In Pain? Too Bad! Part One

I've had some problems lately at my clinic. This, as you will read, may be the understatement of the century.

Now faithful readers of ZPT will note that I've had problems there before, particularly where prescription refills are concerned. Lately, however, that issue had seemed a thing of the past: the Rx Dick was taken off of refill duty and the new procedure (calling the receptionist and making the request through her) has thus far worked pretty well. I personally had preferred Dr. Fetus' method of simply seeing me every 3 months and writing out 3 months' worth of prescriptions at that time, but I understood why Dr. Forthright (Dr. Fetus' replacement) wasn't comfortable with that and honored her wishes.

And then Dr. Forthright finished her fellowship and moved on.

When I got the letter announcing her departure, I was disappointed. I had, over the years, built up a great doctor/patient relationship with Dr. Fetus, and considered myself fortunate to have found a like-minded physician in Dr. Forthright. For me, it's essential that I trust my doctor, and my doctor trusts me...that we can both speak freely and air concerns without fear of censure. I am not one of those people who likes a doctor who "pussy-foots around," as we say in the South: I want to be told directly, honestly and then get on with it. Having had success with three doctors in a row (The Well-Accessoried Doctor, Dr. Fetus & Dr. Forthright), I had high hopes that the new physician would be in the same vein.

Little did I know the awful sequence of events that would be unleashed as a result of Dr. Forthright's departure.

Below is a letter I've written to Patient Relations and the clinic, and it explains it all:


PLEASE PLACE THIS LETTER IN MY MEDICAL FILE. THANK YOU.

To whom it may concern:

I have been a patient at the clinic for a number of years. During this time, I have had numerous difficulties in obtaining prescription refills (both for narcotic and non-narcotic medicines). I entered into a pain management contract, but the problems did persist. Most of these ongoing issues, however, were resolved some months ago when the clinic re-vamped its prescription refill process. I had been happy overall with the new clinic procedures, but unfortunately these procedures failed me in the months of February and March 2011.

I have secondary-progressive multiple sclerosis and MS-related trigeminal neuralgia. It took some time before a suitable medicine regimen was found to adequetly treat my severe chronic pain. Before that regimen was found, I was frequently forced to go to the ER for pain in addition to numerous office visits. Eventually, the combination of medications that I am currently taking was prescribed. That was four years ago, and in that time I have not once been to the ER for TN pain, nor have I exceeded my monthly medication allowance. I have been randomly drug screened during this time and never failed. I have upheld my pain management contract to the best of my ability. I even sent my former doctor, Dr. Fetus, a thank-you card every January in appreciation for the regimen that has made my life bearable again.

A few months ago, my doctor finished her fellowship and I was switched to an NP. I requested, both by telephone and in person at the office, to be switched to an MD and assumed that had been done. When I called to get my prescriptions refilled in February, I was told I could not have them until I was seen and that I could not be seen until the 10th. I was also told I was still on the NPs rotation, but that I could fill out a form to request a change (this was the first time I had been told about this form).

As a result, I went several days without my medication. The medication takes some time to build a "level" in your bloodstream; because I didn't have my medication on time, the entire month I dealth with much more pain than I am accustomed to dealing with. I am permitted to take my oxycodone every 6 hours and at times I unfortunately had to do so. This has led to side-effects that are most unpleasant, and to my running out of medication prior to March 10th.

While at the clinic on 2/10, I was randomly drug-screened, which I passed. I then asked again to be switched to an MD. I filled out the form, and the NP made a note in my chart as well. I was given my prescriptions, and at no time did anyone inform me that I would need to make an appointment for March or I would once again be denied medication. Had I known this, I would have made said appointment while I was in the office and the following situation would not have occured.

