[vamedic4]

Okay, so my wife is in the hospital for a "malignant migraine"..meaning that she's had it since last Thursday and it hasn't gone away despite her home meds (60 mg MS contin qid and Actiq 600 mcg x 4 for breakthru).
She has been to the ER 5 times, resulting in 1 admission (for b/p issues, not pain). I tried to tell them that "if you get the pain under control, the b/p issue resolves." But they aren't listening.
Now she's been admitted again (different hospital - this one her neuro doc is on staff). Before you flame me for "doc shopping" know this...we only go to one ER unless we KNOW she's going to be admitted, because they are the one's who have treated her for 6+ years and know her well. The only problem is that her neuro and pain mgmt docs practice at another hospital.
We also carry a letter from her neuro doc that states her condition and what to do if she presents, which most docs are really good to follow.
My problem is this particular hospital admission. She is in the hospital right now - was admitted about 1500 yesterday. ER did a fantastic job of obtaining access (I stick little babies and she's HARD access) so we have an IV. YAAY, right? So they give her some meds through the IV and call the neurologist...on to admission.
The neurologist has a hospitalist admit her, and he (neuro) comes to see her in the hospital. He tells her that they're going to do alternating meds q1h in hopes of getting her some relief of her pain. This is working excellently at bringing down the headache - until the hospitalist comes back to write more orders. Now the pain meds are only q4h and she can't do any of her home meds in addition to it...it's an "either, or" situation. ***??
Can you say "withdrawal"????
Okay, she's been admitted before with this same type of thing..once 6 months ago...time before that was 3 years ago. Always has the doc continued home meds and given other things "in addition" to whatever they were giving her in the hospital.
This doctor obviously needs to be schooled in pain management.

Arrrrghh. Believe me, I understand his notion of "not wanting to give her too much narcotics"...but he obviously didn't read her history, and that irks me even more. She's been on these meds for the past 4 years and we've NEVER had a problem in the past whenever she was admitted. They just continue her home regimen, and give her breakthru meds every few hours to get the pain to acceptable levels. A day or two of that and the headache goes away...and off we go...BUT NOOO, NOT THIS TIME...

Okay, so THEN I talk to her 3-11 nurse...wonderful woman. She tells me that since the doc only wants meds q4h, she's gonna see if she can give 1/2 the dose q2h..makes sense, doesn't it?? Excellent advocate for patients..kudos.

Then the biznotch 11-7 nurse comes in. She's either a new grad (sorry please don't flame me for this) or an idiot because she 1. has zero compassion for what my wife has been through in the last week 2. told me she couldn't discuss my wife's condition with me because of HIPAA, even though I'm specifically named on the privacy form. I even give her date of birth, got a total attitude with me, et cetera and I'm thinking....arrghhhh...this chick is killing me!!! 3. She refuses to call the physician back and tell him that the treatment regimen he began is NOT WORKING. If it were possible for her to just take her "home meds", then um... WE WOULDN'T BE IN THE HOSPITAL...grrrrrrrrr!!!!
Ugh...ever want to knock the snot out of someone?? Glad I have a heavy bag at home.


I just hate to see my wife suffer at the hands of idiots and those who couldn't care less.

Thanks for listening. Any suggestions?
Have a good day.

We had finally started making progress..the headache was going away. NOW? Back to square one...the same intense pain she's had since last Thursday. I'm gonna have doctor for breakfast.

Thanks for letting me vent. Sorry it's so long...I just HATE to see my wife suffer.

[jmgrn65]

I just want to say that I hope that all turns out, I don't know if I have any advice except that I have not been to fond of Hospitalists. Good luck and I hope your wife gets some relief of her pain.

[Tweety]

I'm so sorry for your wive's suffering.

Here without a PIN # you can't get information, but the nurse should have asked your wife to give you the PIN #.

In defense of the 11-7 nurse if the day and evening nurse couldn't get the pain medicine changed, what makes you think the 11-7 nurse would have any luck? The nurses on days and evenings could have called and re-called over and over relating the severe unrelieved pain. Also, you can't split a q4h dose ever 2 hours without an order.

It sounds like a dreadful situation for your dear wife, and it does indeed sound like her care providers need a lesson in pain control.

[vamedic4]

Thank you both for your responses.


"In defense of the 11-7 nurse if the day and evening nurse couldn't get the pain medicine changed, what makes you think the 11-7 nurse would have any luck? The nurses on days and evenings could have called and re-called over and over relating the severe unrelieved pain. Also, you can't split a q4h dose ever 2 hours without an order"

The problem arose at about 2300 when the doc came up to write new orders. She could either have home meds or IV meds but not both. Up until that time, she had very good management of her pain. The doc was just thinking with his ass instead of his brain. Obviously if she was fine on the home meds she wouldn't be there to begin with...
Oh, and instead of the pharmacy having her strength of pop...they make her do 3 of the 200 mcg pops, all in 15 minutes...can you say bleeding gums?? Arghhh. Those can be very irritating to the mucosa and gums, they're usually done sloooowwwllyyyy so as not to cause irritation.

