Thursday, January 19, 2006

Pain management

"Take two aspirin and call me in the morning."

The other night I was on the phone with a friend when suddenly I felt cold. Cold to the bone. Corpse cold. Complete with uncontrollable shivering and chattering teeth. The room's temperature was 72ºF, but I turned on the heat, put on socks, and wrapped myself from head to toe in a quilt and two blankets—and shivered for another hour or two before falling asleep briefly. Then I woke up hot. My skin felt like I'd been broiling over an open flame. I shed the blankets and socks, turned off the heat, turned on a fan, and took my temperature. It was just short of 102ºF (for me, normal is about 96.8ºF). I took a Unisom (at about 2:00 a.m.) and woke up long enough to call in sick.

I went through the same thing later in the day, around 1:00 p.m.—chills, shivering, chattering, inability to warm up.

Naturally, when I felt like I could crawl out from under the blankets, I staggered to the computer and looked up things like "chills," "shivering," and "fever" on several health care sites, which helpfully suggested that "shivering" and "chattering" should prompt an immediate call to my doctor's office, as though this were a serious medical condition.

Except that my doctor is not available at 10:00 p.m. or 2:00 a.m. or most of the other times that my body stages one of these rebellions. He's also not available on Wednesdays, or during several other weekday hours. Physicians spread themselves out among offices and hospitals and rarely seem to have established, 9–5 hours at any of them. They tend to be elusive at 2:00 a.m. as well.

In fact, the only way for me to see a doctor immediately would be to go to the emergency room. Of course, you shouldn't go to the emergency room unless you've been shot in the head or a vital organ, protruding bones are making dressing and other daily activities difficult, your body temperature has ignited a three-alarm fire, or your heart is in the throes of arrest (in which case I'm not sure you how you motivate it to tick long enough to get you to emergency).

I've heard rumors of "urgent care" centers at hospitals for serious, non-life-threatening illnesses and injuries, but I can't say I've witnessed any in action. I did go, admittedly in desperation, to the doctors' office center at my hospital (which I shall not name) with such searing pain in both shoulders that several people in the waiting area were alarmed by my (presumably blanched) appearance and offered to get help. The woman at the desk, professional that she is, was unimpressed by my pleas. "You can't see a doctor without an appointment," she said firmly. If I had fainted at that point, my odds might have become slightly better, but I am not sure.

The same hospital has a sign posted with patient rights, one of which is: "You have the right to have your pain managed." This is true—but only after you've made an appointment with your doctor and your time has come.

I did try to go through channels once, when I had a fever and a strep infection. For hours, it felt likes someone was twisting a pumpkin carving knife in my throat and inner ear. I've discovered that, for me, pain is cumulative—I can stand a high amount for a while, but after a few hours and after nausea has set in, my fevered mind starts to wonder if there will be an end to it that isn't a self-inflicted end to all pain and if there isn't something someone could do for me—say, a doctor.

At 2:00 a.m., as noted, non-emergency doctors are scarce, so I did the next best thing; I called the CIGNA hotline or helpline or Nurseline (I don't remember the name; I was sick). Between fits of pain-induced nausea and involuntary tears and sobs, I explained the problem and how it was hindering things like breathing, sleeping, etc. I think I conveyed a sense of urgency and even anxiety about the pain. She (correctly) told me it didn't warrant an emergency room visit, but I could take aspirin/acetaminophen/ibuprofen and cough drops ("the numbing ones, like Sucrets"). And I should drink something warm and soothing. This sounded wonderful in theory, but the usual OTCs aren't that effective at a certain threshold of pain. I didn't happen to feel up to taking a stroll down to the 24-hour Walgreens for Sucrets just then, and the effect of any liquid or other substance in my throat was similar to that of salt on freshly flayed flesh. The nurse was kind and understanding, but kindness and understanding don't produce a physician with a prescription pad.

"Call your doctor in the morning." I did, because it was one of the days he was in. There weren't any times available that day, but I was fortunate to get an appointment for late afternoon the following day. He took a peek in the offending ear and down my raw throat, and produced the magic prescription pad. After three doses of antibiotic, I could breathe and drink without crying or feeling nauseated. I was virtually pain free.

I did have a right to have my pain managed, after all.

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