On March 1st, I contacted the office to request my 3 hard-copy prescriptions as I do on or around the first of every month. I was told for the second month in a row that I could not have my medications unless I came in to be seen. I assumed the note had been left in the computer from the month before, and told the receptionist I had just been seen 2 1/2 weeks prior to the call. I was told it did not matter, I had to be seen again. I explained the situation I was in, with higher levels of pain because of the delay the month before and that further delay this month would only lead to more pain and even possibly hospitalization. I was told I could be seen on the 8th, but that was all they could do. I was then asked if I wanted to discuss the matter with the office manager, and I agreed.

I spoke at length with Office Manager "Norene," who was both cordial and helpful. She agreed that my current situation with the medication was due to the clinic's mistakes, and assured me they wanted to do everything possible to "keep me out of pain." She told me more than once, "We certaintly don't want you to be in pain." She suggested I come into the office to "brainstorm ideas" to "help me get over the hump" until I could be seen on the 8th. I argued that the only thing that could be done was to give me medication or a shot, and I did not want a shot. She insisted again that I should be seen. I told Norene I felt I could make it another day or two, and then revisit the matter at that time. She pointed out that another day or two would be the weekend, and my contract disallowed medication requests on the weekend. I would be better off, she said, if I came in to see the NP at 7PM that evening. I was still hesitant, but after considering it for a few minutes, I agreed and the appointment was set.

After my conversation with Norene, I was under the impression that my appointment was set for the sole purpose of finding a way to help me manage my pain until my appointment with my new MD on the 8th. However, when I arrived at the appointment, I discovered that the NP did not believe this to be the case.

When I arrived, the first thing I noticed was the cup for a urine sample. I was taken aback; I just took a random drug screening the month before and as I said above, I have never failed a urine screening. I felt insulted, so I asked the nurse to allow me to speak with the NP before taking it. I wanted to know why I was being asked to take the test.

When the NP entered the room, she immediately told me that she "didn't know why I'd come in." I was surprised, and told her about the medication mishap of the past two months. She was aware of this, and told me there was nothing she "could or would do" about it, and couldn't fathom why I had made the appointment. I told her I had not wanted to come in that evening, but had been persuaded to do so by Norene and repeated to the NP Norene's assurances that we could "brainstorm" a way to "help me over the hump." The NP told me that she had no such intention, and that she was under the impression that I had "insisted upon coming in" for the appointment. I asked if Norene was still in the office so we could resolve this obvious miscommunication, but was told she had already gone home.

At this time I was told I had violated my pain management contract by using all my medication before the date of refill. When I tried to explain what had happened and why I was put in the position of needing more medication than is my usual wont, I was told it didn't matter: I was wrong, I was in violation, and there was no way I was getting any medication or help from her. She asked me what I had "expected" out of this appointment. I became upset and told her that I had obviously been misinformed, as I was talked into coming in to see her under the impression that she would at least have some ideas on how to help me. I pointed out that I was in this position not of my own accord, but because of mistakes and miscommunications by the clinic. I invited her to check my records to see that I had not violated my contract in the many years I'd been there, nor had I been to the ER for TN pain in four years. I had recently been seen and both took and passed a urine test, and had not been in to the office for a shot in nearly a year. There was no evidence that I was drug-seeking, so why was I being treated as if I were?

The NP's attitude became more and more combative. She inquired as to how issues of the pain being out of control had been handled in the past. I told her that years ago, I would go to the ER, but had not done so in four years. I had, however, come into the clinic for a shot twice during that period. She asked what I meant by the word "shot," and did I mean the drug Toradol? I told her that such NSAIDs had stopped working for me years ago and generally were ineffective against trigeminal neuralgia in any case. The shots I had received in the office in the past were either demerol or morphine. She then told me "they don't carry those anymore" and had not done so for months. I pointed out that such shots were covered under my contract, and why had no one told me that part of my "safety net" was now gone? I then asked what I was to do if the pain got out of control, did I have any options other than the ER? The NP then told me I could not go to the ER, either! I was amazed. I informed her that I had an ER addendum to my pain contract and it was my understanding that I was absolutely allowed to go the ER if needed. I was then told I could go, but they (the ER) would have to call the office and they'd be told not to treat me!

