Archive for March, 2010

How Much Pain Can You Bear?

Friday, March 12th, 2010

Have you ever been in so much pain that you wished you would die? Imagine that you are an 88-year-old man with lung cancer that has spread to both your brain and your spine. You attempt to sleep but the pain keeps you awake. You resort to the recliner but that feels no better than the bed. You pace the floors trying to get away from the pain but there just does not seem to be any way to get comfortable. You are faced with such trying agony day after day. Some people may not think that this scenario actually occurs in America with our bounty of modern medical techniques. Others may be more willing to accept this scenario but perhaps only if the situation involves an individual who is uninsured or lives in the inner cities— certainly not in wealthy Boca Raton, Florida. Let me assure you that the mismanagement of pain happens everywhere and is no respecter of persons. This 88-year- old man happened to be my uncle and when he finally gave in to the pain, he asked me to phone the doctor to “see what you can do.”

My first call to the doctor was placed at on a Tuesday at 11:00 AM. Of course the doctor was not available so I left a message explaining the situation. Several hours later, a nurse called back and asked me to explain the situation again, which I did. She said she would speak with the doctor and get back to me. The nurse called a second time and indicated that the doctor felt my uncle should not be in “that much pain” and wanted my uncle to get a bone scan. While I agreed to the bone scan, I was quick to indicate that he would immediately need stronger pain medicine. I was denied and we were told to take the medicine we had on hand and wait to hear from the scheduling department for the bone scan. To make long story short, we managed until that Thursday but by then the pain was so bad, my uncle was incapacitated and insisting he wanted to die. This was uncharacteristic as my uncle was a fiercely independent and strong willed man who was living alone until 10 weeks prior to this event.

On Thursday I telephoned the doctor again and explained the situation in another voice mail message. The nurse called back and again informed me that she would speak to the doctor. When she called back, she informed me that the doctor said we would have to go to the emergency room if the pain was “really that bad.” She said there was nothing the doctor could do, but I had to wonder why an oncologist was not prepared for patients with pain issues. So off to the emergency room we went. The emergency room personnel questioned why we were there since in their view, we really did not have an emergent situation. After nearly 12 hours in the emergency room, they finally decided to admit my uncle. Essentially, he sat in the hospital over the weekend without any significant medical care being rendered and without any active pain management care plan. When Monday arrived, the only other advice we were given was to consider hospice care. My uncle eventually died after being transferred to the hospice service but probably sooner than he would have if he had been given proper pain management from the beginning.

How can an oncologist working in a premier hospital be so insensitive to a patient’s pain? Have they seen so much pain that they’ve become immune to it? Have we as wound care professionals also become immune to the pain? I remember when CMS revised federal regulation 314, the regulatory requirements for pressure ulcers, to include a pain assessment. Many colleagues scoffed at this and wondered what pain had to do with wounds. I have repeatedly heard colleagues dismiss a patient’s pain complaints when changing wound dressings, repositioning, or performing bedside debridement. Please let this be a reminder that you cannot judge another person’s pain, and the presence of pain must be assessed and addressed before treating a wound. One day, you or a loved one may be the patient in need, so treat your patients today as you hope you will one day be treated yourself.