Honestly, if you're going to insult my intelligence by lying so blatantly to me, the worst you can do with your sob story is gin up some real tears. A two-year old can come up with better crocodile tears than you.
Last night proved a classic example of pain. I read a book once, You're Never the Same Once the Air Hits Your Brain, written by a neurosurgeon (sorry, can't remember the author's name) where the good doctor, as a young medical student/intern, learned the difference between real pain and 'fake' pain. Note: when I say 'fake' pain, I don't necessarily mean that the patient is faking being in pain. They may very well be in pain, and usually are in some discomfort, and therefore, must be treated as such (never tell anyone they aren't in pain. No one feels pain the same, and what may be a 10/10 to one patient could be a 4/10 to another). But 'real' pain vs 'fake' pain patients will differentiate themselves.
Patient one called for abdominal pain, due to gallstones. A previous attack had shown what the pain was, and, though surgery was scheduled, another attack came on. The patient complained of pain at a 10/10, and could not find a comfortable position. The entire 25 ride to the hospital was spent with the patient moving around constantly on the captain's chair (no stretcher by patient's request, as it would restrict movement too much), stretching, breathing, sighing, and doing everything to not cry. The patient couldn't describe the pain very well, only that it 'hurt badly' and was so distracted by the pain that she couldn't even remember her age, could barely walk, and just could not find a comfortable position. When asking the patient questions, we had to frequently remind her of the question we asked, or ask several times, as she was so distracted by the pain that she would forget within seconds of what we asked.
Patient two actually called for chest pain, but arrival on scene showed it was a frequent flyer patient with a history of back problems and general muscle pain and spasms. Frequent flyer-ism is not unusual with chronic pain patients, as they call when something happens to disrupt their homeostasis; they run out of meds, have a particularly bad day (weather can do this), or overstretch themselves, and need more relief than they can get from their home meds. This patient had a history of spinal issues after a recent (within the last year) car accident. This car accident was reported to be the patient's fault but the patient was currently suing everyone involved, from the other driver to the police and EMS departments for poor handling of the case. A laundry list of medical history accompanied her. The entire call consisted of much screaming and yelling, and then crying as she related her story, complete with embellishments I'm not sure are ever possible. Her story was related with a lot of detail, including dates and names of those involved. By asking our own questions, we were easily able to distract the patient from her pain complaints, and when we asked about pain in general, we got an answer of 'It's the same.' However, if we immediately asked about a specific body part ('What about your big toe?), the answer was a scream or wail of how it hurt so badly.
Do I doubt either patient was in pain? No. Again, pain is extremely subjective, and who are we to say that a patient has pain or not? Chronic pain patients often have high pain tolerances, and acute exacerbations of their pain are often accepted with resignation and familiarity, and they tend to not trend towards the dramatic side of the scale. Patient in 'real' pain are often unable to describe the pain unless prompted with suggestions, because all they know is that 'it hurts.' Patients in 'fake' pain often use colorful imagery, such as ' it's sharp, like miniature elves are running up and down my legs, stabbing me with red hot pokers.'
Again, this is all very subjective, and I tend towards the treatment rather than not. Patients in pain are in pain, and whether they are trying to sucker you for drugs or for insurance-itis or they are totally and completely really in pain, they all should be treated the same. Keep a high index of suspicion, but don't discriminate.
Another note: I have minor chronic pain. Severe carpal tunnel in both hands, constant shoulder pain that has only been partially relieved by rotator cuff surgery, and lower back pain are my friends. I am no where near some of these patients level of pain, but I also have a high pain tolerance (my rotator cuff was torn for over a year before it was repaired, and that was a year of push-ups and weight lifting and firefighting). So, I'm just saying I have a very slight view of what some patients go through.
Thursday, November 11, 2010
Monday, November 1, 2010
WEEEE!!! It's Stream of Consiousness time!
Why yes, I am still alive. Clinicals are eating my life. And yet, I do so little at them. The past few weeks have been full of medic unit clinicals, with less than 20 calls to show for it. And today, I sit at a station far from home, bored to tears. Only one call all day thus far, and it was a BlS run, which netted me ZERO patient contact credits.
I'm not saying I want people to get hurt. Remember, I am a firm believer in the fact that a bored medic is a happy medic. However, in order to fulfill the requirements of the National Registry, not to mention the much higher (as in double, because 'we're better than everyone else) requirements of my program, I NEED patient contact hours. I NEED people to have the worst day of their lives so that I can graduate and be grateful that they aren't having that day.
