Pink Sneakers

She has become a regular. She calls early Sunday morning.

ď923, respond for the abdominal pain.” The dispatcher gives the street and apartment number.

Itís always her. We have stopped bringing the gear in. We just wheel the stretcher in and leave it in the hallway, and then walk up the three flights of the dim stairwell to her apartment. She is always ready to go, always wearing her pink sneakers. She locks the door, and then walks down the stairs with us to the bottom where we get her comfortable on our stretcher, and then wheel her out to the ambulance.

She has a number of medical aliments, too many for someone in her twenties. While I have never had pancreatitis, I am told it is extremely painful. It is often caused by alcohol abuse, but not so in her case. Not that that should matter.

Her face doesnít always show the pain. Most of the time, it is impassive, but sometimes she is clearly suffering. She is on Percocet and oxycodone, but it doesnít always help. She goes to the hospital for the dilaudid, which they give her, and then send her home. Fentanyl works okay on her. It takes the edge off, certainly. Sometimes, she is nauseous and she gets zofran, too.

She has become a bit of a challenge for me. Acute pain is easy to deal with, chronic pain more difficult, and chronic pain in the frequent flyer, the hardest of all. I know that you are not supposed to correlate facial expression with pain, but I find myself doing it. If she looks like she is in pain, I donít hesitate, even for the frequent flyer, but when she says ten and she looks normal, I ask myself questions. Do I really need to break open my narcotics for her? Can’t she wait for the hospital to medicate her? She has been in pain for awhile. She is always in pain. The hospital has pain medicine and will give it to her. If I break open my kit, then after the call, I will have to go to the pharmacy and get another kit, making me unavailable for a small time. But it is Sunday morning and it is slow usually, plus if it is busy, I have enough narcotics left to handle another call if I have too.

I donít hesitate about the Zofran because I have plenty of that. Two vials in my kit and always at least three on the shelf. It is my most used drug. If I run out, I can usually beg a vial off another car. Zofran is easy to give. Shouldnít Fentanyl be the same? Why should I worry about having to restock at the pharmacy? True I wish restocking were not an issue. I wish Fentanyl could flow from the wall like oxygen. Wouldnít that be nice? To have a big tank of it, and only have to change it when it gets below 500 Psi?

I have talked about her case with other medics. Most have stopped medicating her. The first, second and maybe third time were on the house, but call for the fourth or fifth time and it is a little much. I see where they are coming from, and I confess I have not always medicated her either. But for the most part, I still do. I try to keep the narrow focus. Is she is in pain? Yes. Can I make her feel better? Yes. Are there any drawbacks to her medically from getting Fentanyl from me? No, I donít think so. So I give it. I feel bad if I donít. I feel a little brighter about my job if I do.

And like pink sneakers, a little bit of brightness in a sometimes dim world is no small thing.

1 Comment

  • Paul says:

    Pain in the frequent flyer is tough.

    They usually know what we carry. I share your philosophy on pain medication. In this situation, I let the patient decide, knowing that fentanyl or morphine are not the drugs that will ultimately make them comfortable. “Would you like us to take the time to start an IV and give you pain medication now, or would you like us to get moving to the hospital so you can get dilaudid sooner?”

    It’s not a perfect solution but I have resorted to this at least once.

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Peter Canning

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