When percocet doesn't help the pain

This week at the hospital has left me feeling useless, with two cases in particular.

Let’s call her Jane. She is a 19 year old woman, barely old enough to be on our floor by years. She came into the hospital late one night for sever pain in her abdomen. After a CT scan showed a twisted ovary (known to be very painful) she was wheeled to the OR have a laparoscopic surgery to UN twist it. However, when the doctors had her sleeping and cut open, there was no twisted ovary to be found. Perhaps not knowing what else to do, and perhaps going by an elevated white blood cell count, they decided it was pelvic inflammatory disease, sewed her up, and sent her up to us. One doctor’s note in the chart said that lesions had been seen on her liver. “? Cancer.”

When I arrived on Monday morning, the nurse giving me report said that she was “a baby”. Used to judgmental nursing reports (but still frustrated by them), I took note, waltzed into her room convinced that all she needed to come out of her shell and stop wincing in pain was a little extra attention and TLC. I arrived in the room, smile and stethoscope in hand, and found a gorgeous tall light skinned black woman lying in the bed. She was thin and muscular from the silhouette of her curled up body under the sheet, and clutching the ratty tails of a once-upon-a-time blanket. Her eyes gazed off into space and she did not make eye contact once as we spoke. Her father, who had spent the night, was chatty and engaged and did not seem concerned by his daughter’s strange affect. She answered my cheery questions with grunts and once or two word phrases. She said she “didn’t feel well” but wouldn’t describe the pain. She would just say “it hurts” and “I don’t know.” When I asked if I could place my stethoscope on her belly to listen for bowel sounds (a standard part of a nurses daily assessment) she winced and covered her belly like I had just asked if I could take a sharp knife and jab it into her abdomen. After some coaxing and assurances that it wouldn’t hurt, I gently listened and heard enough gurgles to satisfy me.

The day continued …. I medicated her with anything I could think of: smiles, foot rubs, narcotic for incisional pain, Torodol (liquid ibuprophen) which her mother stated had worked before, anti-gas medication (I thought the sharp pains could be from gas, a very painful ailment post-abdominal surgery), and benadryl for her itchy skin. Her mother and I encouraged her on numerous occasions to get out of bed, but each attempt left her in tears. Her legs were shaky. Her eyes were distant. Her words were few. She left me feeling at a loss for ways to help make her mood and body feel more joy and less pain. By the end of the day, this strong-bodied19 year old woman who told me that she was in nursing school seemed in more pain, and in a more infantile mental state than when I arrived. She whimpered for her “mommy” when her mother left to get a coffee and take a break, and stayed in the bed with a pillow over her head. Somewhere inside my fledgling nurse soul a balloon popped and I felt deflated.

The next morning I arrived again with a smile. Determined that today would be the day to turn her sadness and mood around and help her find her own smile. Instead I returned to more certain news that lesions were lymphoma (“I just don’t know what else it could be. The Picture is textbook,” the resident explained to me. “Does she know?” I asked. “She knows he scan was not normal, but we do not yet have a definitive diagnosis to give her, so we’re holding off.” Gynecologists aren’t really well equipt to talk about lymphoma, I suppose.) Her mother had spent the night this time, and while her body was cared for, he mental space seemed to be even lower. All I could get as responses to my questions today were grunts. She had no more words to share. I left at the end of the day trying to feel satisfied that today she had taken a walk and spoken with the social worker. My heart aches for her and I still feel frustrated by my lack of ability to truly help her begin to heal. I explained it best to her: “my job is to make you feel better. If I don’t know what you’re feeling, I can’t do my job.” At the end of my shift, I shared the elevator with her father down to the 1^st floor. “I just don’t know what to do to help her.” I admitted. “There is nothing you can do. She is just scared, that’s all.” He is right.