I actually like the medics I'm with today. They are including me in their activities (which basically include watching movies and sleeping) and generally being very nice to me. Much more than I get from most crews I end up with, who usually are irritated that they have yet another student to babysit. I'm slowly learning shift days, and have found myself carefully arranging shifts as best I can to coincide with the crews I like and actually learn from.
I only wish I was either closer to my clinical sites or had better hours because I am getting ZERO triathlon training in. I have convinced my mother to forgo purchasing things off The Engineer's and my registry and instead buy me an indoor bike trainer so that I can work out early in the morning before clinicals or classes, or when I get home and the gym is either closed or otherwise inaccessible to my schedule.
Though I didn't help my case much by having a dozen buffalo wings for lunch today.
I am heartened by the fact that tomorrow is the election, which means that once tonight is done, the horrid, pervasive and otherwise boring (and boorish) political ads will be gone. I would say they would be gone for another year, but experience and cynicism leads me to dread that we will only have a few months respite before the next round begins anew.
Speaking of politics (and I heartily try not to), I have several friends who made their way to the rally in DC this weekend. I declined their invitations to go because I don't like crowds, particularly large, pressing crowds where you don't know the people around you. In fact, my normal feelings of 'anti-large groups of people' have intensified by several large factors since returning from The Ice several years ago. At any rate, some friends of mine returned from the rally with a story that nearly made me wish I was there so that I could set people straight. It seems that at some point, an ambulance was dispatched for some emergency in the crowd. As often happens with large crowds and large vehicles, at some point the large white box with flashing lights and loud noises reached a choke point, and was unable to go any further. The paramedics got out of their vehicle and, grabbing their bags, made their way through the crowd on foot to the patient. Some in the crowd, evidently irritated that their moderate vantage point was blocked, and they were thus inconvenienced, decided that the ambulance made a far better perch than the spot of ground they were on, and climbed up. To the roof. Per my friends, there were approximately 20-30 people on the roof or hood of the ambulance, and were reaching down hands to help others up. Now, while I can't confirm the actual number of people (20-30 seems an awful lot of people to be crammed on the roof of an ambo), I have several issues with this. I'm not sure of the rating of the roofs of the boxes of ambulances, but I'm fairly sure that even 10-20 will stress the metal and other structural elements of the roof. Even if you assume that there is some sort of structural element to prevent crushing in a roll-over accident, that does not extend to the 'skin' between those structural elements. Not to mention that the roof of an ambulance has several antennae on it for communicating with the world. I've been on the top of an ambo, and they are not the most sturdy of pieces of equipment. The third thing I have issue with is this: WTF is wrong with people? Even my friends, who are in no way, shape or form associated with medicine other than being consumers and patients, would never ever even consider such a thing. I can say that if I were there, I would likely have said something that would have been seen as at the minimum, moderately provoking. I am not the most tactful of creatures on the best of days, and seeing such a flagrant disregard and disrespect for a public safety vehicle would likely have put me over the edge.
In other news, I am already becoming frustrated with wedding planning. So much to do, and so little time, or motivation. We have the site, we have the hotel for people. We have colors picked out and the registry done (though there is a present we need to return, since we don't know the people that sent it). We still have to pick officiant, photog (though there is a woman in my dog's obedience class who is a photog, so we are thinking of choosing them), DJ, cake, meal, etc. In addition, I am not looking forward to dress shopping, as I am a strange shape, and, if I can get training to better mesh with my schedule, likely to drastically change shape quite a bit over the next few months. Still, the wedding date itself is now 341 days away, and as much as I am much more concerned over finishing school and getting a job, I should get my butt in gear. Oh, and I am sick and tired of people asking "Are you excited about the wedding?" If I had time to think about it, yes I would be, but I am much more concerned with finishing assignments, getting enough patient contacts, and getting a job than I am about my impending (in a year) nuptials. And I'm tired of everyone telling me that I'm weird or strange or wrong to think this way.
By the way, who the hell calls 9-1-1 for swollen and sore gums post-tooth pulling x 2 years ago? Really? Come on....
