Why many chronic pain patients will not go to an ER/ED

I have had some nasty experiences in the emergency rooms/departments throughout my life. It has gotten worse since my physical condition deteriorated to the point where I needed pain medication daily to attempt to control my pain. I’ve written about this before and I have seen other medical patients who write about their experiences in the ER/ED on their blogs. Sadly many of them are far from positive experiences and tend to be the reasons why most chronic pain patients will NOT go to an emergency room unless we think we are dying (meaning: symptoms of a heart attack, severely injured etc.) And most of us would certainly not go during a pain crisis even if our blood pressure is sky high, or we pass out from our pain. Why? Because of the attitude of many people who work in the ER/ED. I was hoping that my idea that some ER/ED nurses punish their patients (and it is not just them) if the patient pisses them off was just an erroneous thought. Sadly I was wrong.

I’ve been reading blogs written by medical employees (in this case I won’t say professionals because I do not see how this behavior is professional at all) over the last week or so. It started out by someone linking to a funny blog post and I read some funny replies in the comments and followed the links. I eventually ended up on a couple different blogs. Many of their posts were funny, some were utterly heart breaking, others were heartwarming and I chose to read a couple from their first posts. But some of these entries were infuriating to me, and made me feel not just sad, but scared as hell for my possible future treatment as I get older and the Obama-care goes into effect.

For example, in one blog post is the following statement: “I head to the cabinet that holds the STAT 16 Fr Punitive Foley Catheter, and Nurse Tinkerbell heads for the cabinet that holds the STAT 16g Punitive IV Catheter. It's called a "16 Squared" and it’s the first line treatment for ODs and fake seizures.”  For those who do not know a Foley Catheter is placed in the urethra to get a urine sample or for other purposes such as surgeries and guage refers to the width of the needle or instrument, the smaller the number the larger the needle/tubing/etc.  In the comment section the blogger is asked “Why do OD’s get a punitive 16g IV?” To which the blogger responds “ODs get the punitive 16g because if they're a real OD, they might need it, and if they're just looking for attention, it makes me feel better. I hate ODs. Use a gun, already.” Basically, one of the reasons a 16g needle is used is to punish them so the nurse who is angry at them for their actions “feels better” about having to deal with them. Another RN commented the following “Although an Ewald is perferred, where's the 16 fr. NG? 16 CUBED, my dear!” (An NG tube is a nasogastric tube, means through the nose, down the esophagus into the stomach) Another commenter Megan (who does not have a profile I can link) “They should teach it at our yearly mandatories- "Fake ER patients, and how best to make them wish they never came in"…”

Now I understand that this was not the focus of this post, the disgusting condition of the patient’s genitals and what was in her panties was the focus of the post. However, this disturbed me as I’ve been on the receiving end of one those those “16 squared’s” before. I had received a spinal tap and developed a spinal headache as a result. These headaches are HORRIBLE. After hours of vomiting, dizziness, blurred vision, and extreme pain I went to the ER on my doctor’s orders. This was back in 1992 or 1993, when I was not on daily pain medication. From the moment I was placed on a gurney in a room,  I was yelled at and ridiculed by the nurse who called me a “big baby”, “Whiner”, and “bitch” and proceeded to give me a 16g IV and catheter then yell at me for crying (and I didn’t bawl or scream, just bit my lips, held my breath and had tears rolling down my cheeks) while she stuck me over and over again in both hands attempting to get this IV. The resulting bruises lasted over 2 weeks and looked like gloves on both hands. She did not use any skin numbing medication before jamming me with the needle over and over. I never understood why this nurse treated me that way as I did not sass her, argue with her or anything else. I was not non-compliant, combative, or argumentative. Now I know and it makes me sick. Apparently since my complaint was “severe headache”, I was seen as a “Migraineur” (one who pretends to have a headache to score pain killers) despite the fact that the headache was caused by a known side effect of a medical procedure; a spinal headache from the spinal tap given during a myelogram earlier that same day.

