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?
OK first off forgive me if my earlier posts seemed a bit smart alic.
What I think is being overlooked here is the actual role of an E.R. in pain management. First one must rule out life threatening illness, second, we can make the patient comfortable. Our job is not the job of Pain Management specialist. I have mainly worked nights over the last 13 years and to be honest, the patient's so called "Pain Managment " PMD either never returns phone calls, is not on call, or cannot recall the patient. Basically they are of no help.
And while it is not a law yet, we are under no obligation (yet) to relieve pain totally. This is what I was attempting to get at earlier, that if someone was truly in 10/10 pain and not someone who frequents the ER, chances are they would relish the chance to sleep. That's all I'm saying.
I've worked all over the country (over 25 E.R's) and it is RAPIDLY BECOMING a major crisis facing E.R.'s. You cannot fault your ER nurse to become jaded by the manipulators that all too frequent the ED's. If they choose to vent their frustrations on this board, that is their perogative. It doesn't make them a terrible nurse.
I also work w/ a local agency in a large metro area. I see the SAME Migraine patients (notice pleural) at 4 different ER's!!!!!!! Come on!!!! And it is all too ironic that they are allergic to NSAIDS, Compazine, tylenol, Phenergan, Talwain, Nubain, etc....
It is sad that these types of patients set a sterotype for the other patients who suffer w/ migraines and do not frequent the ER.
And while it is not a law yet, we are under no obligation (yet) to relieve pain totally. This is what I was attempting to get at earlier, that if someone was truly in 10/10 pain and not someone who frequents the ER, chances are they would relish the chance to sleep. That's all I'm saying.
I've worked all over the country (over 25 E.R's) and it is RAPIDLY BECOMING a major crisis facing E.R.'s. You cannot fault your ER nurse to become jaded by the manipulators that all too frequent the ED's. If they choose to vent their frustrations on this board, that is their perogative. It doesn't make them a terrible nurse.
Hear hear! Great points. If a nurse can't vent here, that's a shame.
As for the girl with the sudden need to play the part of a migraine sufferer, there's only so much time a nurse or doctor has to determine whether or not it's legitimate, and they should no more believe another disgruntled patient's "testimony" either.
How sad that some people are all too willing to make fools of themselves trying to get free prescription meds through an ER because they've obviously tried it before and it worked.
Did you hear the one about the 12 year old boy walking into GNC asking for Percocet and shocked when the GNC employee informed him that they don't sell prescription drugs (much less to minors!). How very sad.
When I read posts like this, the evil part of me hopes that the poster becomes a chronic pain sufferer for a while, just to be on the other side of the sarcasm, disbelief, and hostility.
Yes, there are people who abuse the system. But to penalize all for the actions of a few is wrong, plain and simple. You cannot make a diagnosis of addiction in a brief ED visit.
When I read posts like this, the evil part of me hopes that the poster becomes a chronic pain sufferer for a while, just to be on the other side of the sarcasm, disbelief, and hostility.
Yes, there are people who abuse the system. But to penalize all for the actions of a few is wrong, plain and simple. You cannot make a diagnosis of addiction in a brief ED visit.
There but for the grace of God...
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.
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?
I'll tell you what, due to some recent injuries, I have personally noticed a trend toward undermedicating pts in the ER and on the floors.
Are we that jaded that we think a Tylenol will suffice a broken bone or an Motrin will relieve a migrane?
Pain is now considered a vital sign and is part of a routine assesment. Why do we try and get pts to "tough out" a rating of 8 and hand them Tylenol? Why not the T3 as ordered? Don't deny your patients the pain relief they need.
Specializes in Gerontological Nursing, Acute Rehab.
I am a headache sufferer myself, I get headaches all day every day unless I'm medicated. Believe me, it sucks big time when you go to a doctor's office and they treat you suspiciously, as if I'm a druggie. I understand being cautious and not handing out scripts for narcs freely, but I just need relief, not questions and suspicion.
As for the original poster (I'm sorry, I forgot your name) I cannot reiterate enough the need to realize that pain is subjective. As a nurse, it is hard not to become jaded. As I said, I get headaches every single day, and yet I still have to care for my 3 children, home and husband, and sometimes go and do a night shift on top of that. 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.
The sad thing about all this is I'm on Neurontin now for my headaches, 4 pills daily. I know that I need to increase my pills to 6 a day to have complete relief, but I'm scared calling my doc to have it increased. Maybe it's just my personality, but I don't want them to think I just want to be drugged all the time. Unfortunately, that's all that works to keep the pain away. (I know Neurontin isn't a narc, but it does make you loopy) It's so bad that when I asked for a script for breakthru pain, he didn't give me any refills on it (btw that wasn't a narc either) I guess I just need to communicate with him better, but when you are faced with attitudes like the ones I read above, it's easy to see why I don't want to.
