Saeva (saeva) wrote in bad_service,
Saeva
saeva
bad_service

A recent post about medication mix-ups in the ER reminded me of an ER trip I took last year.

Background: I have what my neurologist calls a "constant migraineous state with persistent aura," which basically means that even when I'm not in horrible pain I'm still having a migraine and seeing spots and colors in my field of vision. I've had this for, well, years -- since my mid-teens and I'm in my mid-twenties now. Mostly, if the migraine decides to make itself known by upping itself on the pain scale beyond how much it usually hurts I take one of two pain relievers I have for it (both in the restricted drug category) and get it back under control.

Well, last year I was in the middle of a migraine episode that was bad even by my standards. It'd gotten bad and stayed that way for about a week before I finally couldn't take the pain anymore and decided to go to the ER since I was in so much pain I was having trouble walking in a straight line. The ER has better painkillers, which will usually breakthrough the pain enough I can function again, so it seemed like a no brainer. Even my neurologist suggests this if the pain is that persistent.

So, I go to the ER with a friend (who drove me but had to go to work right after), sign in, and sit down with a bucket -- because the nausea was about as bad as the dizziness -- to wait it out until it's my turn. It must have been a slow night in the ER because, to my surprise, I got taken back within the hour for just a migraine. Yay -- relief is on the way. Or so I thought. I get situated and they do triage by taking my vitals (high blood pressure and heart rate, which worried them a bit because I was also born with a heart condition) and asking about my allergies, etc.

I handed the triage nurse a card with a detailed list, including spellings, of the drugs I'm allergic and/or have really bad reactions to. [That probably seems weird but, as a heart patient with other conditions, I keep a couple of index cards with this information available at all times because if I pass out and someone calls an ambulance there's no guarantee anyone who knows my allergies will be there to tell the paramedics.] I'm allergic to penicilin and I have a variety of adverse reactions to anti-nausea medications. I'm very, very clear about that. I have the names memorized and even how to spell them because the reactions range from uncomfortable itching (no big deal) to pseudo-seizure behavior (fairly big deal and very, very uncomfortable).

I settle in for a long wait after the triage -- the doctor has to come see me before they can give me any sort of medication so I burrow down under the blanket they've given me and try not to move. But, again, the doctor's all sorts of quick. I'm not the most coherent, given the pain is a 9 out of 10 on the pain scale (the only reason I'd take up space in an ER when more serious conditions could use the space), but I thought I got across that, yes, I'm nauseous but, no, I do not want any anti-nausea medication. I've had allergic reactions to all the drugs in that family that I've been exposed to. The doctor nods and disappears and then a nurse comes in to put an IV in me.

Which is a whole side of bad service in itself. I'm a hard stick. I've had surgeries counting in the double digits. ER visits for chest pain and shortness of breath aren't exactly rare in my history. I usually end up in the hospital for a few days every couple of years while they run tests and make sure nothing's getting worse. Getting an IV into me is something I don't envy anyone trying to do. Which I tried to explain to the nurse, a large, stern woman, when she couldn't immediately find a vein to stick. She decided to go ahead and try anyway, even though she admitted she didn't see a good vein. So she tried and went through the vein -- and continued digging. And, man, getting stabbed with a needle hurts. When she finally gave up on that vein, she tried another and it burst, creating an air bubble. I asked for another nurse to try the third time because I didn't want this nurse anywhere near me with a needle again. She argued, saying she could do it, and I had to lurch myself out of the bed -- no small feat in my condition -- to convince her I was serious. I was not letting her try again. Grudgingly, she got another nurse who managed the stick in one try (this nurse, who I've seen in the ER a couple of times since then, is an absolute sweetheart and so helpful). But by the time they got an IV into me the damage had been done -- I had a mass of bruises down the inside of my right arm and a smattering of ones on the inside of my left elbow for a week afterwards and my whole arm ached.

But the IV was in. Time for relief. The doctor came back in then and told me that they were going to try Compazine, which is in the very family of drugs I told them I was allergic to. I said no way. He explained that anti-nausea medications like Compazine are the best relief/breakthrough medication for migraines, much better than just applying a pain killer. I told him I understood that but I'm allergic to them. He said okay, he'd go look at other options. Some time later the first nurse comes back in with two syringes and bottles. I'm pretty out of it at this point -- my head's still pounding like a rave at three am, I'm really dizzy and nauseous, and now my arm feels like I put it through a meat grinder just for fun -- but when the first medication starts going in I scream. It burns really badly and I know that something is wrong -- painkillers don't burn like this. In fact, the only thing I know that burns this bad through IV is benadryl and why would I need benadryl? She tells me to hold still, I try to yank my arm away from her but she holds tight until the sedative effects of the medication kicks in. Then she explains she's just given me benadryl and now they're going to try the compazine, I just need to relax. Because the benadryl is knocking me out I can barely keep my eyes open, let alone stand up and get away from her.

I start shaking a few minutes after the compazine is pushed through the IV and they give me more benadryl, then everything after that is fuzzy between the pain and the drugs. When I wake up, it's hours later and my migraine is mostly gone. But I'm still shaking slightly and can barely stand. The doctor suggests another dose of compazine to breakthrough the rest of my migraine and I'm afraid my words for him were less than polite at that point. Right afterwards I called a friend to come pick me up and signed myself out AMA (against medical advice). And I thought it was over -- the compazine would wear off in an hour or two and I'd feel better.

No such luck. I had full blown serum sickness by the next morning -- which is when I realized that the doctors had tried compazine on me before, when I was younger, and the reaction then had been just as bad but taken longer to kick in -- and for the next three days I got up only to go to the bathroom and sat up, when I could sit up, only to drink bits of water. To add insult to injury, this was the week before midterms in my semester, which is why I'd caved and gone to the ER in the first place (I wanted to be able to study). The only upshot was that the compazine did break through my migraine and my head felt much better, even though the rest of me felt a lot worse.

And thus ends my (tl;dr) ER trip from hell. I called member services the next week, when I could sit and stand on my own, and gave them a full account and asked that they please reiterate to their doctors that ignoring known allergies is not the way to practice medicine.
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