I was repeatedly told that this was all my fault, that I had run out of pills and violated my contract, and that I had put MYSELF in the situation I was in now. I asked her to explain, and she said, "If you have to take pills every 6 hours one day, then you have to know you can only take one or two the next day, or none." I asked her if she had any idea what chronic pain was like; it simply does not work like that. She said it had to work like that, if I intended to follow my pain contract. I asked her if I was permitted, as the label says, to take the pills every 6 hours if needed. She agreed that I could, but that if I did so I would run out of pills and "face the consequences of violating the pain contract."

I then remarked that I should probably leave, as she had made her intentions to not treat me quite clear and was making me uncomfortable. She then told me I could not leave without taking the urine test. I asked her why it was necessary and she said, "Because I said so." I asked again, and was told, "Because I said so, because I want you to." I rephrased, asking for the medical reason behind the test. She repeated again, "Because I want you to," and then let me know that I had every right to refuse, but if I did, not only would I not get medicine that day, I wouldn't get it on the 8th, either! I felt threatened and coerced, and I told her so. She again told me I was in violation of my contract and this situation was my fault entirely, and the need for this test was also my fault entirely.

I told her I would take the test and pass it as I always do, but that I felt coerced and insulted. It was beyond my understanding why I was being treated in this matter, and being required to take a drug screening while at the same time having treatment for my pain withheld. I told her that I often wished medical personnel could spend a week in my shoes, that they'd be better for it. She asked what I meant, and I told her I felt I was being treated unfairly, as if I were a criminal or a junkie. She insisted she was not doing so, and I told her she did not know how it feels and to not diminish my pain. But the fact is, everyone "ends up on my side of the bed sooner or later," and how would she feel if when that time comes, she is not believed or told to take a urine test first while she agonized in pain? She told me again that I could refuse the test, but the clinic would then refuse to give me any medications; the choice was mine. She told me she couldn't understand why I was "choosing to be offended" by the test, when they were permitted to drug test me randomly by the pain contract. I told her that coming so soon after the last test, and only because I came in looking for help and being told none was forthcoming, it felt both insulting and accusatory. I told her I was amazed that mistakes on the part of the clinic had put me in such a position, and that same clinic was refusing to help me and blaming me for it, not to mention threatening me with further refusal of treatment.

I related an incident that had occured in March 2010: I had an appointment set up and could not get my refills without it; unfortunately, my father died unexpectedly (I have the death certificate, if necessary). I called the clinic begging for an earlier appointment or for them to simply write the prescriptions this time and allow me to be seen when I returned. I was refused, told nothing could be done. I had to wait until 3:45 the next afternoon to have my appointment, then have my prescriptions refilled before I could begin the 3-day trip to arrange my father's funeral. I had believed this was the worst treatment I had ever gotten at the clinic, but at least in that incident I had been apologized to and not told that I myself was to blame!

I could see that attempting to continue talking with the NP was useless; she had no interest in "brainstorming ideas" to help me, and certaintly was not at all concerned that I was and would continue to be in pain. I told her I was taking the test, and was told to give the sample to the nurse and await the results.

In tears, I went down to the bathroom and took the test. I also took a moment to compose myself. I felt let down and insulted by my medical providers, abandoned and humiliated through no cause of my own, and then blamed entirely for it. I had days of suffering to look forward to, and every means my pain contract gave me as a safety net had been taken away from me. I resented the fact that I was being held to every word of the contract, while the clinic felt no need to uphold their end. And charging me for the pleasure!

On the way back to the room, I met the nurse at the computer station and she took the sample from me. I then returned to the room and contacted my husband to come and pick me up. I was crying, and he did become understandably upset. I waited for 20 minutes before my husband arrived, and then waited 10-15 more minutes before the nurse poked her head in the room and asked why I was still there. Again, I was taken aback. I told her I was under the impression I was supposed to wait for the results. She told me my test was "fine" and I could leave now, as the clinic was closing.

