"I don't come into the hospital a lot." Right after he said that, he pressed down with his hands and scooched his bottom back, trying to get himself comfortable in the hospital bed. I saw an antalgic flash ripple over his face. That fleeting wince told me what I'd come to find out. He was in pain.
"When was the last time you were here?"
"I don't know. Like maybe six or seven months ago? But it take a lot for me to come up here."
"I hear you."
He was young. Young enough to be my son but old enough to be out of the pediatric setting for his sickle cell anemia. This hospitalization for a vaso-occlusive pain crisis was one of those bread and butter things you see when caring for an urban population. Youngish patients writhing in pain and with high tolerances for pain medications. Ones who've lived so much of their lives in the sick role that it seems to be ground into who they are. That's tough sometimes. And when it comes to any patient needing or wanting or asking for any really, really potent narcotic pain medication, with it comes some skepticism no matter how hard you try.
I was back at Grady making rounds late that evening. My resident had asked me to pop in to see him because our pain regimen wasn't quite working. And as soon as I saw him, he quickly notified me that the pain medicine we were giving him was only lasting for about 3 hours.
The problem with it was that this was a really strong medication. And giving him even more of a really strong medicine (that is, more frequently) would have put him at greater risk of addiction. And so. I told him just that.
"I worry about giving you this medicine closer together like you're asking. It's habit forming. And one of the most habit forming ones we have."
That's when he just started staring straight ahead, eyes filling up with tears. Nope, not mad. Nope not cursing or yelling expletives either. Just silent and sad appearing.
This was unexpected.
"Sir?" I asked. "I'm sorry. Did I say something wrong?"
He didn't speak back. He just let his eyes rest on the folds of his blanket while blinking back a few more tears. And so. We just sort of sat there for a few moments in this super awkward silence. Him looking down and me watching him.
A nurse walked in and passed a medication. Some kind of pill that looked like tylenol. "How's your pain right now, my friend?" He turned his head toward her and remained quiet. "Okay, sir. I'll let your doctor finish talking to you." And with that she walked on out.
Finally, after what felt like forever, he spoke.
"Do you know what it feel like to be in a sickle cell crisis?"
I swallowed hard, regrouped and thought about his question. But it didn't take long for me to find an answer. "Do I know? No. I couldn't know."
"I'll tell you. It feel like . . . like. . . somebody taking million drills and going in and out of your bones all at the same time. Over and over again. Or like somebody taking the bones in your leg and trying they best to snap 'em in two. Or just putting 'em all in a bag and banging 'em with a hammer until it's nothin' left but dust. And all you can do is just sit there scared it's gon' get worse. And when it finally go away, all you do is pray it don't come back."
I didn't speak. I just listened.
"And you know, Miss Manning? I think that's what have so many people messed up. They don't want that pain coming no where near them. So they ask for more and more medicine 'cause they . . they like. . .traumatized, you know?"
I nodded. "Hmmm."
"But me? I do feel scared of that pain a lot. I do but if you look in my chart, you can see that I don't be up here like that. I try to manage it best I can at home, you know? And when it's real bad, like real, real bad--I come to the hospital."
"I get it."
"But it make you hurt even more to have your doctors looking at you like you some kind of drug fiend. And all I'm telling you is two things: Number one is. . . .I'm me. It ain't nothing in my chart to make somebody think I'm trying to game somebody to get high. But the other thing is that. . .like. . .until you know what if feel like to have somebody break all your bones at once? Cut them folks some slack, man. 'Cause a lot of us be running scared. Scared of that real Boogey Man that's been chasing after us since we was too little to even understand it."
I blinked a few times and let his words sink in. I nodded my head and leaned forward in my chair. "I appreciate you giving me that perspective. I really do. I don't think I'll ever think about sickle cell the same way again.
And I said that because it was true.
I can't imagine what it would be like to have a real, true Boogey Man chasing after me for my whole life. And I especially can't wrap my head around what it must be like to have him catch you repeatedly. In those few moments, that patient gave me a new empathy for those under my care living with sickle cell anemia.
And so. I reviewed his chart. I looked at what he was taking and at all of his numbers. I blended that with his physical examination to guide my clinical decision making. I modified his medication. We talked about his concerns and my concerns and formed a therapeutic alliance. And all of it was good. It was.
A few days later, he was feeling much better and was ready to be discharged from the hospital. He was moving around without pain and felt pretty close to himself again. It made me happy to see him smiling on the way out. Sure did.
I said a little prayer for him as he disappeared down the hallway. Wished on a star that the real Boogey Man would stay away. And that his doctors would no longer become the new subjects of his worst nightmares.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?