oh the pain

i don’t know if it’s karma or irony, but the last night was terrible. everyone and their grandma complaining about their pain. it’s like it was half strength morphine day and no one let me know. got to the point where i was trying to figure out the half life of morphine and compare it to the point where respiratory depression starts to kick in.

consider the patient who got a lysis of adhesions, post op day 1, on dilaudid PCA, toradol, and fentanyl. i get notified she’s in severe pain. i go see her and she’s there just bawling her eyes out. i’m like wtf, does she have bowel leak? then i remember she only got LOA. ok, does she have another small bowel obstruction? well, she’s been NPO and getting NG decompression for 24 hrs before her LOA, so that’s doubtful. puzzled, i ask my chief resident for advice. she’s like, i dunno, bump her pain meds up.

seems easy on first aid for step1 or step up to medicine. increase meds, sure, ok. so i give her a one time bolus of dilauded on top of her PCA, toradol, and fentanyl. i come back an hour later… “did it do anything?” her: “i sort of felt it but now it’s worn out”. at this point i want to put this chick on a vent, max out dilaudid and transfer her to the ICU. but one last try. i double the dose on her PCA and cross my fingers. i didn’t hear from her again that night, which is good because i pretty much stopped caring.

at the same time this was going on, some other chick from a car crash was complaining about muscle spasms and pain. which was reasonable because she cracked her hip. muscle spasms huh… how about some vencuronium, vent, and transfer to ICU? well, even though retiring from medicine at 27 seems appealing, i wasn’t self destructive enough to get myself fired that night, so i did what i’ve been doing all night. increase her morphine. of course there was only one problem. i didn’t know that she took dilaudid and loratab everyday at home. no wonder i kept getting paged about her still complaining of pain. yikes. how much dilaudid can you give again? i don’t remember how much i gave but it was an assload. stopped getting paged about her too, eventually.

i think half the patients on the service were actively complaining about their pain that night.