Success

For two days, I took care of a man who has what is probably some kind of microvascular disorder. The tips of his fingers and toes are black and essentially dying, and it causes him a great deal of pain. For two days, I administered very potent IV pain medication to him every two hours. Even that wasn't enough to control his pain, but on the second day, his primary resident had the day off and the covering doctor didn't want to change the pain management regimen. Finally, yesterday, I received orders changing his regimen to a long-acting oral morphine pill with some IV medication for breakthrough pain. I was so happy that they were changing him over to the long-acting agent he needed, but the excitement was short-lived when I realized that the dose they were giving him was FAR lower than he needed. I went to speak to the doctor immediately. He was very polite to me, but explained that a lot of thought had gone into the orders and that they had very carefully calculated how much medication they were giving him. "In fact," he told me, "this is a little more than he was getting before." As patiently as I could, I told him that I thought his calculation was wrong. He insisted he was right. I proceeded to sulk myself back to my patient's room, where I did the calculation for myself. I paged the doctor with my calculation, and the next thing I knew, I had new orders that were correct AND gave the patient more morphine equivalent than the previous day. Julie: 1, Doc: 0. Did I get thanked for it? Of course not. But it sure did feel good.