It is hard to describe how I felt at this time. I am not ashamed to admit I cried, which only made my pain worse. In all the years I have gone to this clinic, I have never been treated in such a way, nor do I believe I have done anything to deserve being treated that way.

On the following morning, I again spoke with Norene. I was then told that the NP had considered me "aggressive" and that I had talked about death! I was shocked. I explained my comment earlier, and it seemed that perhaps Norene had been told something different, I am not certain. I was also told that my husband was "acting aggressive." I said yes, he was upset at how I had been treated, but the security gaurd was in the corridor when my husband was there and never once approached us, so I find the charge of being aggressive a diversion from the actual issues at hand.

I asked Norene if what I had been told about the ER was true, and she did not know. She told me that I could feel free to call the doctor on call if needed during the weekend. When I asked if there was a note or order prohibiting my treatment at a hospital, she did not have that information. I let her know I had no intention of visiting the ER (and in fact did not go), but I was distressed at having the measures that constituted my safety net taken from me without due notice or cause. I felt I was being told by the clinic that I simply had to suffer with no recourse. Again, she was cordial and attempting to be helpful, but nothing was accomplished.

I then contacted "April" at Patient Relations and told her all that had occured. I was encouraged to document my experience in a letter, which I could mail or email. She assured me she would also contact Norene and try to discern how and why this situation had arisen. I assured her that I had found Norene to be helpful as much as was possible and was grateful for her efforts.

I spent a very unpleasant weekend, simply suffering, as I apparently had no other option. I find this unacceptable, and I am concerned that I am not being given due consideration in my long-standing pain contract with the clinic. I am apparently expected to uphold my part, and threatened with "consequences" if I do not, but apparently cannot count on the clinic to uphold theirs.

I am extraordinarily disillusioned and offended by my treatment. The clinic is keen for me to renew my contract with my new MD, but I cannot help but wonder if I can hope to expect an honest meeting of the minds, or any form of due consideration.

It is my fervent hope that all of this unpleasantness is the result of miscomunnications and minor mistakes that can be easily rectified. I do not wish to believe that the clinic is in the habit of using pain contracts to decieve and coerce pain patients who are, after all, at the mercy of their treating physicians. It is also my fervant hope that my meeting with my new MD on March 8th will be productive and pleasant, and that I will receive both my medications and a reasonable pain management contract at that time.

Thank you for taking the time to read this, and for your efforts on my behalf. I look forward to resolving this issue in a positive manner in the very near future.


Sincerely,

Angel
March 7th, 2011


I did not receive a response to my letter until the second week of June (the letter is dated June 3). Here is the response to my five-page letter detailing my experiences and concerns:


Dear Angel:

Thank you for contacting the Patient Relations Office expressing your concern regarding the clinic. I am sorry for the experiences that were upsetting to you. The appropriate people have been notified and action taken where appropriate.

If you would like further assistance with this, please contact Norene at the clinic.


Sincerely,

Molly


Yes, I got a response three months later....all of four sentences long.

Think things couldn't get worse? So did I.

I was wrong.

Stay tuned for Part Two....

Stranger Things Have Happened

Longtime readers of ZPT are well aware of my problems with my clinic, particularly with the Rx Dick and the procedures involved with getting three of my prescriptions. For those readers, go ahead and skip to the red font. But if you're new here, here's some background:



Three of my prescriptions cannot be refilled like the others. All my other meds, I simply call or take in the bottle and get my prescription filled, or the pharmasist faxes my doctor's office and gets the refills authorized that way. But these three (Oxycodone, Methadone and Diazapam) don't work that way; the law requires a brand-new hard copy of the script every single month.



