Last Wednesday I encountered the reason for the sometimes crappy treatment I get in the ED concerning my migraines. I actually met a real life in the flesh migraine faker! :
I was waiting in the Ed waiting room, waiting for my boyfriend to get off work, and noticed a couple sitting across from me. They were chatting happily, laughing and pigging out on candy bars and chips and cokes. I noticed the hospital bracelet on the girl and after about 10 minutes, I couldn't help myself.... I asked her what brought her to the ED at 3:00 in the morning. She looked at me and says..."Migraine"
I'm in shock at this point but then I get angry!
I say" YOU have a migraine and you can EAT and DRINK? Isn't the light bothering your eyes? You do NOT have a migraine and you know it!"
I turn away disgusted. Well....guess what...she goes into "migraine mode". Gone are the chips, the chocolate and the cokes, and out come the dark sunglasses, the cold ice pack and she puts her head down on her boyfriend's shoulder and starts to grimace in "pain"
I start laughing out loud. :chuckle I could not believe it! I still can't!
I have to drag myself into the ED, feeling half dead, wishing I was, and I get the red flag because the staff encounters people like this girl!
When I finish nursing school I want to work in the ED and I'm guessing I can't do what I did Wed, but I think I'm going to have a hard time keeping my mouth shut.
Honestly, I never quite understood how the cynicism towards migraineurs came about until now. Another part of me can't see how the real thing can be confused with these obvious cases of faking it. A dilemna that shouldn't exist I suppose.
How do you handle people like this? Can you get your license taken away?
I say" YOU have a migraine and you can EAT and DRINK? Isn't the light bothering your eyes? You do NOT have a migraine and you know it!"
I turn away disgusted. Well....guess what...she goes into "migraine mode". Gone are the chips, the chocolate and the cokes, and out come the dark sunglasses, the cold ice pack and she puts her head down on her boyfriend's shoulder and starts to grimace in "pain"
Subjective pain.......? I think this woman is clearly a fake! She may have gone to the ER for a migraine headache but it would be obvious to me is that she can select the severity of her pain at any given moment. To go from eating, eyes open in the light to sunglasses and ice pack on the head and begins to grimace in pain so suddenly..... especially after being accused of faking! I have had migraines where I could function and I could eat (although didn't feel like it) and have had migraines where I couldn't function at all but they don't change that suddenly. It sounds more like she needed a work excuse. If she only wanted drugs she would have come in grimacing with pain.
Subjective pain.......? I think this woman is clearly a fake! She may have gone to the ER for a migraine headache but it would be obvious to me is that she can select the severity of her pain at any given moment. To go from eating, eyes open in the light to sunglasses and ice pack on the head and begins to grimace in pain so suddenly..... especially after being accused of faking! I have had migraines where I could function and I could eat (although didn't feel like it) and have had migraines where I couldn't function at all but they don't change that suddenly. It sounds more like she needed a work excuse. If she only wanted drugs she would have come in grimacing with pain.
Well you are one of 3 people who agreed 100% that there was a basis for my reaction. Thanks for the support. I have since realized what I did was wrong by speaking up in front of the whole waiting room.... :imbar ......next time should I encounter the same situation I will keep my feelings to myself...even if it means biting through my tongue. :chuckle
PS: Is it just me or have almost all the threads related to pain and drug seekers been "activated" almost at the same time? Just an observation. :)
Everyone is right. We can't know for sure whether a patient is in pain. But I DO get to make a decision on how that pain is treated. And quite frankly, if you walk into the ED complaining of a "migraine", and are sitting up laughing and eating except when someone walks down the hall outside your room, the most you are getting from me is some Tylenol PO. I can also arrange for rectal administration if you are too "nauseated".
Its one of those damned if you do, damned if you don't things. You may get sued for not adequately treating pain, but you may get sued if you contribute to a patient's addiction. So I just tend to make the best decision I can. And while I try to consider the fact that not everyone responds to pain the same way, I cannot ignore the classical presentation when evaluating a patient. I only write for 12 doses of narcotics, except on Fridays, when I write for 20. And if your pain cannot be controlled on an out-patient basis by Schedule III meds, you will have to be admitted.
As for the sedation/pain relief argument, I am ambivalent. Pain is such a difficult phenomenon to study because it is multi-faceted and very subjective. My prediction is that in twenty years, the best evidence will suggest that sedation does enhance pain relief. Just because that's how such debates usually end up. And yes, I am a psychic.
