Another raw one this week.
Sometimes, when I'm getting report from another nurse or when I'm sitting at the nurse's station, one of my peers might comment with a heavy sigh that "oh, they just want their pain meds." On some instances, it's simply a letter-of-fact--that is why the patient is calling based on a previous conversation or as a general understanding of the main core of the patient's needs. However, other times it is not meant that way. In the latter, there is a heavy implication that at the very least the patient doesn't need the medication; at worst, the implication is that they're a drug seeker.
And I'm trying to find a succinct way to ask people to stop that, because they don't know that they're talking about me. I've struggled with how to even begin to voice that, how to tell my peers that it sends me immediately back to those places, where I was sick and miserable and told in different ways by my healthcare providers that I was not believed nor worth their time. I see a specific glimpse of my hospital room at Mayos, and I feel my muscles pulling into a quiet guarding, aiming to protect me from an unknown but still very real threat. My body remembers those places. A simple statement or attitude toward a patient regarding their pain medication, and I'm there emotionally in those spaces, if only for a split second. The sympathetic nervous system is triggered and can take a bit of work/time to talk out of it. It is not completely debilitating anymore--it may not even register on my face--but it is a portion of my energy for the day that I now have to refactor, snatching from the emotional energy I would otherwise have for the day. PTSD is a real bitch, sometimes.
I was a patient in pain. I knew without a doubt that my nurses talked about me that way. I know this because a couple of them told me to my face on a few occasions, including multiple instances of explanations that they wanted to see how long I could go without the pain medications and, once, in these words: "You don't need this." I had abscesses cropping up, the effects of sepsis pooling in pockets around my organs. I'd get a new drain placed to allow the purulence an exit or a few times fistulas burrowed an exit for themselves, and, lordy, I am struggling to find words to explain what that actually feels like, to have an infection literally carve its way out of your body over a course of days, weeks. One of those tunneled its way toward my reproductive organs which was a special kind of uncomfortable. Another was nearby and did not close until several months after the proctectomy and permanent ostomy placement--the inflammation did not subside quickly, having run uncontrolled for months and months as we needed time for the right medication combination to find control again.
I was twenty-five and twenty-six in this specific stretch that comes to mind. I was very courteous and pleasant to my healthcare staff when they were in the room, and I did my crying when I was alone. So, no, I did not look like I needed it--I had become accustomed to a high degree of pain, but that did not mean it was not present or unfelt. In certain periods, I had also become quite tolerant of pain medication, meaning that more was needed to have an effect. I remember being lectured about a PCA pump, and I don't know if it's reality or not that I remember that individual being frustrated about having to set it up. I had a family member hide the clock in the hospital room because they felt I was watching the clock rather than actually listening to my own body--I was not, and the clock was replaced later that day. I remember wondering if I needed to show it better in order to be believed, but A) I was already feeling vulnerable enough and B) it felt duplicitous when I wanted to establish mutual honesty. I remember agonizing about the decision each time the medication was available again, whether I would ask or try to last a bit longer this time. When I finally did, I heard my voice trying to make assurances that I was not a drug seeker.
In nursing school, we are taught that a patient's pain is what they say it is--there are places where I weigh my options available to a patient based on their symptoms and what they are telling me, but I do not doubt that their pain is present. Pain is subjective. There are some objective markers, but I am acutely aware of that internal struggle that I see some of my patients go through. Being in pain for too long has physiological effects and otherwise can discourage patients from doing activities (e.g. physical therapy) that they need to heal. In other words, untreated pain--be it physical or otherwise--delays healing. While I have had hospital staff that have made me feel lesser, I have also had nurses that understood it was important to get ahead of the pain again, to catch-up before we could start talking about weaning down. There were those that said they would be back with the medication and proved true to their word, that made me feel seen and heard. I want to be one of these.
I see myself in my patients, a decided bit of transference. This is both good and bad. For every person who has been told when facing adversity that they have "a good attitude," I would not want to talk you out of that mindset, but I would affirm a hundred times over that it is still okay to have a low moment, to take space to grieve as it is needed. One does not lose their "good attitude" status by simply being human. [There's all kinds of good advice for the people with "poor attitude" that I don't feel a need to dig into that today.] As result, I am very intentional in my practice to ensure that I honor my patient's pain. Being sick is exhausting business. I won't say that there are not drug seekers in the hospital; however, the fear of being seen as one can interfere with treatment in its own way. I'm sure I have more to learn on this yet, too. I will also need to decide whether I bring it up directly with my peers (compared to this gentle scream into the void). And regardless I will need to perfect how I manage my emotions when that triggering does happen, how I acknowledge and unclench in those spaces.
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