There’s this patient that everyone has written off as being drug/attention seeking. Crazy old lady, mean as hell. Asking for dilaudid all morning, refusing her Percocet (oxycodone + Tylenol, good shit), and has no actual injuries to “justify” it. Refuses to let anyone do anything that isn’t giving her dilaudid.

Welll. I’ve been in her room for most of the past 4 hours. Talking to her, explaining things (ex. Hello ma’am, I’d like to talk to you about your medication. I know you’re in a lot of pain and you want something strong, but you’ve been refusing the percocet. Did you know it made from oxycodone? Would you like to try it? And shocker—she did!) and just letting her talk.

My nurse won’t even go in her room. When I came out after a straight hour, she asked what I’d been doing bc she couldn’t find me. I told her I was just talking to the patient (about her family, life, etc.), and she didn’t ask me for medication a single time. Nurse was shocked. The patient accepted the percocet that she’s been refusing for 2 days. She let us draw her labs, which she’d been refusing even longer.

Yeah, she’s still a crotchety old lady, but she’s lonely. When it comes to elderly patients, they tend to report pain in 2 ways: 1. They severely underreport bc they dont want to be “one of those” old people that complains about everything, or 2. They are one of those old people that complains about everything, because what they really want is attention, company, and comfort. They just don’t want to be left alone.

Pain management and comfort is very important to me. I hate being in pain, and I don’t want my patients to be in pain. So I’m going to advocate for them as much as I can. But part of that advocation is recognizing when pain medication will do more harm than good, and more importantly, when it won’t actually fix the problem. No amount of dilaudid is going to solve my patient’s loneliness. But I can stay with her and let her tell me about her family, and find that it helps just as much.