I'm not saying I want people to get hurt. Remember, I am a firm believer in the fact that a bored medic is a happy medic. However, in order to fulfill the requirements of the National Registry, not to mention the much higher (as in double, because 'we're better than everyone else) requirements of my program, I NEED patient contact hours. I NEED people to have the worst day of their lives so that I can graduate and be grateful that they aren't having that day.
I actually like the medics I'm with today. They are including me in their activities (which basically include watching movies and sleeping) and generally being very nice to me. Much more than I get from most crews I end up with, who usually are irritated that they have yet another student to babysit. I'm slowly learning shift days, and have found myself carefully arranging shifts as best I can to coincide with the crews I like and actually learn from.
I only wish I was either closer to my clinical sites or had better hours because I am getting ZERO triathlon training in. I have convinced my mother to forgo purchasing things off The Engineer's and my registry and instead buy me an indoor bike trainer so that I can work out early in the morning before clinicals or classes, or when I get home and the gym is either closed or otherwise inaccessible to my schedule.
Though I didn't help my case much by having a dozen buffalo wings for lunch today.
I am heartened by the fact that tomorrow is the election, which means that once tonight is done, the horrid, pervasive and otherwise boring (and boorish) political ads will be gone. I would say they would be gone for another year, but experience and cynicism leads me to dread that we will only have a few months respite before the next round begins anew.
Speaking of politics (and I heartily try not to), I have several friends who made their way to the rally in DC this weekend. I declined their invitations to go because I don't like crowds, particularly large, pressing crowds where you don't know the people around you. In fact, my normal feelings of 'anti-large groups of people' have intensified by several large factors since returning from The Ice several years ago. At any rate, some friends of mine returned from the rally with a story that nearly made me wish I was there so that I could set people straight. It seems that at some point, an ambulance was dispatched for some emergency in the crowd. As often happens with large crowds and large vehicles, at some point the large white box with flashing lights and loud noises reached a choke point, and was unable to go any further. The paramedics got out of their vehicle and, grabbing their bags, made their way through the crowd on foot to the patient. Some in the crowd, evidently irritated that their moderate vantage point was blocked, and they were thus inconvenienced, decided that the ambulance made a far better perch than the spot of ground they were on, and climbed up. To the roof. Per my friends, there were approximately 20-30 people on the roof or hood of the ambulance, and were reaching down hands to help others up. Now, while I can't confirm the actual number of people (20-30 seems an awful lot of people to be crammed on the roof of an ambo), I have several issues with this. I'm not sure of the rating of the roofs of the boxes of ambulances, but I'm fairly sure that even 10-20 will stress the metal and other structural elements of the roof. Even if you assume that there is some sort of structural element to prevent crushing in a roll-over accident, that does not extend to the 'skin' between those structural elements. Not to mention that the roof of an ambulance has several antennae on it for communicating with the world. I've been on the top of an ambo, and they are not the most sturdy of pieces of equipment. The third thing I have issue with is this: WTF is wrong with people? Even my friends, who are in no way, shape or form associated with medicine other than being consumers and patients, would never ever even consider such a thing. I can say that if I were there, I would likely have said something that would have been seen as at the minimum, moderately provoking. I am not the most tactful of creatures on the best of days, and seeing such a flagrant disregard and disrespect for a public safety vehicle would likely have put me over the edge.
In other news, I am already becoming frustrated with wedding planning. So much to do, and so little time, or motivation. We have the site, we have the hotel for people. We have colors picked out and the registry done (though there is a present we need to return, since we don't know the people that sent it). We still have to pick officiant, photog (though there is a woman in my dog's obedience class who is a photog, so we are thinking of choosing them), DJ, cake, meal, etc. In addition, I am not looking forward to dress shopping, as I am a strange shape, and, if I can get training to better mesh with my schedule, likely to drastically change shape quite a bit over the next few months. Still, the wedding date itself is now 341 days away, and as much as I am much more concerned over finishing school and getting a job, I should get my butt in gear. Oh, and I am sick and tired of people asking "Are you excited about the wedding?" If I had time to think about it, yes I would be, but I am much more concerned with finishing assignments, getting enough patient contacts, and getting a job than I am about my impending (in a year) nuptials. And I'm tired of everyone telling me that I'm weird or strange or wrong to think this way.
By the way, who the hell calls 9-1-1 for swollen and sore gums post-tooth pulling x 2 years ago? Really? Come on....
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