I tried to dismiss this as a one-time only thing and continued reading the blog because some of the posts were quite funny. But this same topic of punishing a patient kept cropping up. This entire post, entitled “Punitive Procedures” turned my stomach. The commenting replies were just as bad or even worse such as this one from ERMurse: “18 Foley – Dry Insert”. Or this one by Ambulance Driver “Do both. In the same place. 18 Fr in the urethra, 14 gauge in the corpus cavernosum. It's an easily accessed vascular space, it's non-positional and you only need one Betadine

One post was about a patient who died in the ER/ED waiting room because she was basically dismissed as a drug addict. The comments on that one ranged from some outrage to other medical employees saying it was no big deal, its her own fault, etc. The link given to the news story no longer works but I read it along with the link that showed the woman’s autopsy report. The autopsy report showed the woman had only two drugs in her system, her drug of choice crystal meth and Vicodin (hydrocodone) which was at therapeutic levels (page 13 “ Forensic Laboratories” of autopsy pdf file). This means that she was not taking the Vicodin to get “high” or enhance her addiction as was assumed by the commenters. It means she was taking it as prescribed because she was actually in pain. She died in the ER/ED waiting room when her bowels ruptured due to obstruction which had been made worse by the Vicodin (which causes constipation that can result in obstruction etc.).  She was dismissed as a drug abuser by the ER/ED staff and died as a result. The nonchalant uncaring response of the supposed “medical employees” made my stomach turn. I knew that ER/ED departments don’t like people who take pain medication regularly or drug addicts, but the idea that they would shrug off a death so obviously caused by incompetence and malpractice just makes me sick.

I read the blogs of some of the commenters as well, especially the ones who identified themselves as nurses or other health care workers. Again, many of the posts were wonderful, many were very sad, yet many made me angry to read. Many posts showed how hard these people work, how much stress they are under, and how they struggle with low staffing and other issues. However, I found a few common threads in these blogs:

1.  Derogative terms used to describe patients that are meant to dismiss their complaints as not real, made up etc. such as “migraneurs, fibromyalgeurs, and chronic paineurs”
2.  Within the first 5 to 15 words a patient speaks to a triage nurse in an ER/ED that they make up their minds whether or not you are a “real” patient or just a “drug-seeker”
3.  The use of large bore IV’s, catheters, and nasogastric tubing as punitive against patients who piss them off is NOT isolated to a few people, but common among these ER/ED personnel who blog and comment on blogs and they think it is appropriate and funny
4. A very negative view of anyone who comes to the ER/ED complaining of pain of any sort, especially if that pain cannot easily be verified by a test
5. A very negative view of poor people and/or people without medical insurance
6.  A very negative view, as well as substandard care, of people on Medicaid or medicare who are often viewed as nothing more than lazy jerks sucking at the tit of hardworking martyrs such as medical employees
7.  A complete dismissal of certain medical diagnoses as “fake” and thus making people diagnosed with such diseases “fair game” for “punitive procedures” and ridicule

To be fair, I do understand how many drug addicts go to ER/ED’s seeking drugs. I do understand, and agree wholeheartedly, that this is aggravating, annoying, takes precious time and resources from truly sick people, and infuriating. I realize and understand how upsetting and infuriating it is to see so many people taking advantage of the systems set up to aide people (food stamps, Medicaid etc.), such as people who show up in name brand fashions dripping gold jewelry and chatting on expensive smart phones who are on Medicaid. However I do not agree that such feelings give any doctor, nurse, or other healthcare worker the right to punish the patient by deliberately hurting them through the use of large bore IV lines, or unlubricated Foley catheters etc.

One of the major parts of the oaths undertaken by medical personnel is “do no harm”. This is why many doctors and nurses are very careful in their treatment of patients. However, people like these not only break this oath but shatter it as their first action is punish the patient for angering them, thus harming the patient.

I’ve been treated with the “16 squared” (spinal headache), and the ignoring of my symptoms (chest pain with abnormal EKG) solely because I am a chronic pain patient. The last time I went to the ER/ED it took me 30 minutes of arguing with the doctor and the nurses to get through to them that I was NOT there for pain medication. As soon as they see that I am on pain medication daily, it doesn’t matter WHY I came to the ER/ED as that gets completely dismissed. Instead I am immediately labeled an addict, drug-seeker and treated accordingly. This most often means I am ignored for hours on end, as I was with the abnormal EKG and chest pain when I truly was having an issue with my heart. I was just lucky it wasn't a heart attack.

I realize these are older posts but they clearly illustrate an issue that chronically ill patients (especially those whose illness includes chronic pain) have been talking about for years; that medical workers treat them poorly and many do it on purpose.

I am terrified of going to the ER/ED because these are the kinds of nurses and doctors that I've run into most often and I know how these attitudes can easily lead to my dying or being permanently injured because they refuse to act on someone they consider "beneath them", a chronic pain patient.

I am not alone.

This is why.