As if it never occurred: Pain medication errors affecting a nurse patient
Laura's Story
I herniated a disc in my back when I was very young and, although I was diligent with my physical therapy exercises and had tried many healing modalities, nothing helped my chronic and debilitating back pain. Still in my twenties, I was told to have breast reduction surgery to help my back. Although I didn't particularly care about the cosmetic effects, overall I was hopeful that the surgery would help and thus increase my enjoyment of my life. The health insurance I had at the time of the initial recommendation would not cover the surgery, but I was finally able to have it a few years later when I changed companies and the new one was willing to cover it.
Because of restrictions imposed by my health insurance, I was required to go to a hospital that, even then, I could not strongly recommend even though it is a major Boston teaching hospital (I worked in healthcare so have some knowledge). I did not have anyone to stay with me because my father had recently died, my mother was dying, and my friends were busy during the day with work or children. Still, I was reassured that I would be ok because I trusted and liked my surgeon, I would only be in the hospital one night, and my surgeon had come up with a strict pain management plan for after the surgery. I would have strong pain medication available to me every two hours, as well as Tylenol in case I needed it in between.
Unfortunately my trust was misplaced. Still sedated, disoriented, and numb immediately after four hours under general anesthesia, I was allowed by the orderlies and nurses to lift my entire body weight from the gurney to the hospital bed, despite orders that I not use my arms or lift heavy weights for a month. As a result, by the next morning, I was in agony. I had had my chest spliced open, very tender body parts were stitched back together. Yet my nurse refused me any pain medication at a time I should have been able to get it, and said I was not allowed Tylenol. She left and did not return, despite repeated calls from me, through the floor secretary, to her (which I overheard through the intercom). I was left crying, sweating from pain, my heart pounding, frightened. I felt trapped and vulnerable because I could not get out of the bed due to the pain. I was helpless.
At least two hours elapsed with me in this difficult state. Towards the end, growing desperate, I attempted to page my surgeon from my bedside phone but was told by the operator it was not allowed, and I should ask my nurse to page him (!). Later I called back and, explaining my plight to the operator, was connected with a helpful hospital employee who then reached various nursing supervisors, resulting in a parade of nurses of various levels coming to my bedside. My nurse told me she had not come because I wasn't due for my medication; I said she should have come to see me anyway, because I had a right to know why no one was responding to me. She and her supervisors seemed angry and hostile to varying degrees, which I found upsetting at that vulnerable time. No one took responsibility; in fact my nurse blamed the innocent secretary for not relaying my pleas for help. She did not tell the truth, which I found alarming in itself.
I was discharged home without my pain under control and thus suffered from severe side effects from taking the maximum dose of oral pain medication; I almost landed in the emergency room. I was in too much pain to change my bandages as required so I had to have a visiting nurse come to my home to help me, which I am told is very unusual after this procedure. A year later, I had to have my scars re-excised because they were so severe; my surgeon thought that could be due to having lifted myself after surgery. At that time, along with a kind outpatient surgical nurse, I reread the medical chart from that hospitalization. It was clear to that nurse that the medication orders in the chart, readily available to my nurse on the day after my first surgery called for strong pain medication every two hours if I needed it. The Tylenol order was also spelled out in black and white; all just as my surgeon had stated to me beforehand. My nurse the day of surgery seemingly had lied to protect herself and had not bothered to even re-check the orders as they were clear even to me. There was no notation at all in the medical record of me lifting myself or my multiple calls for help, or my severe pain that morning. It was as if it never occurred.
Worse than the physical scars are the emotional ones for me. Something happened in my soul when that nurse left me so vulnerable and helpless. To this day I have trouble with trusting healthcare providers and hospitals, which is unfortunate for me because I have some minor but chronic health problems that require regular visits to such places. Additionally, I used to work in healthcare and find that I am less interested in working in such settings due to the unpleasant feelings that come up. It is remarkable how one person's unprofessional behavior can impact your life when you are a patient and thus intrinsically more helpless, vulnerable, and reliant on others.
Advice: Even nurses need a patient advocate when they are hospital patients themselves.
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