No Pain, No problem?-Not so easy anymore.

03/18/2009 at 5:47 AM Leave a comment

When I started seeing patients in medical school I had to overcome the resistance of causing patients pain. There is no way to do our job if you aren’t willing to stick a needle here and there, drain an abcess, or move a painfull joint. And by the time I was a resident I was way over the pain thing and although I certainly had no interest in causing pain that was unnecesary, I lost not one moment worrying about what I had to do to get the job done, quickly and professionally.

This made me much better at my job. If you hesitate doing a lumbar puncture on a baby that might have meningitis, the baby could die, or worse.

Yet something has happened in the last 20 years. I find myself thinking about the pain and resisting doing what must be done. It takes a little of my concentration away from my task, until I can get past it. I find it interfering (mildly) with my work. So I ask myself, What the Shit is going on?

Aside: My 12 year old daughter told me that I was evil. I asked her why that was. She said that when people came in hurting she knew I pushed on the spot that hurt.

I told her that was true but that it was essential to help the patient and that the patients expected that. Then I told her that it was the second time I pushed on the spot that was purely for fun.

I  have come to the conclusion that it is my long term connection with my patients that is making this a bit harder. I am no longer hurting some semi anonymous person, but someone who I have known for years, whose daughter I sewed up, whose wife had a cancer scare, etc. I am now hurting someone who I am connected to. Wether a good thing or not, It is getting in my way of doing the most I can do. And that is pissing me off–at myself.

So I mentally slapped myself last night and plan to get over this quickly.  Last night I had a patient with a fascinating problem. I had removed a splinter 6 weeks ago and he had done fine , until a few days ago when the spot opened up and started leaking pus. I saw him immediately and he has a pus pocket in his thumb about an inch away from the opening at the base of his thumb. I could easily feel it.

I know better that to start cutting and exploring in that part of the anatomy. It is very dangerous territory for the untrained.  So I sent him off to a hand specialist and placed him on an antibiotic. What i should have done, which did not occur to me for a while was to insert a small IV cannula into the opening and irrigate the cavity to clean it out as much as possible. It is more than most family docs would have done, but it is exactly what I usually do. There is no risk, it will help slow down the infection, but it will be painful and there is no way to ameliorate it.

His 6 year old daughter was there and in retrospect my mental block had all to do about the pain.

No more, I am back on a mission. Pain? what Pain? I feel no pain.


Entry filed under: Uncategorized.

A mother’s true worry. Natasha Richardson

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