Extremely Offensive ER experience

[NickB]

FYI: Long Rant.

So the last 8 days of my life have probably been the worst 8 days of my life. It started 8 days ago while I was fishing with the abrupt onset of a horrible headache on the right side of my head. Irronically I got called into work for a stat C-section so I took a few motrin and fought through it. The next day the headache was still there so more motrin and I worked a 12 hour shift. By that night, the headache was getting worse. By sat. evening it had gotten even worse. It was still unilateral and it's focal point was at the base of my skull and radiated up the right side just shy of my temple. Sunday was basically unbearable so Sunday night I went to my local ED to make sure I didn't have a bleed. I drove myself so I informed them I wouldn't be able to take anything for pain. I had a negative CT and the ER doc wanted to do an LP. I had no fever, no stiff neck, no nausea and had delt with an LP headache about 4 years ago so I politely refused. He offered me Lortab and I declined and requested Tramadol so I could still function. He also wrote for neurontin and tegretol thinking it may be trigeminial neuralgia. I saw my PCP on monday and she told me to hold off of the heavy neuro drugs so I only filled the Tramadol. She checked me and gave me a consult for a neurologist and wrote for steroids. I scheduled an appointment with them for Wednesday. Tuesday night was my worst night. Tramadol and 800 of motrin with 650 of acetaminophen wasn't touching it. I was also nauseas. I decided to go to the ED at the hospital my neuro has privledges incase they admited me for pain and obs. When I got to the ED, I gave them my history. They put me in a room and the doc asked me a few questions.

Here is where the offensive part starts. The Doc comes in and asks me questions. I give him my history. He offers LP and I decline again. He says he will start an IV and give me something for pain and I also asked for Zofran. Nurse comes in and gives Toradol 30mg and Zofran. Fine with me. Then, I don't see anyone for about an hour. I'm still in terrible pain. Nurse comes back in and I ask for water. She says she needs to check. 30 min. go by and she stick her head in to say she still is waiting for doc to tell her if I can have water. One hour later, another nurse comes in (this is not shift change by the way) with a glass of water and discharge papers. I'm baffled. I ask what this is all about and he responds that I didn't want an LP. No plan, no labs, no regards for my pain as far as I'm concerned. I ask him that if they are so concerned about a brain bleed and want to do an LP, than why did they give me toradol. He tells me that's not the only reason they do an LP and that they also check for meningitits. I promptly reply that I have no symptoms of meningitis. He looks at me baffled and leaves to get doc. While I'm sitting in the room, I hear someone in the hallway say "the medical professionals always know the right things to say to get them." Now I'm in severe pain and ****** off. The doc comes in and asks me what I want him to do. I tell him to help me figure out what is wrong with me and help me figure out how I'll survive through the night. He says he can give me a couple of pills and writes a script for 6 percocets. Fine. Get me the hell out of here.

I have never been so offended in my life. I plan to write a letter to the president of the hospital which happens to be in the same system that I work. I am not a drug user. I actually hate the things and still have 4 of the 6 percocet left, not to mention about 25 tramadol left. I have been taking Fioricet and motrin for the last 3 days with tegretol. Turns out I have Occipital Neuralgia which is a headache worthy of suicide. Today I received an Occipital Nerve Block. It is helping quite a bit. I'm not 100% but at least I'm not debilitated. So much for being a drug seeker. It's unfortunate that in today's society there are some many people addicted to these things but it's not fair to assume that everyone that comes in complaining of pain is drug seeking. I would love to see those nurses or that doc experience the pain I have experienced for 8 days and then tell me I was drug seeking.

[oshkosh20]

I had nearly the same experience, went for back pain to an ER for the same company I work for. I have had a herniated disk at T7-T8 in that past, I could not even walk in, my wife had to go get a wheelchair. I was in so much pain that I sat in the waiting room shaking, sweating, and vomited. Not that I wanted pain meds, although they never gave me anything for the pain, nausea, NOTHING! Sent me home with a script for vicodin and skelaxin. Just typing this makes me ticked off and I think I will write a letter. But yet we treat frequent offenders coming in for pain meds and yet have no substantiated reason to have such pain. Bunch of B.S.

[Simply Complicated]

Yikes, that sounds horrible. Was it your neurologist who ended up figuring out what the problem was? What was the test they used to diagnose it?

Thankfully you had a doctor who took you seriously and got you in to a neurologist, who also took you seriously!

[EmergencyNrse]

...and yet you're still alive.

Sounds like a good visit to me.

[MursingMedic, DNP, RN, EMT-P]

Sounds like you got caught up in a mix of high expectations and some poor communication from the ER staff.

ERs are unfortunately in the business of throughput. You seem to have been well versed on your condition and what you were looking for. While you were obviously not seeking, you were there expecting some sort of assistance while ruling out many differentials that the ED doc was contemplating. This may have just been a case of the ED doc not knowing where to go next since all of his bases have either been covered by your provided history and previous encounters, or that he didn't like to be cut short with his choice of examinations and decided to let you settle with the zofran and toradol and rest a bit before sending you on your way.

While I can totally understand your frustration with your condition, I think that you may be going a bit far in writing letters and complaining. ERs are not places that cater to your every whim and desire. They exist for emergencies. While suffering is definitely an emergency, when you go in with the intent on asking for specific meds and then get mad when all you get is what you asked for and nothing more, I think you need to step back and look at it from the point of the ED staff.

