Friday, June 26, 2009

Caregiving - Ahh, Duke orthopedics does understand pain

One of the toughest parts of caregiving is watching your loved one suffer and you feel helpless. My dad has been suffering with remarkable pain with his external fixator.

Sometimes when my dad is in a lot of pain, he loses some cognitive and mental function. Through the two plus years that I have been with him 24/7, I have come to understand that a great deal of his temporary lost cognitive and mental function is due to stress and fear.

My dad has not been scared once since the external fixator was placed. He has absolute and unconditional trust in his orthopedic surgeon (Mark E. Easley, M.D.) and Dr. Easley's team. You really cannot minimize the importance of the patient trusting his medical team. I am pretty sure that Dr. Easley or his team could tell dad that he had needed to wear dangling crystal earrings in order to fix the leg and my dad would do it!

The tough part of caregiving is when you have to go through nursing staff and PAs to get pain relief for the elderly loved one. I completely get that the standard line is to get patients off of medications like narcotic pain medications fast! But pain is a vicious cycle. If the pain prevents the patient from getting a restorative sleep then the patient is more sensitive to pain and then the sensitivity to pain
prevents the patient from sleeping.

Many elderly persons have difficulty talking the newer class of sleeping pills (like Ambien). My dad sleep has a history of sleep walking while on Ambien. And our home has about 20 large brick steps leading out the front door. Oh, that would not be pretty.

I talked to the orthopedic nurse about a long lasting pain medication on Tuesday of this week. I left a message on Wednesday and I spoke with the PA on Thursday. The PA was fervent that the orthopedic surgeon would prefer my dad be on Ambien, despite my warnings about his prior experience with the drug. The PA told me she would ask the orthopedic surgeon and call me back.

The PA never called me back. Dad slept about 3 hours a a time last night (and therefore I did too).

The orthopedic surgeon's staff frankly does not like me - undoubtedly because I am a vocal and strong advocate for my dad.

Last night and this morning, my dad was weeping with pain. And dad kept asking me to talk to Dr. Easley about the degree of pain. Neither my mom nor my dad thought that Dr. Easley would want dad to be in pain.

And so my mom followed up where I could not (I am exhausted from lack of sleep and mom has slept!) My mom called Dr. Easley's office and just plainly said that there would be no way Dr. Easley would want his patient to be in pain and tears.

Finally, the staff (that understandably tries to protect the surgeons from nuisances like the patient's family) asked Dr. Easley about pain medication so that dad could sleep through the night. Of course Dr. Easley okayed the prescription. And those were my dad's precise words. Then dad said thank Dr. Easley for me.

Once again, you cannot underestimate the importance of a patient trusting his or her physician. It was dad's unconditional and well placed trust in his orthopedic surgeon that got us all through the last couple of days.

I am off to Durham to pick up the prescription so that my dad can get more than 4 hours of sleep and he can start healing!

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