step-down hell....

On a step-down unit I receive an admit from the ED. Patient is 84 years old who lives alone. She tells me her problems started as she attempted to get out of a chair a little too fast, became dizzy and took an express trip to the floor. She claims that she never lost consciousness and big surprise this is not the first time grandma has taken a floor dive.

As she is delivered to the room I help the transporter slide her from the stretcher to the bed. Immediately, she tells me she needs pain medication and a hamburger.

It always amazes me that no matter what these patients come in with they all expect the kitchen to be open and serve them three squares and snacks.

I ask the woman about her pain and she becomes angry that I am not spending the same effort to locate her meal. At this point I have had enough. It has been a busy day moving from unit to unit and I have no remaining empathy left in my tank. With the last remnants of composure I have left I explain that I will work on obtaining something for her to eat and try to help her with her pain.

Her admit order do not provide squat for pain - surprise! I never understand how patients who are admitted with falls, cuts, accidents or any complaint that involves pain are never ordered medications to address the pain.

It is the afternoon so I must page the resident who is covering the hospital. She calls back very quickly and when I give her the background information:

R1: (imagine a slight accent - or maybe not so slight) Lady so old - I not give her narcotic.

Me: Well, regardless of her age she is in pain.

R1: Ok, give her Tylenol 325mg time one.

Me: and...

R1: Call me back if that no help.

So, I give the patient 650mg Tylenol.

Patient: I am hurting and you want to give me Tylenol??!!??

Me: I am sorry, that is all the resident will order. If it does not help - I will call her back.

An hour passes and surprise the lady is not happy! So I call the resident again.

Me: Our little is writhing in pain 10/10 and the Tylenol did squat.

R1: Oh..

Me: Can we perhaps give her a little something to help her out? She takes Vicodin at home.

R1: Let me call you back. I am not familiar with her so I need to get a better understanding of her history.

almost an hour passes and by now the patient is livid and not a happy camper! So I give the resident another call.

Me: Remember me? The patient is still waiting for some relief.

R1: Oh..

Me: Can we give her the Vicodin?

R1: But I don't want to give her narcotic because her age.

Me: So you want to leave her in pain? She is completely A&O, her vitals are great, no renal problems and did I mention she is in severe pain. Plus, she is a DNR/DNI.

R1: Oh..

Me: So....Vicodin??

R1: Ok, you give her one Vicodin.

Me. and...???

R1: If that no work - call me back.

I am so tired of working these shitty step-downs!!