Pain

Pain
2 a : usu. localized physical suffering associated with bodily disorder (as a disease or an injury); also : a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort (as pricking, throbbing, or aching), and typically leading to evasive action b : acute mental or emotional distress or suffering : grief
(from Merriam-Webster online)

For me, pain has to be one of the most frustrating aspects of going in to the medical field. It seems that everyone happens to know off hand when their Lortab is due for a refill or has some allergy to codeine and every other narcotic except oxy or lortab. How do you manage a patient with pain?

When I was on palliative medicine, we didn't concern ourselves with addiction or DEA stuff. We manage the pain, we make sure our patients our comfortable at the end of their lives. It seems so simple, so straightforward. We take an oath to do no harm and comfort measures fulfills this, yes.

But what about the guy who says he can't spend time with his family, that his pain is 10/10 but yet I can take his shoes off without him flinching. Later my attending asks what I noticed about his shirt? He was drenched in sweat. I also noticed the dilated pupils and the tremor... the man was more than likely having withdrawals...

How about the lady who explains that she can't work because she's in so much pain and because she can't work, she can't get money to pay for physical rehab that might attenuate her pain. She claims she has a family history of arthritis and that "everyone" takes Lortab.

"Do no harm"
How about when we can't avoid harming our patients?

Just the other day, I was "recruited" to do a urethral swab on a patient who wished to be checked for STDs. Everyone could hear him moan and OH OH and OWWWWW and EFFF in the hall as I attempted to get the best possible specimen I could.


Then there's emotional pain, the pain of loss:

My very first trauma case involved a child that was run over by a parent accidentally. The child was without substantial brain function on arrival. At one point, the team wanted to allow the father an opportunity to see his child, say goodbye. The whole team looked on as they saw a father ask his child to pull through to come back to him. The look of sadness on each of our faces, the ache in our hearts was one sort of pain. The pain of looking at your lifeless child on a trauma bay stretcher was another.

But yet we, we being future doctors, are trained to suppress emotions and to act in the face of uncertainty. I read about this study a year or two back:

http://www.news-medical.net/news/2007/09/27/30497.aspx
"Without some regulatory mechanism, it is very likely that medical practioners would experience personal distress and anxiety that would interfere with their ability to heal,” the researchers write."


So as a student doctor, doctor in training, medical student, how do I cope with these issue of mortality. Well, principally there's God. For many of my peers and myself, the concept of mortality and the peace we must seek with the fact that we can't prevent all outcomes is rooted in our spirituality.

“I have found the paradox, that if you love until it hurts, there can be no more hurt, only more love.”
Mother Teresa