so maybe it's my post call delirium and lack of caffeine, but instead of doing work here i am contemplating about the pain scale.
it is now a mandatory part of nursing assessment, along wiht vitals, to document pt's (that's patient's) pain level and adequate address it. the pain scale, for those who dont know, is based on 10 points: zero being no pain at all, 10 being the worst pain of your life. because pts are asked so frequently to assess their pain, this whole 10point system is pretty well known. so pts come in complaining of 10 out of 10 pain. and because it is so widely used, it is now being widely ABused.
so pts show up in triage, with something stupid like stomped toe and claim their pain is 10/10. now, i know pain tolerance is different for everyone. pain receptors, neurons, whatever makes you experience pain different (and sometimes even enjoy it ;) ) and i am in no way trying to discredit someone's pain as unreal or minimal, but sometimes i wonder if it's really that bad. of course, i've never been pregnant before so i arguably i dont know what labor feels like or how bad contractions can get. but i have been in pain before, maybe even significant pain (ask me about my injuries sometime), and when someone claims their pain is 10/10 and their cervix is closed....i dont know...
so i must admit i am a pain scale conservative. i do not give away pain points easily. and there is a whole rational reason behind it. if you had to rank your pain, ever, on a ten point scale, one should proportion points thoughtfully. if 10/10 is the worst pain of my life, then whatever i may be feeling now is probably not it. i mean i'm not dying yet, my limbs are all attached, it can potentially definitely get worse. now i've never been in labor, but i imagine having a baby squeeze through my vagina WITHOUT epidural is probably like a good 8 or 9. so we'll save that. now, i've also never had a kidney stone and that's prolly like a 7. so we'll save that. so how bad is this pain? now if i'm sitting in the ED trying to evaluate my pain and suddenly a bomb goes off and i have to run for my life, i'd probably be able to get up and go. i mean, despite whatever pain i'm feeling i'd survive this bombing thing. in fact, if push come to shove, i'd probably even push some little old lady in her wheelchair to safety. so i'm guessing my pain is probably like a 5. and so my worst ED visits, my pain has never gotten above 6. which just makes me think...next time someone asks you about your pain, be reasonable and dont just say it's a 10...because in all things possible...maybe just maybe it's not so terrible?
Sunday, May 29, 2011
Monday, May 2, 2011
the thing about birth plans
so here is the thing about birth plans. i don't like them. seeing a birth plan immediately sends me into this ugh feeling that makes me want to roll my eyes. which is ironic because i feel like i would be exactly the patient that will need a birth plan.
so birth plans. they are actually a pretty good idea: it allows a woman to have a controlled and positive birth experience, the way she wants it. after all, it is her body adn this way she voices her wishes as to how to bring a child into this world, showing that she has thought about it and planned ahead. in theory, everyone should have a birth plan. in reality, it doesnt work that way.
first of all, as far as i know, creating a birth plan is basically a guarantee that everything possible WILL go wrong. it's a like a death sentence to have all the wrong things happen and doctors intervene as much as possible. second, it offends me as a provider...a little. because i feel like i'm a reasonable human being, you can tell me the things you want or dont want. dont write them down in a definitive manner, in a list-like fashion. it makes me feel like you dont trust me as a provider. just tell me what you want, i'll do my best to make it happen.
the birth plan itself, however, possess for me the biggest difficulty. while some things on the list are completely reasonable, like having the baby's father cut the umbilical cord or having you breast feed the baby as soon as humanly possible, others are either ridiculous or just impossible. yes i can completely relate to the fact that you want to keep your contacts/glasses on as long as possible. i'm pretty blind, i know the feeling of complete and utter fuzziness. so please, keep them on, you dont need to write it down. i also dont really care if you listen to music. i mean if cardigans, or yoyo ma or lil' wayne help you focus during contractions, be my guest, listen on. if you want to try for a natural birth and want to refuse all pain meds, by all means, try. chances are you wont make it, but i am not in any shape or form am going to MAKE you get an epidural. i dont care! what i do care about are ludicrous things on the list. like fetal monitoring. in this country we monitor babies during labor. if you dont want to be monitored, i'm sorry you need to be somewhere else giving birth. similarly, things on the birth plan that have to do with intervention are also ludicrous. you cant say that you, under any circumstances, do not want a csection. i mean, technically, you as a patient have the right not to consent one, but then you're basically consenting to letting your unborn baby die. similarly, with episiotomies. we dont cut those, only if absolutely necessary, again, to save the baby's life. so for someone to say i would never ever want one....this is what bothers me because then you're just dictating medical care, whcih you cant do. it';s sort of like telling your oncologist that you dont want chemotherapy but want your cancer gone--some things just dont work that way.
