I Dulled Her Pain, and My Judgment
SHE was my favorite. We met at the clinic toward the end of a long August afternoon, just a few weeks after I had received my nurse practitioner license. Some people say hospitals are most dangerous in the summer, when so many of the residents are new. These were difficult times for me as well, dashing from room to room to keep pace with the waves of patients, stealing glances at reference books and drug guides, and feeling the dread of having to answer too many patients’ questions with, “I don’t know.” I was eager to earn their trust.
That afternoon I walked into the room as if into a one-act play. The patient, a dirty blond in a wheelchair who looked to be in her mid-30’s, observed me coolly from behind sunglasses. Her husband, who had moody eyes under the rounded brim of a well-worn baseball cap, looked exactly like the daytime courier and moonlighting guitarist he was. They watched as I located the rolling stool, opened her chart, reviewed her vital signs and looked up. The encounter could now begin.
She told me she was on an antidepressant (Paxil) as well as Toprol XL for an irregular heart rate. Until recently, she had also been on pain medication, the Duragesic fentanyl patch, which releases a low dose of narcotic over three days. Her relationships with doctors, she explained, had been contentious. A psychiatrist had refused to prescribe Paxil and insisted on switching her to another antidepressant. Another had tapered her pain medication against her wishes. And a third had made inappropriate comments and had begun to stalk her.( Collapse )