Getting this done has proven to be difficult. The office policy was for me to call 5-7 working days (not on weekends, this is prohibited on my pain management contract) and leave a message for the Rx Dick. The Rx Dick (in theory, mind you) would write up a note to the doctor requesting the meds. When that is sent to the doctor, the meds are now "pending." After the doctor approves them, the Rx Dick calls your home (again, in theory) to let you know that the scripts are waiting for you at the front desk. You then go to the office, get an envelope with your name on it, check the scripts to make sure they are correct, show your ID and sign for the scripts. Finally, you take it to the pharmacy to be filled.



Sound simple?



It's not.



I get my scripts on the first of the month. Rather, I'm supposed to get them, but this system has more holes than a collander. The majority of the time, when I call to leave the message for the Rx Dick, the voice mail is full. The receptionists refuse to take messages for him, and if you try to speak to your doctor's PA or nurse, they refer you back to the Rx Dick.



One of the reasons the voice mail gets clogged for days is that on top of being the prescription coordinator, he's also the clinic radiologist. If that sounds bizarre to you, you're not the only one.



When you do finally get the message sent, you are told it will take at least two days. This rarely happens. Whatever you do, though, you don't want to call and check up on the status until day three, because you will get chastised by anyone and everyone you speak to on the subject.



Finally, the Rx Dick rarely if ever calls you to tell you your scripts are waiting to be picked up, leaving you to call every morning and afternoon for days, even a week or more. The receptionists are often annoyed by these calls and by being forced to look on the computer to see if you're still "pending" or if they are at the desk waiting for you. You can leave a message on the Rx Dick's voice mail, but even if it isn't full he's very unlikely to call back.



When there is a holdup, the Rx Dick will not contact you to let you know what's going on. The receptionists will not be told, so they have no information to give you. Your doctor and their PAs and nurses have nothing to do with the presciption refills process, so there's no point in enlisting their help (they will just refer you back to the Rx Dick anyway).



I go through this every month. At least, I used to.



A few months ago, the office changed their policy. There is no more Rx Dick (he's still there, as radiologist). Now, you must call the receptionist 3-5 working days ahead and have THEM send the "note" to the doctors. And then again, you call and you call, hoping that your meds are ready for you before you run out (and run out I have, more than once).



Now when I call, I have to explain to the receptionist why their immediate response of, "Just have your pharmacy fax the request to the office" won't work. The law requires my having a hard copy every time. This annoys many of them. All you can do is cross your fingers and hope they send up a "note" in a speedy manner with the right meds requested.



Yesterday, I made the dreaded phone call. I had tried the day before, only to have the annoyed receptionist snap at me and tell me that it "isn't three days prior yet." Gee, I'd been told 3-5 days, but whatever. I made the call yesterday, and prepared to go over the whole rigamorale all over again.



The phone call went like this:



RECEPTIONIST: Hello?

ME: Hi, my name is Angel, and I need to make a request for three hard copy prescription refills.(bracing myself to have to explain)

RECEPTIONIST: Oh, yes, I see in your chart! By the way, my name is "Norene", and I'm the new office manager. Would you mind staying on the line while I write and send the note?

ME: (surprised) Yes, of course.

NORENE: (over the sound of the computer typing) Request for these three prescriptions, request that attending sign if prescribing doctor is unable, send. There! All ready.

ME: (shocked at the added request, as I usually have to beg and plead for that eventuality) Thank you so much.

NORENE: Now, could you do something for me? Could you call tomorrow and check on the status, make sure it's moving along so they'll be ready for you to pick up Friday?

ME: (completely, utterly stunned, as making such a call in the past led me to be lectured, snubbed or oraly bitchslapped) Sure, I can do that. No problem. Thank you so much!

NORENE: Well, thank you. And if you have any problems, you just ask for me, Norene. OK?

ME: (not sure I'm awake, as this must be a dream) OK. Thank you again.

NORENE: Have a nice day!

ME: You, too.



I hung up the phone and stared at it. Did that just happen?



Has the Rx Dick been replaced in my life by Nice Norene?



I have no idea what will happen when I call today. Lecture? Rudeness? Or more Nice Norene?



