Go Back To The Emergency Room To Manage Pain? Part 2

Well I don't believe in your institutions
I did what you wanted me to
-- Nine Inch Nails

In Part 1 I described how I was faced with the issue that the painkiller prescribed by the Emergency Department (ED) doctor that was most beneficial was a narcotic and was going to run out before my orthopedic doctor appointment for a pinched nerve.

My options were:

1. Do nothing, run out of prescribed narcotic, and hope for the best using OTC painkillers until my appointment with a specialist (exacerbating my anxiety/depression to possibly dangerous levels)
2. Keep calling appointments phone number to see if any orthopedic doctor had an opening (and explain my decades-long experience with depression, maybe even attempting to get squeezed into an earlier appointment by exaggerating and claiming the situation was pushing me toward being actively suicidal)
3. Return to an ED to ask for some sort of painkiller, probably the same narcotic
4. Visit my general doctor to ask for some sort of painkiller, probably a narcotic

The stage was set by days of interrupted sleep, mostly controlled but constant pain, and chronic low self-esteem causing me to question whether I deserve effective painkillers or even help from doctors. I forced myself (using Opposite Action for anyone familiar with DBT lingo) to call the appointments number a few times to check if any patients had cancelled which might have made earlier appointments available to me. But this is an absurd system to begin with: a cancellation could happen at any moment...should I seriously be tied to my phone redialing every few minutes to be the first lucky patient to grab an opening? If not every few minutes, maybe every hour? Every couple hours? Daily? On some level I wanted to call every 5 minutes to see if I could annoy every appointments person in the system -- the squeaky wheel gets the grease, right?

My imagination went into overdrive for a bit: what if there was some other patient, worse off than me but not so bad as to warrant a trip to the ED, trying to get an earlier appointment with the first available orthopedic doctor? What if my repeated calls into the appointment system would clog the system and prevent patients with all sorts of other afflictions get the prompt attention they need (never mind increasing the anxiety/depression of those who lean toward self-destructive behaviors whenever they are on hold for longer and longer periods)? What if the appointments people/system labelled me as a troublemaker or attention-seeker or malingerer who should not be taken seriously when I called in the future?

Ultimately I did not play the suicide card exaggeration. But I did learn during multiple calls that in my situation, I should try to go to the ED or primary care doctor for assistance before running out of my prescribed narcotic. I struggled with my self-esteem some more -- if my primary care doctor juggled schedules to squeeze me in but by some miracle I was able to also get an earlier appointment with an orthopedic doctor, I would hate cancelling on my primary care doctor.

Another wrinkle with my primary care doctor: 6 months ago I had a few days of intense pain from a health issue that recurs every few years for me. My primary care doctor has a nurse with prescription-writing privileges who I saw for this and she was not familiar with the level of pain I was in so prescribed a relatively low dosage narcotic for pain (until I could get in to see a specialist for the recurring issue). I did not realize that the dose would barely touch my pain until I took the first couple as prescribed so I had to call back when their office was closed and leave a long voice mail for my doctor, pleading with him for either a higher dose or some other painkiller all the while swearing up and down that I was not an addict. Even though I was completely truthful, I do not know how convincing I was but he was able to get me more of the narcotic which got me through until that health issue was resolved. But I worried that that encounter would have started the red flags in the system that I should be monitored for drug-seeking behaviors.

By the time I psyched myself up enough to call, it turned out that the earliest appointment for my primary care doctor would only be the day before my appointment with the orthopedic doctor so I rejected that option.

Which left me with returning to an ED if I wanted any semblance of a tolerable weekend. This seemed absurd. I have heard that some people use the ED for almost everyday health concerns but that is a horribly inefficient, and expensive, way to consume healthcare. I can't imagine my health insurance company would like it very much if I did that and, consequently, do what it could to reject covering costs of multiple ED visits for the same issue in a short period of time.

So not wanting to lie, not wanting to raise flags with the appointments department, not wanting to raise flags with the ED, not wanting to raise flags with the insurance company, not wanting to raise flags with the pharmacy, and in general not feeling worthy enough for proper management of my constant pain, I had a crap weekend even after trying parts of Options 1, 2, and 4 listed above. One of the appointment operators I spoke with did send a message to the orthopedic doctor's office asking that I be contacted ASAP for some guidance (maybe exercises or something to supplement the OTC drugs I would be on) but that combined with me directly speaking with the doctor's assistant on the phone the week before my appointment only lead to "well, we can't legally prescribe/recommend anything until the doctor has a chance to see you in our office," but I think anyone with a few decades on this planet has run into that before so no surprises there.

Although I did not have a positive experience with the orthopedic doctor I eventually saw (anxiety and all that in the exam room), I am on a more appropriate, non-narcotic painkiller and doing prescribed physical therapy which I think is improving my symptoms so I did get on the right track. I just feel a little more forcefulness on my part or a little more empathy on the healthcare company's part could have gotten me there sooner which would have alleviated a good deal of suffering sooner.

On a whim I called the appointments department again after my pain was more controlled and maybe my thoughts were more coherent. Although a supervisor was not available at that moment, I did speak to someone with more stroke than the phone-answerers. We had a long talk about how I could better navigate the system if I was in a similar situation in the future. Now your mileage may vary based on your healthcare system/situation but for this company, there are ways the appointments department can elevate/expedite certain situations. Had I said "I am suicidal" I might have gotten an ambulance dispatched for me but had I said "I am being treated for depression and although this is the first time in my life I have had to manage constant pain for days on end, I honestly do not know how I will feel in the days between now and the first available appointment you found for me -- please help me -- I am relying on your expertise and knowledge to get me in to see a specialist sooner in anyway you can because I really do not want to end up in the ED or worse" might have lead to a better outcome.