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?