Every time I read about doctors being arrested for prescribing pain medications all I can do is shake my head. As an RN, I see the insanity of the Drug War at work on a daily basis. I think this must be the first time in history that the sick and dying were denied pain medication. In fact, people have been so brainwashed that even cancer patients are sometimes afraid to accept medication – assuming they have a doctor who dares to prescribe. Every day I see 90-year-old patients, with both feet in the grave, protesting that they are afraid they'll become addicts. As if they were going to run out and mug someone with their walker!
When I was in nursing school, I was shocked to see the cruelty with which cancer patients were treated. Not only did they receive inadequate medication, the nurses regarded them as complainers. They were not really sick but merely whining in order to receive drugs and undue attention. I was assigned to a woman dying of bone cancer, and told it was my job to make her get up and do her "activities of daily living" as they call washing and dressing yourself. She cried at the slightest touch, and even my untrained eye could see that she had a mountain range of tumors protruding from areas of her chest where protrusions were not supposed to exist. Worse yet, when her regular nurse came with her morphine pill, she employed the meanest bait and switch I have ever seen. She showed the patient her MS Contin briefly, then took it away and shoved a giant laxative pill at her, saying, "Isn't THIS the pill you want? You don't want that other pill do you? It's making you feel worse…."
I see this sort of thing all the time. Patients are offered blood pressure medications, anti-psychotics – anything that might shut them up and keep them quiet rather than an actual pain medication. Even more bizarre, nurses are pressured to refrain from giving the medications that are prescribed. For instance, if a patient has something like Percocet ordered PRN (as needed) every four hours, and she gives it every four hours, she may very well be fired for handing out too many pills! The MAR (medication administration record) is carefully scrutinized to make sure nurses are not giving out too many pain medications or sleeping pills. Once I saw the same unopened bottle of Roxanol (morphine) passed along for a week, each shift proudly announcing they had not opened it and expected the next wouldn't either! The patient died quietly, never having received a drop of relief, and the nurses were congratulated on the good job they did, preventing another addict from being created….
Nursing homes are especially bad where pain control is concerned; there seems to be a general consensus that the elderly don't feel pain. The fate of my favorite patient, Helene, still haunts me. A lively 70-year-old lady, I always tried to carve out some time to spend visiting with her. She had untreated uterine cancer and diabetes, but it was a broken hip that had brought her to our institution. Although the cancer didn't seem to be causing her much distress, like many diabetics she was having problems with her circulation and developing gangrene on both feet. I tried to get the doctor to pay attention; he was uninterested. Still, she was receiving some pain medication – a lone Percocet every four hours, which she always asked for on the dot. The day before she was finally scheduled for surgery, she confided that she was terrified of losing her toes. I tried to console her, but I thought she would be lucky if that's all she lost. It was worse than I expected, however.
Two weeks later Helene came back…legless. After multiple u2018salami surgeries' they had successfully removed both legs almost at the hip. She had decompensated mentally, and was now confused at times. She wept and screamed, demanding to be allowed to die. Every morning, the nurses’ aides got her out of bed and sat her in the wheelchair on those fresh stumps, and there she remained for the day. When I protested, I was told that was "Orders" and nothing could be done. If that was not bad enough, her doctor had decided she was an "addict" and discontinued all pain medication while she was in the hospital. Now, she was receiving nothing, so she could "recover from her addiction" as he put it. All night, she shook the bed rails and screamed, "PAIN! PAIN! Help me, oh please let me die." Her roommate requested to be moved but there were no empty beds.
One day the aides said they saw something u2018strange' and asked me to examine Helene. I was horrified to see a tumor the size of a baby's head crowning, protruding from her vagina. Once again, I tried to get her more medication, but the doctor was adamant – she was a manipulative addict who would do anything for a pill. Her son, who appeared to be mentally ill, agreed, as did the nursing staff. I was overruled. Finally, after six weeks of sheer agony, she expired. When I saw her doctor, I couldn't help saying sarcastically, "Well, Helene finally died. Gee, I'm surprised she lasted so long."
He replied proudly, "That's because I took care of her!"
I just looked at him and walked away.
February 28, 2004
