Monday, July 3rd, 2006...10:02 pm
Pain.
Sorry guys! I have been off blogging for a while …almost a month, I think. I was bogged down with work at my place, and sometimes it was plain laziness. I was also busy at wikibooks.
But anyway, today after a long time I felt like talking. We have quite a few patients who undergo hip surgery at our hospital. We leave a drain tube in the wound and connect it to a bellow unit so as to prevent collection of blood at the wound site. We remove the drain tube at 48 hrs. By 48 hrs the blood is clotted, and the bellow cannot drain it out anymore. Secondly, it is the only connection to the exterior from what otherwise is a closed wound, and so we do not want to risk any infection. We do not, as a routine, anchor the drain to the skin with a stitch so that we can just pull the tube off.
The patient was a 63 years old lady with a hip surgery. She had had it two days ago. She had a change in the pain medication to Fentanyl infusion as the previous drug (Tramadol) did not bring her pain down at all. With this background in mind, my consultant asked me to be careful with the drain removal and take a decision to mobilize her. Ok boss, done! Ok Miss J, shall we go ahead with the change in dressing? As I peeled the tapes off her skin she jumped in pain. I apologized and went about gently removing her dressing. I tried to take her mind off the dressing ritual. She glanced at the tube and asked me if pulling it out was going to hurt. I replied in the affirmative saying it is going to sting a little. I cleaned up her wound with betadine and covered it with a piece of gauze. I then proceeded to remover the tube. I let her know that I was going to pull it out. I asked her to inhale deeply and suddenly yanked it out at one go. She screamed and tears rolled down her eyes. She was crying in pain. I apologized for the pain I had caused her, and went on to tape down the rest of the wound. I tried to talk her through it but did not quite succeed. She felt the pain was like nothing she had ever felt before. It was the worst pain in her life. I felt miserable. I helped her get into a comfortable position. I made attempts to ease her pain …but they were not good enough. She kept repeating that her pain was horrible. It was another thing that she went through her physio and she even went onto walk. I walked out of the room dejected wondering if I should have been more gentle in pulling out the drain.
The other day I was removing the drain of another patient who had undergone surgery on a previous occasion, and he urged me to yank the dressing off in one single go, rather than tug at it slowly. He could not bear the slow torture. I could not agree with him more. If I was in his position I would want it to be yanked off rather than have it removed gently. I suppose with that notion I had pulled the drain out of this lady’s wound hoping I would keep the painful period short. But I was wrong! Sometime the intensity of pain is more unbearable than anything else. Maybe I should have pulled it out carefully. The way I pull the drain out, or give an injection should depend upon the patient. A small discussion with the patient about how he/she would want it out should go a long way in gaining the patient’s confidence. Doing that is, I believe, the best way of tackling the patient’s painful state.
What do you think?
Tags: Pain, Drain tube, Pain threshold
4 Comments
July 5th, 2006 at 7:04 am
Orthodoc! Good to see you again! I was beginning to wonder where I should send the flowers … ;o)
Now, I have no idea what that sort of pain would be like, and I’m thinking that if I were in the same position as either of the two patients you’ve mentioned, it wouldn’t do any good to ask what I’d prefer – I simply would not know.
However … I think that some people demonstrate a lower pain threshold overall, as your elderly patient seemed to be doing. Perhaps taking extra care to premedicate her with something a bit stronger (or different) would have been a good idea, rather than simply trying to remove the drain with a fast or slow technique …
I think it was excellent that you were honest with her – and told her that it would hurt. Being told that something isn’t going to hurt, and then having it impact you like a sledgehammer leaves a real bad impression.
That’s a hard one to answer, Orthodoc … I would say that perhaps you might just need to go “a bit beyond” with certain patients who have a low tolerance for pain … or who react like they do.
Can’t be easy getting it all sorted out … *comfort*
July 5th, 2006 at 10:48 am
Good to see you back Ortho Doc.
Honestly my first reaction to your post was stereotypical. Blame the orthopedicians, who are typified as crude clinicians, compared to carpenters, not sensitive enough to patients’ needs and pains, etc.
But your questions reveal how wrong such stereotyping can be…
July 6th, 2006 at 7:39 am
Moof: I feel better already! Drain tube removals are done in the ward without any premedication. It stings a little …when I say that most of the patients would agree, but this lady kept on correcting me that it was not little. Yes I should have gone a ”bit beyond” with ”her”, and I agree with that. However I failed to recognise or maybe accept that she had low pain tolerance. I kept confusing my response witht hat of hers.
Scanman: Yup, we have been called carpenters before. But I don’t particularly hate that. I have seen patients walk away extremely satisfied with the work we did. And that brings me immense pleasure.
July 8th, 2006 at 11:00 pm
By the way, my patient suggested a more simpler solution. She peeled the tapes herself. Though she squirmed is pain, I think, the pain levels were more acceptable. I remember having seen our paediatricians do the same with kids. Since they are an apprehensible lot, they get to peel off their own dressings! Next time around I am going to apply the same for my ’sensitive’ patients.