Thank you both for your kind words.

[rn/writer]

Had considered closing this thread as it has verged awfully close to the line regarding medical advice.

Will leave it open with the caveat that advice needs to concentrate on ideas for moral support and strategy, not anything medically specific.

As I PM'd you, vamedic, please look into whether or not the hospital has a pain management team or if there are any docs in your area specializing in pain management for whom you could get a referral.

Another option might be to pull med records on past treatments that have been more successful and showing what worked and what didn't.

If possible, try to get the hospitalist up to speed. These docs can be a good first line of defense if you can only educate them to the specifics of your situation. Not always easy, but worth the effort if you're successful. They seem to be able to cut through lots of bs and provide a unified point of view much like a primary care physician does outside the hospital.

Some docs are just jerks who don't bother to connect well with their patients. Others--and these are the ones you want to try to work with--need your help to figure out why a particular course of action is a wise one. Once they have a reasonable rationale, they'll play ball.

I do so hope you can find someone who will take your wife's problems seriously and help you get the help she needs.

[Jolie]

I promise not to go anywhere near "medical" advice, as this is WAY out of my league (I'm a NICU nurse).

I'll stick to "logistical" advice.

PLEASE implement the chain of command immediately. Speak with your wife's current nurse and make your concerns clear to him/her. Ask for assistance in gathering the hospitalist, neurologist, and any other medical specialist for a care conference (by phone, if need be). If the floor nurse is unable to assist you, then request the nursing supervisor or administrator on call. If that doesn't work, then call the neurologists's answering service and notify them that you will be contacting the department head and/or chief of medicine within 2 hours if your wife's condition is not satisfactorily addressed. Also, page the hospitalist. That should take all of 2 seconds. The whole idea of a hospitalist is that they are to be IN HOUSE and available to address patient's needs promptly.

If all else fails, request a transfer to another facility due to lack of satisfactory care. That is within your rights and will certainly get their attention.

Sorry for your sad state of affairs. Best to you and your wife, and thank you for advocating so strongly for her. Please let us know how things turn out.

[P_RN]

Just what JOLIE wrote.

I so sympathize. My sister could be your wife's twin. She finally found a Neuro/Pain Management doc group.

[VivaLasViejas]

Vamedic, I PM'd you with a couple of suggestions.

I wish both you and your wife the best as you continue to seek relief from these headaches. I've had them most of my life, at least until I went into perimenopause, and I can't even imagine having one that lasts for longer than a couple of days. All you want to do is lie down in a cool, dark room and sleep until the blasted thing goes away; mine were so bad that I literally couldn't function for at least 12 hours, and after that I'd sleep for another 12. Sometimes I wanted to put my head through a wall, other times I prayed for death---anything to knock myself out and stop that horrid, throbbing, nauseating agony.

Hope your wife is better soon!

[TazziRN]

I have no suggestions other than to ask for the house supe to get involved, possibly the chief of staff, since you're not getting anywhere with the docs.

As for the noc nurse, she should have at least made the call and if new orders were refused, documented that. As the OP said, she has very little compassion for her pts and I would not want her caring for me or mine.

[vamedic4]

Update...

Okay, I apologize if it seems I was looking for medical advice...I was not. Thank you ALL for your kind words of support, it means more to me than you know.

She is under the care of a neurologist, and has a pm doc, but for some reason the MD writing the crazy orders is the hospitalist - and he's not a "thinker"...let me tell you. He knows next to nothing about pain management, and he admitted that when I saw him this morning.

Her neuro I saw as well, and we're continuing the med regimen HE began when she was initially admitted.

I must apologize for my language. Sometimes my little fingers fly across the keyboard faster than I can think.- thank you all for taking the tiime to read and respond to my post...even with all their "color".

As I said before (i think)...I told the doc...all it's gonna take is a day or two of meds, and she'll be ready to go home. We've done this a few times before, unfortunately.

Working in a hospital I understand about chain of command, and I escalated this morning after a horrible night. I informed both her AM nurse (another amazingly caring individual) and the charge RN, both of whom apologized and assured me that today and tonight would be better for my wife.

Again, I'm sorry if it sounded as if I was looking for medical advice. You all obviously care about your profession and patients and I am grateful to all of you for your kind words, input, and ideas.

vamedic4