How would you feel if a 36 week woman came in (I'm assuming you're an OB nurse) and told you that her water broke but that she is refusing a digital exam from you because she had a nurse with big hands hurt her with a previous exam? You can't go in and tell the staff what will and won't happen and expect them to be fully understanding of your situation.

I'm glad you're feeling better and that your have a diagnosis to work with though. Good luck with your continued care.

[DixieRedHead, ASN, RN]

I am sorry you had so much pain. But let's take a look at the situation as it occurred: logically, and in order.

1. As a medical professional, you know what a normal headache is and yet you went at least 4 days without seeking medical attention, and went to the ER on Sunday night for treatment.

2. You expected to dictate the treatment yourself. Doesn't work that way.

3. You wanted and succeeded in declining the diagnostic tests that the doc wanted to order, again, dictating you own care.

4. You refuse the medication the doc wants to prescribe.

5. PCP

6.Neurologist (apparently already some neuro problems)

7. Now to ANOTHER ED.

8. You tell the doc "your history" which I assume includes all the above. (And you are surprised that he might think you are doctor shopping???)

9. And now apparently you go back to your doctor at some point and either get what you wanted done, but at least come up with a diagnoses and a treatment that you will accept.

10. As it happens you end up ON THE VERY MEDICATION the first ER doc wanted to give you and a diagnosis that is not so far off from what he said.

And YOU are offended??

[TA123]

Write a letter to the president?? exactly what are u offended about. From what you typed.. none of the ER staff seem to act like you are seeking drugs" you just assumed it. And i hope u are not mad because the nurse did not get you water on time...It's ER not hotel.

I actually think you got good treatment from the ER. The doc even included you in the care plan. you had CT done-negative, pain med given and also prescribed and nausea med given. Personally I wish nurses will act like a patient for once when they go for medical treatment instead most act like they know more than the doc and want to treatments their way. sometimes act very rude. And ...I agree with what Dixie said also. No need to write letter.

[TA123]

I meant to type " none of the ER staff seem to act like you are seeking drugs" you just assumed it .

[VolunteerCPR]

A patient has the right to refuse any care they want, and they should still never be talked about in the hallway outside their room with a statement like "The medical professionals always know the right things to say to get them." when the pt is in extreme pain. I'd write a letter, too. Whether or not anyone is happy with whatever you did or didn't take or tests you did or didn't want, medical staff cannot stand in the hallway (within earshot!) and chat about how they think you're a drug seeker.

[1968cowgirl]

I have excruciating migraines at times. Even with my letter from my neurologist as to what needs to be given to me, I no longer go to ERs. I just suffer. I can sympathize with the poster. You are made to feel like a drug seeker and you are just in pain. Personally, ERs are no longer for emergencies, unless you are in a large metro, It's for your golden 100 and uninsured for their colds, etc. Flame away.

[Altra, BSN, RN]

You had a head CT. You refused an LP not once, but twice. The previous LP in your history says to me that you've probably had some kind of unexplained headache and/or neuro s/s at least once before. You had an appointment with the neurologist for the next day, so there was a plan for further evaluation/continued care in place.

At my large hospital the next step might have been CTA and/or MRI -- but this may not have been available at the ED where you presented.

I'm not sure what there is to be offended about.

Admission for headache without other neuro s/s? Not happening where I work.

And as another poster pointed out -- LPs are not to diagnose bleeds, but to check for meningitis.

I hope you continue to follow up with your neurologist and also discuss with him/her what is the plan for continued care and return/exacerbation of symptoms. Good luck to you.

Oh, and if I presented to L&D and attempted to dictate my care there, in a specialty area I know next to nothing about, that might be considered offensive, no?

[kayak133]

Had similar experience with a gynecologist....and, I have seen this gynecologist three times. Went in because I was somewhat remiss on my annual and had one cycle that was early by three days. My gynecologist switched hospitals and therefore did not have access to my information. He completes the Well woman exam and tells me that I have an endocervical polyp and, because the stalk is wide and he does not have electrocautery equipment in this office, he feels uncomfortable removing it there. I have no issues with this at all. This is fine with me. He then tells me that he would like to do a d and c and a hysteroscopy. He also recommends birth control pills. Noting my apparent anxiety...he tells me that "I can come in next week and sign the papers then." I said: "ok" I was "ok" outside of the office. The gyno handed me educational pamphlets, none of which indicate the complications of the procedures, to read. I was also ok on the ride home with all of these procedures...however, when at home, out came the books...and I went from ok, to not ok, to hot you-know-what by the time the next appointment came. On arrival at the next visit, my BP of 157/70 clearly indicated that there was to be no signing of consent forms. Stood in the office and refuted this doc. This doc then turned around to me using the tone of a two year old who was refused dessert, "I need to get my sample." Let's just say I held my tongue...as we were standing in the hallway. Will never to return to this doctor. My PAP/HPV are neg, CBC is normal, and mammo is neg.....sorry TA123, wish doctors would behave as though student nurses and nurses had a brain. Folks, this is the situation I used for the basis of my post Ethics 101...should nurses just stand by, not act, when a doctor advises a patient of a need for a procedure that is not necessary, and carries complications? A dilation and cutterage, according to my new gyn, is an old fashioned procedure...and, no, I didn't grill my former gyn in front of the new one.

To NickB: Did you initiate any discussion with the nurses or doctors questioning why you felt that they felt that you were seeking drugs, or is this something you actively observed but did not question at the time?

To all: Is it wrong for nurses/nursing students to be proactive and become knowledgable in there own care? Why or why not?