.
Professor D.: Thanks so much for sitting with me before my surgery and waiting for me through the procedure. i don't know how you knew I needed someone, but I did, and I thank you for being there.