Gypsymoon

Wherever you decide to live, please make sure it is close to the hospital that you plan on working at as the traffic is horrific! Windermere is a really nice area and Florida Central is close by. I live in Altamonte Springs about 4-5 blocks from Florida Hospital. Takes me about 5 minutes to get to the hospital. You definately do not want to live in an area that you have to fight traffic to get to work, and believe me, it's BAD.

How can our patients be honest with us if they cannot trust us to maintain their privacy? Don't you think that you could have made a more positive difference in this person's life if you had maintained an honest, trusting relationship with him rather than jumping to conclusions about his drug use and possibly sending him to jail? How can it be better for this human being to be in jail because he smokes a joint now and then (assuming that he is smoking it). It's no wonder that we have an epidemic of untreated drug abuse because no one is willing to discuss their drug use, even with their doctors, for fear of being turned in and going to jail . It all boils down to who reaches these people first....doctors/nurses or police. If our healthcare professionals decide to make themselves policemen, then who would they be able to turn to for help? How can a drug abuser receive the help they need in order to make their lives better if we all negatively pre-judge them and send them to jail? Imagine a world where diabetics and cancer patients were incarcerated rather than treated if their diseases where illegal. Addiction is the only disease known to man that is treated by our legal system rather than by our healthcare system. Finding a marijuana plant in one of my patient's home would be a signal to me to open my lines of communication and trust in order to move forward with counseling and drug treatment rather than trying to get them busted and incarcerated. Many nurses are so quick to claim how open and non-judgemental they are, when in fact, many of them jump on their high horses and "better than thou" attitudes when it comes to drugs of any kind. Many just are not willing to accept the scientific data that proves addiction is a disease that can be treated, not to mention that many studies show that the active ingredient in marijuana has been shown to reduce pain and nausea. I think that our society would be better served through education about addiction (marijuana in particular) rather than allowing our legal system to manage the care of addicts.

I think that it is pure ignorance on the part of health care professionals thinking that if they give an opiate for pain it will exacerbate their addiction. I'm sure that for many nurses, they mean well. I have a very good friend, beautiful and intellegent, who has suffered from addiction since she was 13 (she's now 46), and has been in recovery since 1998. She just found out last week, after having an x-ray after an automobile accident, that they discovered a "spot" in the upper lobe of her left lung. We have done many nights of long-distance prayer together and discussion. She wants to be honest with her doctors about her addiction and recovery, but she's terrified if things get really bad, that they will not manage her pain. I felt compelled to tell her not to say anything because they might let that cloud their treatment of her (especially in the area of pain management). Of course, and hopefully, it may turn out to be benign and not even get to that point. And proper pain management doesn't always mean using an opiate. In fact, the best pain drug that I have ever been given wasn't an opiate at all. It was Toradol and it was a "miracle" drug for me at the time. We can also use a host of other things to make the patient comfortable and better able to cope with pain. I know that when a person is still in school, it's probably best just to do things the way that the instructor tells you to do it, and that was a huge problem that I struggled with throughout school . But when you get out on your own, you can use your best judgement about pain control. I have had instructors that would use the least powerful pain med like Tylenol, and then make the patient (I'm talking about cancer and post-surgical patients) wait another 2 to 4 hours for something stronger. They would say, "let's give them the tylenol first, and if this doesn't work, then we will give them the 2mg of morphine," instead of just giving them the morphine to begin with. What I do is, if it's on their MAR, I go ahead and give them the strong stuff (if it's indicated). This makes the patient more comfortable, more quickly, and allows me to be able to tend to his/her other needs and the needs of my other patients.

I have a really hard time with some nurses and their attitudes toward pain management. I've run into situations regarding both young and older nurses with the attitude that "all they ever want is something for pain!" I had a nurse last week who was managing a pt who was about 12 hrs post amputation of r foot. The doctor had sent him back to the floor without a PCA and he hadn't had anything for pain except one shot (2mg Morphine IV) about 6 hours prior to my arrival on the unit. He wasn't my patient. I just happened to be walking down the hall when the wife came out of the room, tears streaming down her face, begging for something for pain for her husband. When I walked into the room, he was leaning over the side of the bed with his head in his hands, sobbing and BEGGING for something for pain. I found his nurse and explained what I had just seen. She acted as though, this was the first time she had heard anything about this pt being in pain. She goes in, comes out, starts walking to the PIXIS, mumbling, "I'm so tired of this BS...the only thing they ever want is something for pain.." I had to think to myself, "well, if I had just had my foot cut off, I'd probably want something for pain too." I honestly think that a course on proper pain management should be taught in every medical and nursing school before anyone is allowed to graduate. Although we may not be able to alleviate all pain, it is possible to make it bearable and managable. People should not be allowed to suffer like they are forced to do because of ideas like, "pain makes us stronger," and "you're just a whimp if you complain." I remember a doctor and a hospital in California being sued by a deceased cancer patient's family (not that long ago) because they allowed him to die in insufferable agony because of their fear that the patient would become addicted. The family won. I'm sorry, but if more doctors and hospitals were sued for this, and it started affecting their bottom line, they may start thinking differently. Opiate type drugs are usually the safest drugs to give for pain. They cause very little tissue and organ damage, compared to NSAIDs and tylenol, and less death to bleeding, liver damage, etc. They also cause, according to statistics, less addiction than once was believe. Even for addicts, I believe that their pain should also be addressed by whatever means is possible. In today's world of medical advances and technology, there should be no reason in this world that someone should die in agony.

What is the most appropriate action when dealing with a geriatric patient who refuses to take oral medications? Specifically, they refuse to communicate in terms of discussion and language, but refuse by turning their heads, saying "no" or "leave me alone." My clinical instructor got angry with me because I didn't want to force the medication in the patient's mouth. She had already tried and the patient spit it out. When I tried, the patient shut her mouth, refused to open it, and said "no." The patient was 95 years old with renal failure, dehydration, and anemia. Nothing in her chart indicated that she suffered from dementia. Although the patient wouldn't speak, I got the feeling that she knew that she didn't want to take the meds, and I didn't want to actively force her mouth open and cram the stuff down her throat like she was a dog. I wanted her last few days or months on this earth to be one of peace, love, and comfort, and not for her to remember someone standing over her forcing her mouth open and cramming some awful tasting, drugged applesause down her throat.

Does lacking this enzyme affect other drugs as well? My husband has always said that morphine does nothing for his pain but in 95% of his hospital admissions that require pain meds, they always insist on giving him morphine. Although the doctors don't say anything, we assume that they think that he is just drug seeking as they insist that morphine is the strongest pain med available. When the doctor asks if he is allergic to any meds, he will tell them that morphine doesn't work for him but they insist on giving it anyway. It wasn't until his brother was given morphine for a post-surgical procedure, and got no relief, that I began to think that it may be a genetically inherited trait.