“Wait, you said you’re a medical student?”
“Yes, I am.”
“I will be seeing a real doctor though, right?”
“Yes, of course!” I smiled, then attempted to defuse his frustration with a quip about getting two opinions for the price of one.
He didn’t laugh, understandably. He was only 25, built like a linebacker, draped in a backwards hospital gown that exposed his unfamiliarity with this environment, among other things. Yet he was here in hospital, in pain, and presented with a relatively powerless medical student to assess him. There was no mystery about his situation. The patient had been on a painkiller cocktail including morphine since a football injury some months ago. His family doctor was away, and he ran out. He needed drugs.
It was 10pm, though, and the team that managed complicated pain wouldn’t be around until the morning. The senior resident on my team was hesitant about giving opioids to an unfamiliar patient at bedtime – too high a dose and the patient could stop breathing while asleep. He had already received several doses of morphine in the emergency room while waiting for our team to assess him, yet still had “11 out of 10” pain. She ordered one more dose of morphine to hold him over until the morning.
The nurse paged me at 1am, “He’s in a lot of pain, can you come and reassess him?”
Unsurprised, I went to see him. I explained that my hands were tied; I told him how much he’s already had, our concerns about his breathing, and that I’d need to wake up the senior resident if he really needed more morphine. He repeated that he did.
The resident came up, reassessed him, and ordered a little more. “That’s all,” she insisted. By now she was convinced he didn’t truly need all this morphine.
4am, my pager rang again. I again headed to face my frustrated patient. He was angry that he always had to go through me before reaching the person with prescribing power. I called the resident again, who refused to come up this time. “Give him Tylenol,” she scolded, “and don’t wake me up about this anymore.”
Infuriation. “Tylenol!? Why am I here? I could be at home with my family if that’s all you can offer!”
I couldn’t give him morphine, but I couldn’t just go back to bed. All I could do was stay and try to talk him down. I asked about his football career, his kids, the sketches he was drawing. He explained the fallout from his injury – no longer could he bend down to pick his daughter up and make her fly, and no longer was he her big tough daddy. She always saw him in pain. He cried some, and as 6am approached, he calmed.
“Hey,” his voice trailed off, “I think I can sleep now.”
“Sounds good, get some rest,” I replied. He was already asleep. “The real doctors will see you at 8.”
Samuel Wasswa-Kintu is a medical student can co-founder of PREMED.me.
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