I envy anyone who can even barely FUNCTION during a migraine. I get these only once a year or so, but when I do, all I can do is lie in a cool, quiet room and pray for death........nothing touches the pain or nausea, the only way to escape at all is to take some Ativan and go to sleep. I don't go to the ER because I'm too ill to be moved, and anyway, I wouldn't want my co-workers to think the same thing some of the above posters think!
I have a migranie about once a year too. It started in my late 20's; I was so worried that I was having a stroke I went to the ED. I was treated like I was an addict too. It wasn't till they called my pri. doc did they finally treat me. :stone
I have a migranie about once a year too. It started in my late 20's; I was so worried that I was having a stroke I went to the ED. I was treated like I was an addict too. It wasn't till they called my pri. doc did they finally treat me. :stone
I'm sorry to hear how you were treated. Maybe you can get your PCP to write a letter with your diagnosis, treatment options, prevention meds...
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
But you must admit (unless you have not worked in an ER recently) that there is a growing epidemic of narcotic abusers using the ER to feed their habit(s). And it is not "just a few" as you say. Ask ANY ER nurse to name the "regulars" in their own ER and they most likely can rattle off name and SSN of each pt. Where I work currently, I have only been there three months and I can name 15 people off the top of my head right now.
I am not nulifying a person's suffering and if indeed they are under a 'Pain Managemen MD" I am sure their treatment plan does not include go to the ER whenever the need arises.
Its one of those damned if you do, damned if you don't things. You may get sued for not adequately treating pain, but you may get sued if you contribute to a patient's addiction. So I just tend to make the best decision I can. And while I try to consider the fact that not everyone responds to pain the same way, I cannot ignore the classical presentation when evaluating a patient. I only write for 12 doses of narcotics, except on Fridays, when I write for 20. And if your pain cannot be controlled on an out-patient basis by Schedule III meds, you will have to be admitted.
You know, the more I read posts like this, the more I think about suing for how badly my pain was undertreated(not treated at all). But, I know me and I might think about it, but I wont do it because I have an aversion to lawsuits. The times that I broke down and tried to get help in the ER, I was in such agony that I would've jumped at the chance to be admitted, I would've stayed as long as they'd let me if it meant escape from the pain. I can't stress enough how much pain I was in, and for so long. I went so far as to ask them to just sedate me if they didn't want to give me something for pain. Anything would've been okay with me.
The one time out of all of those visits that I did get something for pain, I did ask them to admit me and was told no. They thought it was funny but I was serious. I knew that whatever they gave me had to be pretty strong stuff, and that they certainly weren't going to give me a scrip for it, and that unfortunately it was going to wear off pretty soon. I would have gladly stayed.
I've worked the ED for a long time. I'm wondering if any of my fellow ED'ers have noticed this.... it's the weekend, most people are not working, means time spent together. Have you noticed how many more women migraine pt's you have on weekend nights? I think they have psychogenic pain, I think they don't want to spend time ( a euphamism for have sexual contact) with their significant other, so suddenly they have a migraine that requires them to come to the ER and get a BIG shot that will knock them out for a while. Now I am not saying that there are not real migraine sufferers, I used to be one so I know. Just wondered if anyone else noticed this?
In London weekends are sometimes quiet...the "migraine sufferers" come in on mondays as they still hung over and dont want to go to work :chuckle
I can't stop just because I'm in pain. So you may see me, chasing after the kids, or reading a story to them, or dancing with the baby to keep her from crying, and think "You can't be in pain." But believe me, I am. I have just learned to deal with it over the years, because I have no choice.
Here here, I am a chronic migraine sufferer and an ER nurse. I have had migraines for over 20 years. I went through school with them and I work with them most of the time no one notices. If you saw my medicine cabinet you would have been shocked, until then I did not go to the ER but I did live on Tylenol #4 ( I am Canadian). I did go to the ER once and got Immetrex and my life began. No more narcotics. Yes there are real sufferers like me and yes there are drug seekers. but never met a true migraine sufferer who ate drank and giggled with friends then quickly donned the dark glasses and wimpered as soon as she thought someone would see her.
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DutchgirlRN, ASN, RN
3,932 Posts
Subjective pain.......? I think this woman is clearly a fake! She may have gone to the ER for a migraine headache but it would be obvious to me is that she can select the severity of her pain at any given moment. To go from eating, eyes open in the light to sunglasses and ice pack on the head and begins to grimace in pain so suddenly..... especially after being accused of faking! I have had migraines where I could function and I could eat (although didn't feel like it) and have had migraines where I couldn't function at all but they don't change that suddenly. It sounds more like she needed a work excuse. If she only wanted drugs she would have come in grimacing with pain.