So, please nurses, remember that we can't know what our patients are going thru, and I understand how easy it is to think the worst when you see the worst everyday, but a lot of people out there are like me, and just want to go thru one day without pain.
Lilgirl: The phenomenon you mentioned actually has been studied, and has been linked to a change in schedule. On the weekend people tend to sleep in a little later. For someone with chronic headaches, this can actually trigger headaches. It happened to my father, and as soon as he started getting up at his usual weekday hour, the headaches abated.
And yeah, harry krishna, I worked in the ED until last year, when personal circumstances (namely an injury) forced me to move to another specialty. So I think I know what I'm talking about.
Jkaee; I'm the original poster and a migraine sufferer myself. I'm sorry if I offended you in any way. I am aware that it is possible to function with the type of pain that would bring an otherwise normal person to their knees, but you have to admit...although I was waaaay out of line
to say what I said, if she fell into your category of the functional migraineur, she never would have all of a sudden, fallen into "character". Or would she? Do people with migraines find themselves exagerating in order to make others believe their pain is genuine? How sad is THAT?
I find myself having to go the ER once every 4 months for an intractable migraine that gets so bad I can barely talk. At this point I've exhausted my orificenol of meds that include, Imitrex, lots of Naprosyn, Fiorinal and the daily propranalol. For this reason I ask not be given MORE Nsaids. Red flag? No, after 1500 mg to no avail, just a really upset stomach:D
I understand how easy it is to become judgemental towards others and I've only seen one who raised my eyebrow! God help me when I get into the trenches!:chair:
Judgemental Doctors and Nurses kept cancer patients in agony for years. Three states had triplicate perscription pads. One copy went to the state, one went in the files and the third copy went to the DEA. Patients from Ohio, Texas and Michigan were so under treated who needed any scheduled drugs. The DEA would keep track of what doctor prescribed what, and made doctor's who cared pay for ther crimes.
People used to go to the ER and expect a shot of demerol, newer drugs have come out in the last 10 years.
Few people are admitted for migraines, so most Emergency Physicians have their own routine to handle them.
Even if given a narcotic injection, you only get one. Most give injectable imatrex , so drug seekers leave without their buzz.
My husband sees a neurologist, and had a card to hand the Emergency Room staff telling them of the Neurologist's routine orders, so my husband's ER care is consistant.
Well, I am always in pain, and most people never even know it. I have DJD, need a hip replaced, and I get migraines about twice a year. As for having to shake a patient awake and have them rate their pain 10/10, not BS. Do that with me, and that is precisely what I would say. It has been my unfortunate experience that most pain meds do not relieve my pain, only my ability to complain about them. I still feel the pain, I just can't make my mouth work well enough to complain. So my solution is to simply refuse narcs, etc. I have just had to learn to accept that I am going to hurt, sometimes more, sometimes less. But there will always be pain.
barbpick - i don't think anyone - i know myself - was ever referring to ca pt's - i truly believe they should be given whatever they need.....as for migraine pt "only getting one narcotic shot" - i would love to work in your ed......if we only gave SOME of them one shot - they would threaten our lives (these are the ones that i believe to be deceptive about what they are really there for) - we of course see true migraine patients - i can truly say i feel their pain and have no disagreement in medicating them as neccesary....
catrn10 - i am sorry you have to live in pain - but i think you made a good point - there are some who will always be in some amount of pain - i have an issue w/ those who want us to basically conscious sedate them to relieve their pain -sometimes it is unrealistic to believe that all the pain can be made to go away.
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harry Krishna
67 Posts
OK first off forgive me if my earlier posts seemed a bit smart alic.
What I think is being overlooked here is the actual role of an E.R. in pain management. First one must rule out life threatening illness, second, we can make the patient comfortable. Our job is not the job of Pain Management specialist. I have mainly worked nights over the last 13 years and to be honest, the patient's so called "Pain Managment " PMD either never returns phone calls, is not on call, or cannot recall the patient. Basically they are of no help.
And while it is not a law yet, we are under no obligation (yet) to relieve pain totally. This is what I was attempting to get at earlier, that if someone was truly in 10/10 pain and not someone who frequents the ER, chances are they would relish the chance to sleep. That's all I'm saying.
I've worked all over the country (over 25 E.R's) and it is RAPIDLY BECOMING a major crisis facing E.R.'s. You cannot fault your ER nurse to become jaded by the manipulators that all too frequent the ED's. If they choose to vent their frustrations on this board, that is their perogative. It doesn't make them a terrible nurse.
I also work w/ a local agency in a large metro area. I see the SAME Migraine patients (notice pleural) at 4 different ER's!!!!!!! Come on!!!! And it is all too ironic that they are allergic to NSAIDS, Compazine, tylenol, Phenergan, Talwain, Nubain, etc....
It is sad that these types of patients set a sterotype for the other patients who suffer w/ migraines and do not frequent the ER.
.Enough of my spewing.....