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PSA:
When you or your loved one is confronted with the obstacles of “we don’t do MRI’s in the ER” and “the earliest appointment is two months from now”, please understand that these seemingly absolutes are simply formalities in a behind-the-scenes checklist. There are earlier appointments, perhaps even one tomorrow. They can and will do MRI’s in the ER under specific conditions. But not everyone can have their appointment tomorrow and there aren’t enough MRI machines to accommodate everyone in the ER who may want one.
So how do you know when to accept what you are told and when to challenge?
Bruce woke up on Sunday unable to walk and in so much pain, he vomited. Since the pain was uncontrolled, off to the ER we went. Bruce had a strong suspicion that this was a recurrence of a back issue, although this time felt different in intensity. Bruce also knew that in is previous ER visits with a similar, yet somewhat less intense issue, he was never given a MRI that day. But he also knew that this was different and that he needed to get this process moving as soon as possible. So he did a little research, learned about what type of back symptoms would warrant an MRI and evaluated if those symptoms were valid for him. Yep. They were. They were valid enough.
And so even though Bruce’s pain was so high in the ER waiting room that he actually passed out, it was through a little self-research and knowing which of his symptoms to emphasize that landed him a that-day MRI and got things moving, probably a week or two sooner.
And then came the discussion about pain medication.
I get it. There is an opioid issue, likely resulting in part from doctors over-prescribing. I understand the caution. But if you have been in the medical system lately with legit, uncontrolled pain, you may have seen that things have potentially swung too far in the other direction. Oh, you say your pain is a 11/10? Oh, you had a vasovagal response to your pain level and passed out with a BP of 70/40? Yeah, take some Mortin. Good luck. And so came the second battle.
How do you communicate your pain effectively so that you can get it controlled?
Bruce had already communicated that his pain was off the charts and he demonstrated that this was true by losing consciousness in the waiting room. But Bruce took the next step of radical vulnerability and honesty.
“I cannot care for myself with this level of pain. My wife is small and I am concerned that I will pass out on top of her when she is trying to help me to the bathroom. I have three kids that have to be cared for on top of all this and we have no local family help. I’m asking for enough meds so that I can get to and from the bathroom safely and so that the situation is manageable so we can continue to care for our kids.”, he explained.
And with that honesty and no prior history of drug abuse, he got meds prescribed to ease his pain enough to make it to the next step – an appointment with a surgeon.
When is the “earliest” appointment?
The original follow-up appointment was scheduled for two and half weeks from the ER visit. This was the “earliest” available. This appointment may have been the earliest available for how he was evaluated in the ER, but with more information, I knew that there may be an even earlier appointment. So we made the calls. We asked to speak to more people. And most importantly, we communicated with raw honesty about our situation. After about three hours of this, the “earliest” available appointment was actually less than a week away.
Lessons:
A little self-research can go a long way. Educating yourself and then using that education to articulate your situation in a way that solicits action is smart, not pushy. And often necessary in today’s medical environment.
If your pain is uncontrolled with over-the-counter meds, it’s time to take more action. Communicate more clearly what that means in terms of your functioning. “I can’t go to the bathroom by myself.” or “My kids aren’t getting the care that they need because my spouse is taking care of me and we don’t have any local help.”, as examples. You don’t have to make things up, but just be more willing to share what’s going on. As long as you don’t have a history of drug abuse, they may be more likely to listen to this additional information and respond appropriately.
The “earliest” appointments available are most often not the “earliest”. Make more calls. Give more details. It’s very possible that the earliest appointment is actually much earlier than the one that they initially gave you.
We are taught to be polite. We are taught that advocating for ourselves or others is being “pushy” or “aggressive”, especially if you are a woman. Do it anyway. The medical system is overloaded and understaffed. The assumption will be made that you can wait for the MRI, that you don’t actually need the meds, and that you’ll figure life out as you wait for an appointment several weeks/months away. These are the defaults and it’s only through your additional communication that other options are even considered. If you can handle the situation as is, great. Accept the defaults. Someone has to because not everyone can receive the immediate care that they are hoping for. But if you know that you are in uncontrolled pain and can’t manage your life, pick up the phone and start advocating. It’s no guarantee, but it may be the only way to have a chance to get your needs met.
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