June 15, 2012
A Lesson in Pain Management
When my mother and her contemporaries had a baby, they were kept in the hospital for four to five days. They were coached and aided in every way to ensure proper healing and were encouraged to use the time given to rest up for the task of motherhood ahead. Apparently, it was when I was born that my mother first met the woman and mother of thirteen children who was to be my godmother. They shared a room in the maternity ward and by the end of the week they knew each other well enough to be friends for life.When my first child was born at Grace Hospital, which is now Vancouver Women's, I was well looked after for the first twenty four hours, my every need attended to - until the next shift change when a new and nasty nurse appeared. She was quite certain I exaggerated my pain and overall weakness from losing a lot of blood during the birth, quite sure that I was ready to go home after only one night in the hospital. When my doctor made his rounds and heard about her aim to get me out of there, he put his foot down and insisted to the ward that I be allowed to stay a second night. My husband, just as new to parenthood as I, was unsure as to how to advocate for me and was immensely relieved to have our doctor take matters into his own hands.
Last weekend, my husband had to undergo emergency surgery. The kidney stone he had been battling for three weeks had originally been diagnosed as 4 mm and thus small enough to pass through the urinary tract on its own. He had been to one emergency ward already and our own family doctor, been prescribed specific medications to aid in passing the stone, and told to drink plenty of water. Last Friday my husband endured several hours of intense pain as we thought he was going to pass the stone at last. When the pain increased I called our doctor's office which advised us to take him to the hospital for 'pain management' - a term I had not heard before but was to learn the meaning of fully and soon. We went to the emergency ward at the small hospital in the nearest town - we have no hospital here - where we were to spend the next eighteen hours. Hooked up by intravenous to a morphine drip, my husband was able to relax enough to lie down and sleep off and on. After the first x-ray it was 'good news - the stone is making its way out.' It was just a matter of time, and they would take another x-ray in the morning. In the morning, myself having caught a few tiny winks with my head on the bed, the x-ray showed 'bad news - the stone is stuck,' and they called the urologist, who said, "Send him to me." An ambulance was dispatched and my husband was transported to Abbotsford Regional where he was again put on intravenous pain medication and sat in an easy chair to await the consultation. He told me to go home and sleep and wait for his call. The call came at 4:00 pm that afternoon. My husband would be going into surgery momentarily to undergo a uteroscopic stone removal operation for what was now determined to be a 6 mm stone, and would be in recovery by 7:30 pm as an outpatient. A bit more rested and having cooked a good dinner for my children, I enlisted our eldest son, Ian to drive me to Abbotsford, as I was still a bit bleary eyed. We arrived just after my husband had been brought up for recovery to the surgical ward, which that evening was fairly quiet and not at all full as far as I could see. As the general anaesthetic wore off the pain became unbearable, and soon my poor husband was off the bed and pacing around the room, unable to rest and sleep which he so badly needed to do. Off I went to the nurse's station.
I was most polite - you do attract more bees with honey. "Um, excuse me, my husband is in a great deal of pain. I wonder if you might tell me what pain medication he has been given." The nurse assigned to us, a seasoned professional by the looks of it, assured me she'd be with us momentarily, which she was, and gave him two Tylenol 3's for his pain. He continued to pace and groan. An hour later I appealed to the nurse again, telling her in no uncertain terms and on the verge of tears there was no way my husband should be expected to endure this pain. By 9 pm they finally gave him the morphine. He collapsed on the bed and slept for the next hour and a half, besides the times when the nurse came in to check his vitals (blood pressure, temperature, etc.). Ian had gone for a long walk and I went in search of some tea, which I found thanks to the nurses offering me some from their kitchen. Ian brought me back a KitKat as well, which we shared. In that time, I realized that as an outpatient, unless he was exhibiting signs of infection or complications my husband would be expected to go home with us as soon as he possibly could. By midnight his pain seemed stabilized and the nurse was sure he would be ready to go very soon. She was not unkind, in fact she was quite maternal and sweet, but she had orders to follow and was doing her best to follow them. She took out her clipboard and went over a form, checking off the criteria needed to release my husband. We signed the release papers as there was nothing else to be done and with Ian very tired by then, I drove the forty five minutes home.
The next twelve hours were not too bad for my husband but by Sunday afternoon he was in so much pain that the prescribed morphine tablets were no longer of any use. I drove him to the emergency ward where we had been the Friday night for more 'pain management'. Hooked up this time to some wonder drug the pain melted away and my poor husband was again able to rest. The doctor on call was very good and made certain we knew we could stay as long as we needed, and only when everything seemed greatly improved and she had made a call to the urologist who prescribed better medication over the phone, did she ask us politely if we wanted to go home. We did, and we have not had to return to the hospital since. We have been able to manage the pain at home with the help of generous friends who have given us special tea which in Germany they give to kidney stone patients and probiotic fiber, homemade yogurt and beautiful flowers and messages of love to cheer us up.
My husband seems to have 'turned the corner' today in his recovery and so now I am able to relax enough to reflect properly on the experience we have had. Spending hours upon hours in the various hospitals has been a lesson in itself. It is only natural that the doctors start patients off with the mildest pain medications possible, because they do not as yet know the pain threshold of the patient, and the mildest form may do the trick or it may not. I am also aware of the fact that some patients have addiction issues and drugs must be prescribed with due consideration. I understand that the medical system is taxed and struggling with efficiencies and bottom lines, and patients who have undergone 'minor surgery' need not stay for long in the hospital, that they will probably be more comfortable at home in their own beds. What I do have a hard time with is the fact that the surgeon did not visit or call my husband at any time after the surgery - other surgeons have when he had his two knee surgeries. It would have been rather good to be able to ask him questions in person instead of attempting to communicate with him through his secretary. It would have been good to know what to expect for recovery and to have a ball park figure of how long my husband would be off work. Instead, I had to consult the internet which is full of people's postings of worst case scenarios and not terribly informative in our case. I had to make a call to the urologist's office on Monday after the surgery, to make an appointment for a required two week follow up to remove the stent which was implanted during the surgery. I was told the surgeon was fully booked for the month of June and we would not be able to see him until July 10th. I've made an appointment with our family doctor in the meantime to see what he can do to hurry up the long wait ahead. I do not like to think how my husband would have managed if he were on his own, if I were not there to advocate for him when he was too drugged to process information coherently.
I know that we have just endured what most people endure at one time or another in their lives. We all have to go through these episodes of ill health and of extended pain - the downside of being human I suppose. I am grateful my husband was able to have the surgery so quickly and that it was successful. I am grateful I was able to advocate for him, to care for him and to cook healthy food for him. I am even more grateful today that he seems to be more comfortable than he has been in a week, and that the Eurocup has been on television to keep his mind on something else besides his pain. I do, however, think the health care system here must realize that patients and their families need some more post-operative support, even if it is just a follow up call with some verbal reassurance that all will be well. We have a good health care system in Canada, but like any other system, it should always be open to improvement.