The woman heard a pop as (twisting) she tried to help her (stumbling) mother out of her wheelchair and into the church pew. The pop came from the woman’s knee and she crumpled in pain. She screamed again as we tried to pivot her on her good leg onto our stretcher. The entire congregation turned at that sound. I felt like a barbarian in the gates. There had to have been a gentler way to move her, I just didn’t anticipate the little bit of movement would cause such pain — such a loud scream. My partner and I try to talk soothingly and get her all cushioned and comfortable, trying to cover up the memory of that scream, and maybe get her to see us a little less like untrained ambulance attendants (on a work-release program) and a little more like trusted caregivers.
Out in the ambulance, we elevate her leg, and wrap ice around the knee. From the pop, I’m guessing she tore a ligament. I ask the woman how much pain she is in.
“A lot,” she says. “Ten of ten. It hurts.”
After she tells me she doesn’t have any allergies, I say, “I can give you morphine.”
She looks at me with an evil eye. I’ve already caused this church woman pain by my bumbled patient-handling methods, and now I am trying to push morphine on her.
“I’ll bear it,” she says. “You don’t have any Tylenol, do you?”
I shake my head. I start to tell her morphine is really not so bad, but she isn’t looking at me. She looks at her iced and elevated knee like she is pissed that life has put her in this situation, forced to ride in the back of the ambulance with a painful throbbing knee that she must bear because she certainly does not trust the man fate has put in the back with her.
I wonder how it would have come out if I had just told her I was going to give her a little something for her pain, and just gone ahead and given her the drug. Naming it probably wasn’t the smartest thing. She’s a church lady and morphine might as well be the devil to her.
If they are awake and alert, what obligation do we have to our patients to explain how we are treating them? How much detail do we have to use? Do we have to tell them we are giving them medication? Do we have to name the drug?*
If I had just said, “I’m going to give you something for your pain,” and hearing no protest, gone ahead and given it to her, she’d be feeling better right now. But maybe if we had been smoother and truly careful with our move, we would have spared her pain, given her no cause for a scream, and she would have taken our morphine on blind faith in her Good Samaritans.
I don’t know. As it is, I’m feeling quite guilty. I watch her grimace as we bump down the highway, patient and ambulance attendant.
* I think the answer is probably yes to all of those questions. In practice, I tailor my explanation to the patient on a case-by-case basis depending on my guess of the patient’s understanding or desire for an explanation. To one patient, I might go in detail about the pharmacokinetics of Cardizem as I prepare to treat them for their rapid afib, to someone else, I might just say, “This will make you feel better.” I do know that the word “morphine” has negative connotations to many people. I wish it had a nondescript trade name or better yet a market-researched product name. I’m going to give you Tincture of Unicorn. 5 milligrams of Happiness. A touch of No Worries and you’ll be all set.