Friday, May 28, 2010

Attaboys, dalala and bonus buttons.


Ask any doctor or nurse what dalala is, and they will immediately answer, why dilaudid, of course. Duh. Not surprisingly, most patients can't recall the name of the medication that works for their pain, but their close approximation clues us in. It is a favorite of patient's with chronic severe pain and cancer, but also a favorite of ER frequent fliers and drug seekers. It's 7 to 10 times more potent than morphine (depending on your reference). I've never had either one, so I can't tell you which I'd prefer. The strongest medication I've ever had is 25mg of demerol (a drug that is rarely used anymore) for an appendectomy and this knocked me out for 8 hours straight. I don't think I'd wake up at all if someone gave me dilaudid. I'd be in la-la land for good.

I get a kick out of the nicknames my patients (and family) give to drugs. My mother in law used to call ativan her, attaboys. "Hey sweetyheart," she'd say, "give me another one of those attaboys." And of course, I would. Keep 'em coming is my motto in hospice. We prescribe 1 mg hourly as needed and don't be chintzy with the meds.

For a week now, I've been seeing a difficult patient who never rates pain less than a 9 (out of 10), and I believe this. We started a dalala drip at a steady rate with no bolus--meaning the patient could push a button to deliver more medication as needed. The next day, faced with pain rated a ten, we added the bolus button that could be pressed 6 times an hour. Daily interrogation of the pump shows the patient never, ever, pushes the bolus button. When we see the patient, we might push the button if pain is still rated a 9 or 10, but the patient and family seemed afraid to try. Daily, we get calls about poorly managed pain, but the tools to manage it are right there in the house. It's particularly frustrating, but last night, I think we made a breakthrough in teaching when the patient asked me to, "please pass the bonus button."

Finally! Someone there had an, ah-ha! moment! We'll see if it lasts.

In the meantime, TGIFTGIFTGIFTGIF. Do you see the word GIFT repeated over and over there? Yes! It's Friday, and not a moment too soon. I have already worked 38 hours this week and I'm scheduled to complete another 8 tonight before my holiday officially begins. I think I'm going to paint my bedroom and plant some flowers this weekend. Of course, I'll knit.

What are your plans?




20 comments:

Wallene said...

So THAT explains why all my blog posts from the hospeeetal last month are barely coherent! LOL

I wrote 25 mg of dalala [and yeah I was lala alright] but it was .25mg I am sure and that still knocked me loopy. I was happy to get home and off of that stuff.

We are staying home this weekend [as usual - the pool biz y'know - Pooldad is on call - heaven forbid someone have a [gasp] pool emergency] but we will go to our community pool, cook out and take the girls to all their parties and such. Hopefully it won't rain.

Have a great weekend. And pics please of the new paint and flowers! :)

Sandy said...

First off, enjoy your time off - that's a lot of hours. I got a laugh out of this post and then to finish it off with a "bonus" button, hahah!!

My friend who just passed away, was receiving that dalala at the end I believe and she was definitely in dalala land.

Stephanie V said...

That's good. Isn't it always true that we have to know the 'language'?

Rudee said...

Skippy, you're a light-weight contender in the dilala department. I hope nobody has a pool emergency, but of course, you know they will.

Rudee said...

Sandy, I hope your friend was comfortable in dilala land. I'm sorry for your loss.

Rudee said...

Stephanie, exactly! I'm going to work on the language of the charted stitches this weekend. I'm going to be doing those twist stitch socks in the last issue of knitty. In purple.

Winifred said...

That was a great post. You always have a wonderful perspective on things.

I don't know much about pain relief thankfully but my husband who has recently had an operation was on Tramadol in hospital. The side effects seem to be hallucinations. The man in the next bed to him kept asking about the party they'd all been to the night before. My husband kept thinking he was drowning as he was dropping off to sleep. He wouldn't take them once he got out of hospital, made do with paracetamol.

Have a lovely break Rudee.

Miss 376 said...

We have a holiday weekend here too. Sewing and knitting for me I think. Enjoy your weekend

Rudee said...

Winifred, the vet gave my dog tramadol, and it made him a little loopy, too.

Miss--enjoy your knitting and sewing.

Lisa L said...

my plans? hospice call .....16 patients all spread over a 460 square mile area. i'm praying for it not to be too 'heavy'..have yet to receive report..

Gail said...

Enjoy your holiday, may your flowers not wilt and your thread stay untangled.

Cheryl said...

Oh, Rudee, what an amazing woman and nurse you are. All that comfort that you give to people, when they need it the most, it can't easy, but your there, always.

I hope you have a wonderful weekend that is full of yarn, pretty colors, beautiful flowers and everything else that is beautiful.
XXXXXXX

Catherine said...

Dilaudid, is that pethidine? or is that Demerol? I don't know my American drugs, but I know they have different names than their european cousins/siblings! Yes, TGIFTGIF ++++! I feel the same, even though our work week is only 37.5 hours. I feel every big of it as I moved office this week to the town with colleagues, from my lonely isolated health centre where I was the only occupant. It was nearly derelict and there's no money to do it up so it was cheaper to move me. I ain't complaining! And I am knitting a cricket slipover for my son!
love Catherine

Rose said...

Sounds like you're looking forward to the weekend as much as I am! Love, love, love the yarn you sent. Hope you're doing the spinning group again.

Empress Bee (of the High Sea) said...

sarge still has an epidural and is feeling no pain. i learned about bolus just yesterday!

smiles, bee
xxoxoxoxoxoxo

laurie said...

ack, i can't imagine being in that kind of pain. oh lord.

enjoy your time off!

The Crusty Crone said...

TGIF... oh wait. That was yesterday. Never mind.

I don't have a lot of experience with pain meds, but its been my experience that morphine doesn't do squat for pain. I had a morphine drip (with "bonus button") after a surgery and I was totally disappointed. The pain was very present until I fell asleep. Morphine was just a sleeping aid.

Hope you enjoy the weekend.

Ruth said...

Enjoy your time off.
Explaining how to do chronic pain manangment to patients is something I do over and over and over it takes so long long fo them to "get it" along with the i don't want to get "Hooked".

willowtree said...

I call Zoloft my 'happy pills'.

Kathleen said...

Fascinating post, Rudee. I'd never heard of "dalala," which I suppose means I've been fortunate as have my love ones. About the bolus, my father, a biochemist , once said Americans were such prudes about pain. He thought it was ridiculous to gut out unbearable pain. No martyr he! And I appreciate that tGIFT from him.