I'll keep you posted...

Tin God Syndrome: The Hit-and-Run Doctor

If you haven't read the post below...I have had two run-ins with Tin Gods in the past few months. The one below, the Doomsday Doctor, is a thankfully rare beast.

This one, the Hit-and-Run Doctor, is not.

It is possible that Hit-and-Run Doctors are the most common of all forms of Tin God Syndrome. It is very rare that a person with a chronic health issue doesn't have a run-in with at least one, and usually far more than that. Of all the Tin God stories I hear, H&R Docs are the most common.

My story begins about a month ago. Summer started early in Portland this year, and temperatures were at near-record highs. Not good news for those of us, like myself, who suffer from heat-reactive disorders. All you can do is embrace the central air and cope with the symptoms with liberal doses of medication & good-old fashioned North Carolina sweet tea (of which I am an expert).

I've had MS now for well over a decade. My most hated symptom is not pain. It's not the loss of mobility. It's nausea. I absolutely loathe being nauseated. And while I cope with mobility issues rather stoicly, and I have a high threshold for pain which goes a long way towards dealing with that unpleasant aspect of MS...I am a giant crybaby about nausea. I am the least likely person on earth to become bullimic: the idea that anyone FORCES themselves to vomit is just beyond my ability to comprehend.*

It's just my bad luck that every summer, the Nausea Fairy comes to visit me in force. I have tried damn near every medication on the market. Phenergan worked well for me for years, but it's now to the point that in order to take enough of it to be effective, it turns me into a complete zombie. I almost enjoyed watching Rock of Love on it once. It's that bad.** One of the medications I tried last year was Reglan. I used it for about three days, and it was ineffective. I was switched to Zofran, which works very well (and the pills are super-tiny, making them very easy to swallow when you're feeling sick to your tummy---I'd like to shake the hand of the scientist who realized that). I put the remainder of the Reglan away in a box, and promptly forgot about it.

Fast-forward to last month: I was suffering severe pain and terrible nausea. And wouldn't you know it: I ran out of Zofran, and the pharmacy was closed. Desperate, I checked the medicine box and found the long-forgotten Reglan. I called the doctor on call (I had begun taking one different med since the last time I was on Reglan, and I wanted to be sure it wasn't counterindicated). I got the go-ahead, and took the pill. Within 20 minutes, I was nausea-free.

Since the Zofran is rather expensive, and the Reglan was working, I continued to take it for the next week. The only side-effect were some vivid and disturbing nightmares, but I can deal with nightmares. Nausea, not so much.

Then one day, I woke up and just felt WRONG. I couldn't immediately put my finger on it: but I knew something was up. As the day progressed, so did the feeling. But now, it was accompanied by some startling symptoms: terrible anxiety; confusion; tremors in my hands; a sensation of being freezing cold (during a very hot summer afternoon); a loss of appetite; and a tightening in my chest, face & jaw that was causing my TN pain to go into overdrive. I called the doctor, and waited for a call back.

While I waited...all hell broke loose.

I began to sweat, while still feeling freezing cold. My heart was racing and pounding, the anxiety went from mild to overwhelming, and it was coupled with a debilitating sense of paranoia. I couldn't cope. I began to have a panic attack...which is not like me in the least. Most people who know me would describe me as a calm person, and at that moment, I was the least calm person in the known universe. I felt like I was going crazy. I didn't feel like me at all.

The doctor called back, and told me that this sounded like a "known and not uncommon" (WTH?) bad reaction to Reglan, and I needed to go to the ER right away. By the time my husband raced home from work to take me, I was rolled up in a ball in a corner of the bed under three blankets, shaking and crying uncontrollably, startled out of my wits by the slightest movement or noise (confusing the hell out of the cat), trying desperately not to scream because I knew, with what little sanity I had left, that if I started screaming I would not be able to stop.