i think that's really the thing. intervention in medical care. i get it, hospitals are scary and deliveries can get hectic and emergent and out of control and as a patient you want to maximize your control in an uncontrolled situation. but birth plans just make it sound like you dont want to be in a hospital at all. home births do exist, that is an option. so the goal of the patient should be sitting down with their obstetrician and figuring out what their practice is and what can be compromised on. dont write it down like a list, that will only make me roll my eyes and think that you dont trust me. and that's not cool. and when i'm a patient i promise to do the same: let go adn allow my obstetrician to make the decisions, and not freak out.
so birth plans. they are actually a pretty good idea: it allows a woman to have a controlled and positive birth experience, the way she wants it. after all, it is her body adn this way she voices her wishes as to how to bring a child into this world, showing that she has thought about it and planned ahead. in theory, everyone should have a birth plan. in reality, it doesnt work that way.
first of all, as far as i know, creating a birth plan is basically a guarantee that everything possible WILL go wrong. it's a like a death sentence to have all the wrong things happen and doctors intervene as much as possible. second, it offends me as a provider...a little. because i feel like i'm a reasonable human being, you can tell me the things you want or dont want. dont write them down in a definitive manner, in a list-like fashion. it makes me feel like you dont trust me as a provider. just tell me what you want, i'll do my best to make it happen.
the birth plan itself, however, possess for me the biggest difficulty. while some things on the list are completely reasonable, like having the baby's father cut the umbilical cord or having you breast feed the baby as soon as humanly possible, others are either ridiculous or just impossible. yes i can completely relate to the fact that you want to keep your contacts/glasses on as long as possible. i'm pretty blind, i know the feeling of complete and utter fuzziness. so please, keep them on, you dont need to write it down. i also dont really care if you listen to music. i mean if cardigans, or yoyo ma or lil' wayne help you focus during contractions, be my guest, listen on. if you want to try for a natural birth and want to refuse all pain meds, by all means, try. chances are you wont make it, but i am not in any shape or form am going to MAKE you get an epidural. i dont care! what i do care about are ludicrous things on the list. like fetal monitoring. in this country we monitor babies during labor. if you dont want to be monitored, i'm sorry you need to be somewhere else giving birth. similarly, things on the birth plan that have to do with intervention are also ludicrous. you cant say that you, under any circumstances, do not want a csection. i mean, technically, you as a patient have the right not to consent one, but then you're basically consenting to letting your unborn baby die. similarly, with episiotomies. we dont cut those, only if absolutely necessary, again, to save the baby's life. so for someone to say i would never ever want one....this is what bothers me because then you're just dictating medical care, whcih you cant do. it';s sort of like telling your oncologist that you dont want chemotherapy but want your cancer gone--some things just dont work that way.
i think that's really the thing. intervention in medical care. i get it, hospitals are scary and deliveries can get hectic and emergent and out of control and as a patient you want to maximize your control in an uncontrolled situation. but birth plans just make it sound like you dont want to be in a hospital at all. home births do exist, that is an option. so the goal of the patient should be sitting down with their obstetrician and figuring out what their practice is and what can be compromised on. dont write it down like a list, that will only make me roll my eyes and think that you dont trust me. and that's not cool. and when i'm a patient i promise to do the same: let go adn allow my obstetrician to make the decisions, and not freak out.
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