Wednesday, November 12, 2008

Poetic Justice

Tonight I had the dubious pleasure of taking care of a 36 year old fibromyalgeur. She was also unemployed, obese, a 2 PPD smoker, with a history of COPD and hypertension. I was surprised to find that she doesn't have diabetes and CHF, too. Give it time.

She predictably has "allergies" to all non-narcotic pain medications, several antidepressants, a couple of psych meds, and methadone.

Her current prescriptions include:

  • MS-Contin 30 mg Q 4-6 hrs
  • Lortab 10/500 Q 4-6 hours PRN (apparently her allergy to Tylenol is tempered by the hydrocodone)
  • Celexa 40 mg/day
  • Lyrica 225 mg BID
  • Ativan 1 mg TID
  • as well as various HTN and COPD meds.
Today, either because she saw the full lobby, or because her complaint of "abdominal pain" last week didn't score her any narcs, she signed in with "Chest Pain".

As per usual, her workup was stone cold normal. Well, as stone cold normal as an obese non-compliant hypertensive COPD-er could be.

Unfortunately, her "chest pain" just wouldn't go away. "Hey, Doctor, could I have some of that Dil...Dilad...Dila-something medicine?"

Eventually she turned into an admission for observation, mostly because she was giving the ER doc chest pain.

When I took her upstairs, as I pushed her wheelchair into a semiprivate room, past a gorked-out, snoring-like-a-lumberjack old lady, she said, "You mean I don't get a private room?"

I said, "No ma'am, there are no private rooms on this floor." I had to practically shout to be heard over the lumberjack in the next bed.

I smiled all the way back downstairs.

The ER doc laughed out loud when I told him.

That Karma, sometimes she is a bitch.

23 comments:

Nurse K said...

I need to do more transports...

keepbreathing said...

That...that is like music to my ears, except on my eyes. If that makes any sense.

Anonymous said...

even better would be if the "lumberjack" was a person that talks 24/7 when they are awake about the most boring or annoying subjects possible.

Julie said...

hehehehehe

Evil Transport Lady said...

Oh brother! That's one of the types we take home! AND they usualy bitch about having to be squeezed into our litter;)

36 with COPD?? geez.....

Evil Transport Lady said...

Oh brother! That's one of the types we take home! AND they usualy bitch about having to be squeezed into our litter;)

36 with COPD?? geez.....

EE said...

Haha, that is great!

RehabNurse said...

Aww...too bad she didn't have any sleepers on her list, but, nevertheless with all those narcs, you'd think she'd sleep like a baby.

I'm getting sleepy just looking at her list. You or I would be cruising to the Narcan Express on that load!

Anonymous said...

UGH.Every admission ( or so it seemed ) I had as an intern last year was just like this woman. I heart karma !

crankylitprof said...

God, you're so mean. Why can't you docs and nurses understand that my fibro is real, and that I need staggeringly vast quantities of drugs every single day, and that just because I am a depressed, slovenly, lazy, miserable human being, that I neeeeeeeeeed...

Maybe you should leave nursing until you can be more compassionate towards drug seek...uh, fibromyalgiauers, uh, batshit crayzeee...I, mean, sick people.

GuitarGirlRN said...

Wait a minute. Do we work at the same hospital? I SWEAR to GOD I had this gal last night too. Chest pain for blah blah days radiating to blah blah, hurts here and there and everywhere and where's my dilaudid?

Pepcid, a Green Goddess (with extra Maalox!), motrin, complete chest pain workup (negative), and EIGHT MILLION trips to the ice machine for ice chips later, she was admitted to the floor.

Oh, and when she got out of her bed to get onto the wheelchair, a HUGE WAD of tunafish that she had picked off her sandwich fell out of the bedclothes. G-ROSS!

Elizabeth Bryant Alexander said...

Could a nurse please explain what is so fantastic about Dilaudid? Is it so popular b/c all these sufferers/addicts are tolerant of most other pain meds?

And I'm not going to lie and say I haven't found popcorn in my shirt after a movie, but tunafish? I didn't need to know there were people like that. Though I think finding the coins in the fat folds still takes the gross obesity cake.

Don't you just love it when Karma quickly rears it's ugly head?

Elizabeth Bryant Alexander said...

Could a nurse please explain what is so fantastic about Dilaudid? Is it so popular b/c all these sufferers/addicts are tolerant of most other pain meds?

And I'm not going to lie and say I haven't found popcorn in my shirt after a movie, but tunafish? I didn't need to know there were people like that. Though I think finding the coins in the fat folds still takes the gross obesity cake.

Don't you just love it when Karma quickly rears it's ugly head?

mshkosh said...

i heart karma......too bad her TV wasnt broken too

Joeymom said...

I was flipping through a catalog, and saw a plaque that says:

Your boots may be made for walking.. but mine are in case I need to kick your ass.

I immediately thought of you.

Stefan said...

That is a pretty smart solution!

ERP said...

Too bad the gorked out lady was not incontinent of stool.

911DOC said...

hey MG,
we 'fibro-ed' together! lost a bet to drackman and had to post about it... hope you like my haiku. i thought of you when i wrote it.

PD Warrior said...

too bad the gorked out lady wasn't a screamer.

Lynn Price said...

MG, I'll have you know your post inspired a scene for my book. Big kisses to ya.

Detail Medic said...

GOD. LOVE. YA. It is my hearts wish when I drop these people off in the ER that they meet their Karma. Thanks!

Anonymous said...

Studies prove fibromyalgia is real

In 1981, the first study confirmed that symptoms and tender points could actually be found in the body. The areas of the body where tender points are typically found include:

• The front and back of the neck
• Mid to upper back of the shoulders
• Upper chest
• Elbows
• Upper buttocks
• Hips
• Knees

Nine years later, in 1990, the American College of Rheumatology wrote the first set of guidelines to help diagnose the condition. While these guidelines have done a lot to help people get an accurate diagnosis of fibromyalgia, there is still much to be learned about its cause. One of the first theories to come out about fibromyalgia was that it was caused by a brain disorder. While there is still no clear-cut answer, there are theories that in some people with fibromyalgia, changes occur in the nerves and brain cells. Due to these changes, people with fibromyalgia become very sensitive to touch and feel pain more intensely. Researchers have conducted studies to assess pain reactions in people with fibromyalgia while looking at images of their brain. In these studies, more activity in certain parts of the brain of people with fibromyalgia are activated under painful conditions. In addition, studies confirm that people with fibromyalgia feel pain more intensely at lower levels than people without the condition.

Glenna said...

Hey, I think she was at my hospital last week...and the week before...and the week before...heehee. That Karma, she is indeed a bitch.