Sunday, March 20, 2005
An experience like Brody's
From the RoundTable blog
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Ardan, of Roanoke, is a registered nurse and works for a community-based behavioral health care organization in the Roanoke Valley.
My husband recently had a total knee replacement. We concurred completely with Jane Brody's experience with pain management.
We attended two "joint school" classes to prepare ourselves for the impact this surgery would have. We also did reasonably extensive research on the Internet to gather as much information as possible. The "joint school" educators assured the attendees that pain should not be a major concern because the surgeon and all the staff worked well together to make the patient "comfortable."
Like Brody, we had to be demanding and, I am sure, obnoxious to get his needs met regarding pain management. My husband did not sleep and because of the pain and swelling was unable to fully participate in the physical therapy regimen until one of the physicians in the practice finally listened to us. Once his medication was increased appropriately, he was actively involved in his recovery and rehabilitation.
I wonder what entity prepares and establishes the protocols used by surgeons. All surgical procedures have written protocols regarding the care of the patient as well as the actual surgical procedure.
Whoever established the pain management protocol for knee replacements clearly didn't consider body size and tolerance when setting the medication protocols. Being told at 3 a.m. that the patient is "already on a lot of medicine now" doesn't suffice when he is clearly in distress and cannot be made "comfortable." Nor do the protocol writers consider that the surgery entails sawing off the top of the bone, ramming a metal spike into the bone and pulling all of the muscles, tendons and ligaments back into place.
There were other events that caused us frustration during the early recovery stage, all of which reminded us that we had to be our own case manager and, in effect, our own doctor. We then thought about some less-competent citizens who must endure excessive pain because they do not have the will or the stamina to argue when the doctor's office tells them they are already on a lot of medicine and really shouldn't need any more.
I have worked in the health care arena for the past 28 years and know that many forces have come to bear on the delivery of health systems. Insurance, malpractice suits, drug abuse and addiction, and technology have all had a part in creating the situation with which we have been faced.
My worry is that in this new medical world, practitioners are unwilling to think outside the protocol box, listen to the patient and to demonstrate compassionate responsiveness. Individuals who don't want to know or admit to the reality Brody reported, and that we affirm, condemn future patients to believing something is terribly wrong with their surgery because the pain is so much greater than anyone ever warned them about.