When I got to the hospital, I was almost immediately taken back to triage, where another startling symptom came to light: my blood pressure was sky-high. I have never had high blood pressure in my life, having dealt with the opposite for much of my life. I was then overcome by the need to not go back into the waiting room with all the people in it. I begged the triage nurse not to send me back out there. I cried, I pleaded. I had no rational reason for it; I was far beyond being rational at that point. I just knew I did not have it in me to face that room full of people. I just couldn't do it. The startled nurse called a doctor in, a very kind woman who took me by the hand and told me, "I know you think you're going crazy, but you're not." She gave me 2 Benadryl (the first and only time I've ever been given meds in the triage room) and told me that they'd take me back to a private room right away, and I'd be ok.

If only she'd remained my treating physician!

I was left alone for about 20 minutes, to see if the Benadryl would work. It didn't. A nurse came in, got that information, and went to get the doctor.

By the time H&R arrived, my husband Jonathan was there with me and I was once again crying uncontrollably. I was also feeling very sick to my stomach. My husband helped me to explain what was going on. As soon as he heard "pain," his demeanor completely changed. I'm accustomed to this, but usually the change is skepticism, annoyance, or rarely, pity. But this time, it was more like...fear. Reticence. Maybe even cowardice. I thought perhaps it was the paranoia, but my husband noticed it as well. I didn't much care; as long as he made this nightmare stop, he could be as fraidy-cat as he wanted to be. Besides, I didn't want any pain meds at that point. I just wanted not to go insane.

Over the next few hours, I got an EEG (I have a very minor inherited heart condition) and had some blood taken (which didn't go well; I have very bad veins, and they couldn't get much blood from me before the only vein they could locate collapsed). Before the nurse left, I told her the Benadryl was not working. I was worried that if these symptoms continued for much longer, I would have a serious attack of the trigeminal neuralgia as a result of this tight-jaw business. I asked to see my doctor.

The doctor did not arrive, another nurse did...with a cup. Oh, great. Another drug test! And I wasn't even in there asking for pain meds. I just wanted to be able to stop crying and hiding under the sheets!

I took the test. And asked to see my doctor right away.

Time went by, and the tightening in my chest & jaw became markedly worse. This did not help either my TN or my panic. When next the nurse came to check on me, my husband told her I was in pain and needed help. The Benadryl had not worked. I was getting worse, and the anxiety was overwhelming. The nurse wrote on a dry erase board that my "top concerns" were anxiety, nausea and pain. I asked to see the doctor. Again.

Finally, in comes the doctor. He sees the board and looks like he's going to have a panic attack himself! He seems to be barely able to speak. We talked to him, he murmured. I couldn't understand him; it was like trying to decipher the lyrics of an early R.E.M. song. It's the end of the what as you know it? Well, I don't feel fine!

I told him I felt I needed something for this anxiety, for the nausea, and yes, I now needed something for the dreaded "p" word. He asked me if I had any of my pain medication with me. No, I had left home in a terrible state, and for the first time since I was 14, without a pocketbook. He quite visibly paled. You would have thought I was asking him to remove a thorn from the paw of that tiger who mauled Seigfried. It was then that I put two-and-two together: this was a Hit & Run Doc! Oh, joy. I'm losing my mind, and I have the bastard child of the Cowardly Lion and Speed Racer for a treating physician.

The only semi-effective way of dealing with H&R Docs is to corner them: insist they make a decision, right there and then, that they deal with your symptoms (if you let them go "look something up," or "discuss this with a colleage," you'll probably never see them again). I told him I needed this disaster to be over: NOW. I had done nothing to precipitate this. My pain was not a matter of my having eaten nachos or stood outside in the wind or put on blush. I took a medication that one doctor prescribed, and another ok'd me to take. The reaction was a KNOWN AND NOT UNCOMMON one (I'm still trying to get over that morsel of information). I passed your little drug test, so what exactly is the issue here, H&R???

