It Was All Prescribed

A nurse told me, “she called the clinic and she was ranting.  She must have been drunk.” I did not think she was.  She was a born-again Christian who did a lot of Bible-thumping, not that Bible-thumping by itself actually prevents anyone from drinking. She was in her fifties, trying to go back to school to get a college diploma she had missed earlier in life, with marriage and children. Something spiritual and faith based.  I didn’t care what she wanted to learn about, for I truly respect people who are trying to accomplish things. I just didn’t think she would want to be seen buying a bottle of anything, for she was so sensitive about a public image that did not mean very much to anybody else.  I think she was sensitive about it because she lived alone and her church was her surrogate family and they lived near her.  All her life was in walking distance.  Somehow I just did not see her as a drinker.

“I think she did something she usually does not do when she calls us. I think she just took everything her pain doctor prescribed for her.”

I had seen this woman in the office a few days before.  She told me she had not yet taken any of her pain medications that day.  She was awake and alert and pleasant, really pleasant.  She told me she did not sleep and so she needed some sleeping pills. She had been in the hospital for something unrelated, some kind of a minor surgical procedure.  Somehow, a nurse I work with had done the research and talked to someone who had taken care of her in the hospital. She slept.  Lots.  Late.  Missing breakfast and eating it when it was cold.  She had been on a relatively low dose of pain medications for her chronic pain problem.  As far as I could figure, and I had taken care of her for a while, her pain was what you call “benign” pain.  I mean, and she had told me the truth on this one, she had osteo-arthritic pain..  So how did she end up on so much pain medicine, and asking me for sleep medicine which she had not received, since in the hospital she had been taking the same thing I had prescribed.

She told me she only took pain pills when she  needed them.

I got her to sign a release to her pain doctor and tried to do the best I could to straighten things out.  Here is some of what was going on.

The government actually has a decent screening for people who think that they have sleep problems. Although there is some awareness of sleep paralysis, a condition where people seem to remain conscious when they appear to be asleep. I have never, ever found anything about people who claim they didn’t sleep, but really did.  I know I have rarely felt this way myself, but I have often heard it from patients.  The best I can do is to tell them to have someone watch them, someone whom they trust.  It is very hard to get anyone to follow through on this.  What usually happens is the people start having daytime troubles from sleeping pills that are more than what is necessary.  They come up with problems. There aren’t many, but they seem to drive staffs (nurses and doctors of outpatient clinics) to start considering other professions, as they are never quite happy.

This woman had another problem with which I was more familiar.  Using pain pills when she felt pain, although it may have made some practical sense to her.  It made none to me.  With her release I called her pain doctor, who was as happy to hear from me as I was to talk to him. First, he was a reasonable fellow.  Most of the pain doctors with whom I had dealt with were anything but. Most pain doctors I know just seem to give patients whatever they want.  This makes for happy patients and lots of them.  A thriving practice of patients who are happily addicted to pain medications and who will require higher doses.

He had given her a regimen to follow.  He was kind enough to fax me a copy.  I presented it to the patient who claimed that her pain medications caused (surprise-surprise) memory problems.

At least I can say that nobody has spoken to her on the phone when she sounded drunk since this has happened. She says she is trying.  Every five minutes I see her I have to tell her she is a good woman, and certainly not a liar, and that I know her pain is real. What I do not tell her is that ever since there was some kind of an anti pain initiative that caused me to do several hours of continuing medical education on pain, generally on the “humane” prescription of pain meds, there has been an increase in the use of prescription pain medications, an increase in their average doses, and an increase in deaths from the same.

Other countries know more than we do about treating pain.  I can’t count the number of times I have used emotional freedom technique to the satisfaction of patients, or someone has told me “nothing works but acupuncture.”

I believe America to be the only country in the world so dominated by drug companies that people still believe only drugs are an appropriate treatment for pain.  The only thing we know for sure about the most powerful (opioid) pain medications is that the more you use them, the less sensitive people seem to become, and the more they seem to need. The distinction between use and addiction is fragile, built on words that help certain entities to make money.  Not built on sincere caring for humans.  The ideal of human length and quality of life being why we are all here is distant as a dream.

As I mention EFT and acupuncture, they have one powerful thing in common.  They use the body’s natural electrical fields to fight pain, so do “pain patches.” An entire source of freedom from pain, electromagnetism, that has NEVER been developed in this country because economic interests, if left unchecked, can dwarf the most elemental humanitarian considerations.

The patient described above is unlikely to ever afford any of the electromagnetic methods.  Yet she or somebody would pay less and less often, for something that could and probably would help.

Besides that, there is my first day of clinical (how to actually treat people) in medical school, when a short and strange looking man who has also a classical scholar wrote on the board in enormous letters something in Latin.

“Primum non nocere”

I was one of a few who knew its meaning, which I had been called upon to give.

“First do no harm.”

I think we lost that, too.