Duck before you get hit by the opioid pendulum!

I have recently been made aware of a situation that shines a light on just how far the opioid pendulum has sailed to the  restrictive side. A young mother and wife (who is otherwise very respectable) had the extreme character flaw of growing a kidney stone.  She presented to the emergency department at a large local medical center.  To make a long story short, she was given intravenous ketorolac (NSAID) and an anti-nausea medication during her very brief stay.  She was then discharged home with a urine strainer and encouragement to “drink lots of fluids”.  She spent several days in excruciating pain that was unnecessary.  We wouldn’t treat our pets this inhumanely!

The hospital providers have become “heartless” but surely your trusted PCP with be more compassionate.  Maybe not… Some primary care providers are choosing to stop prescribing narcotic pain medications all together.  It’s just easier that way right? This is inconvenient for the patient that has been compliant with a stable chronic pain condition but it’s not totally unreasonable. Hopefully said patient finds his way to a pain management provider and not the street pharmacist or even worse loses hope and turns to suicide. This may sound shocking but I’ve heard this sentiment from more than one patient.

And finally I learned of a horse of a completely different unreasonable color!  While chatting with a health care provider I was taken aback to listen as she bragged that the neurosurgeon she works with does spinal fusion surgery and prescribes only acetaminophen and gabapentin post operatively! (I will add however she practiced in a state that allows recreational marijuana so perhaps her patients were finding relief elsewhere)

So to sum up the issues at hand; providers are decreasing opioid doses, discontinuing prescribing them all together and otherwise making broad generalized decisions instead of treating each patient as an individual.  I wonder what the magic number is. How many people need to die from street drugs or suicide before the pendulum can begin to swing back to a more reasonable middle ground?  What famous or influential person will need to develop a painful condition to convince the powers that be that we need a little more soundness of mind when it comes to pain relief?


Health Care Providers Are Human Too

A RN who is also a legal professional recently told me that he would leave the state of Arizona if he needed mental health care or pain management.  Apparently it has become a well known fact that nurses are considered unfit to care if they are addressing their mental health needs or are suffering from conditions that cause chronic pain.  The thought is that these individuals should go on disability insurance.

No other profession including physicians exacts this penalty.  Why would it even be public knowledge that a nurse has any of the above mentioned maladies unless HIPAA rights are violated? What discipline is administered to said violator?  Nothing it seems.  They are “doing what they think is right” or so I’ve heard.

I can only hope that the powers that be find this unacceptable as well and make changes.  I am not hopeful based on the track record of the nursing governing body’s reputation.

To my fellow nurses, please speak up.  Let your voice be heard.  Remember that those in power will come after you too eventually if they are not checked.  Where is the line drawn?  Will only those in perfect health be allowed to provide healthcare in the future?

What do you do when the thrill is gone?

When I was a young girl I dreamed of being a nurse.  I wrote an essay in third grade about my dream job.  The idea of helping others and wearing crisp white uniforms was my idea of the perfect life.

Getting a degree would be a huge challenge for me as a child with no parents being raised by retired grandparents.  With the help of grants, student loans and working as a nurses aid I made it happen.  These circumstances made it even more sweet when that BSN was placed in my hand.

This newly minted nurse was over the moon excited to accept a position on the high risk antepartum unit of a large prestigious hospital in the Texas medical center in Houston.  I learned so much at that first job. (Don’t we all truly learn to be a nurse at our first job?)  Life changes and unexpected events carried me through an adventure of many different jobs and specialties.  Learning and becoming more knowledgeable and capable along the way. I just assumed it would always get better and better!

Reality however along the way things happen that could easily crush your spirit if you let them.  Any position that puts you in a large group of mostly women can be challenging.  I think these bumps and bruises to my ego made me stronger and wiser. But now nearly 30 years into this morass with healed wounds and callused ego I am struggling. Where is that joy that the younger me felt to put on the fresh white coat?  Are patient’s less grateful, feeling empowered with their Google knowledge?  It’s difficult to put my finger on the problem but I know I cannot be the only disenchanted nurse in wonderland.

I still give all I have to each and every patient that I see however it is difficult to pull water from a well that is not replenished.  What is the source of refreshing that well?  Education? self-care? I honestly do not know. I will push forward in search of that fountainhead.