The problem with backing H&R Docs into that corner is that those doctors with the more advanced form of H&R will always respond in the exact same way: they will lie. To your face. With the guile of the junkie they not-so-secretly fear you are.

This one had it bad. And so he lied, and told me he'd send a nurse in right away with some medication for me. He confirmed that my "top concerns" were anxiety, pain and nausea. He asked me what I "usually take" for a bad TN attack, and what the dosage was. He even wrote it down, the deceitful thing. And off he went!

The nurse came back with something called Cogentin: a medication to end the bad reaction. I asked her if this would address pain or nausea. No. Of course not. I sighed, took the meds, and asked to see H&R, knowing full well the likelyhood of seeing that guy again was about the same as my finding Hoffa buried under the petunias in my backyard.

Time moves on, and I wasn't feeling much better. I told this to the nurse, and asked (again) to see the doctor. Instead, she returned with another dose of the Cogentin. I was not in the least surprised. Tellingly, neither was the nurse. Twenty minutes after that...the panic was gone. I stopped crying. I felt more like myself again! But the damage was done---I was in a full-blown TN attack. When the nurse returned (no H&R! What a shock!), she told me she was "having difficulty locating" H&R. "Anxiety" was removed from the dry-erase board. "Pain and nausea" were all that remained.

By this time, Jonathan had become exasperated, and went home to retrieve my pain meds. I took two Oxycodone, and waited for H&R to reappear. I was very worried about the nausea getting worse, as I had no medications for that save the Reglan, and I sure as hell wasn't about to take THAT stuff again!

We waited. And waited. And waited. The pain subsided. The nausea, thankfully, did not get worse. I got dressed. I just wanted to go home.

And then, some unpleasant news. That tiny little amount of blood they took from me? It clotted. They would have to try again. I refused. I had been stuck now, repeatedly, in both hands. They found one vein, and that obviously was inadequete and in any event, couldn't be used again. I was already bruised, badly, from it. I was gaurenteed site reactions. I was exhausted, I was embarassed by how I had behaved in the triage while under the effects of that bad reaction and I just
wanted to go home. I had had enough.

The nurse argued with me, but it was no use. I wasn't going to budge. I wasn't always that way. Once, I let an ER stick me eleven times, quite literally from my hands to my feet, trying to find blood. They didn't get a drop. I was in agony from site reactions for so long, I went to my doctor to see if there was a cream or home remedy or something I could try to give me some relief. She chewed me out instead. "If they don't find anything in three sticks, they aren't going to find anything," she told me. "Tell them NO. You have the right to do it; exercise it." So I did.

The nurse was seriously unhappy with me. "I wonder if H&R will show up now!" I asked Jonathan.

He did. But not to admonish me over the blood work: I was being discharged. I had underestimated the level of H&R Tin God Syndrome this guy had. It was so bad in him, that even the hint of an argumentative patient was enough to terrify. I had to go.

He never asked me if my pain or my nausea were any better, or worse. Not once.

I don't know which was more stressful: the bad reaction to Reglan, or being subjected to yet another unfortunate "victim" of Tin God Syndrome while having it.




UPDATE: I was given three days of the Cogentin, but it was inadequete. My doctor upped the dosage and I took them for another week. I am, for the most part, fine now. I do have a lasting, low-level anxiety that I can't seem to shake. Two days ago, I went to the clinic and got a prescription for an SSRI to combat it...via yet another new Tin God! I am attracting them like MAGNETS these days. The feast, after the famine. I will share that story soon...








*Please don't send me hate email or comments on this. I am not making light, nor am I showing intolerance of, eating disorders. My aunt has suffered through an eating disorder for decades, and I have seen firsthand the devastation it causes not only to her but to her family as well. My heart goes out to anyone battling an eating disorder, and to their loved ones.
**I am, however, making light of Rock of Love. My heart goes out to anyone who is forced to watch it, and their loved ones. And to the poor soul who does Bret Michael's hair extensions. We're down with
your struggle, buddy.