An ER visit worth writing home about (preceded by some TMI, just so you know)

Lately, I've been having a little medical issue that isn't quite related to my pancreas - well heck, I'll just tell you. This fentanyl patch that I wear, being an opiate, has the unfortunate habit of slowing down peristalsis of the intestine (meaning that it slows your gut to a crawl and greatly decreases its squeeze-squeeze-squeezage.) While I am on a "bowel regimen" (probably too much information, sorry) of MiraLax and Colace, I will admit that I maybe haven't been 100% faithful to the regimen. Occasionally I'll skip a day. (Nevermore though, nevermore.)

Anyway, the thing is, I was literally full of crap. Hardy har har.

It actually has made me really, really sick - I feel so sluggish and spend lots of time sleeping. I have no energy and not much of an appetite, and I stay nauseated with abdominal cramping, on top of the pancreatitis. I've been working with an urgent care doctor who first tried lactulose. No go. Then magnesium citrate, which may as well have been water. Then he took an xray, saw that I'm indeed full of crap (but not visibly obstructed and there are no dilatations - i.e., areas that look like they're about to explode.) So now, I'm on the five-star regimen: mineral oil 3x/day, lactulose 2x/day, and MiraLax, Colace and Sennakot once a day. Fuuuuuun. Guess what, though? All of that stuff just made the cramping and nausea worse. So I finally went to the emergency room (and you know how I HATE being an ER patient - if you don't know, see previous posts here and here.)

I went to a different ER than I went to in those two horrible accounts, though (if you know me and are from around here, it's the "green" one, not the "blue" one. The one where you're more likely to find the most medical students.) Well, they were ridiculously nice. They asked me if I was in pain and gave me some Dilaudid and Zofran without me even having to beg and plead for relief. Then they did some "washing out" procedures which I totally don't want to do again, and then they gave me another dose of meds and sent me home. But the ER docs were SO nice, and the experience was just a 180 from the mean and ignorant doctors I encountered at the "Blue Hospital".

I'm still feeling really tired and sluggish with general malaise, but maybe it's getting better. We'll see. I go to the pain clinic on Wednesday, and I'm going to ask for an extra dose of my breakthrough meds for each day because six days out of seven, I have about 5-6 hours of severe pain (in addition to the other two peaks of breakthrough pain) and nothing to treat it with. That's one of the reasons went back on leave - I just can't work with that much pain. I complained about it at my last appointment, and do you know what they gave me? Seroquel. Which is an atypical antipsychotic. I'm beginning to think that I don't like this clinic as much as I thought I did. Please pray that the appointment will go well - it's Wednesday afternoon.

But for now, yay for the Green ER!

How to have your spirit crushed in 10 minutes or less

My last rotation, before I took "personal leave" for this rotation (which should have been my OBGYN) was Internal Medicine. I expected this to be difficult, because medical students know that the internists, especially general internists, are supposed to be the "thinkers". They have to know a little bit about everything. They have to know indications and contraindications for a whole slew of drugs, compared to the relatively minute number that psychiatrists master (don't get me wrong, psychiatrists know their drugs and they know them well). They have to know classic and not-so-classic presentations for a bunch of different conditions. They have to be able to work algorhithms in their head when the occasional zebra comes through the door. They interpret a ton of lab tests and radiology studies and they have to know when they should order more. In my Internal Medicine review books was a ton of information (the textbook itself, Cecil's Internal Medicine, was a workout to even carry.) And I was looking forward to learning it all, hoping to shine on this rotation since I had previously planned to try for a residency in Internal Medicine at the hospital that I was assigned to for my 4 weeks of inpatient service.

But.

I have pancreatitis. And if you've been reading my blog, you know I had a ton of problems with doctors right as the Internal Medicine rotation began, getting me off to a bad start with everyone - having to call in sick and looking like a slacker. My 4 weeks of outpatient service was first, so calling in wasn't a huge deal to the physician I would be working with for the day (it's not like I was part of a team yet - this was outpatient) but since the rotation was organized so smushedly (is that a word?), we only had a couple of days to spend on each specialty. So miss a day, miss pulmonary medicine. Or whatever. Anyway, it didn't exactly further my learning.

And then when my trusty GI doctor, the one who has cared for my pancreatic maladies (and those of my other family members) for YEARS, decided to be a giant buttface one day and tell me that he'd treat my pancreatitis, but he couldn't treat my pain. I'd have to go to a pain clinic for that. (Okay, there ARE no treatments for chronic hereditary pancreatitis except for pain management. If someone knows of an effective one, PLEASE, do tell.) I begged him to just treat me for the duration of this rotation, about six more weeks - to not make me try to find new doctors and switch my medications all around in the middle of this difficult rotation. Nope. He was committed to his buttfacedness. So I was forced to try to find new doctors and switch my medications all around in the middle of the difficult rotation.

I ended up finding a pretty great pain clinic and a good, compassionate doctor who treats me like a person, a patient in pain, instead of a junkie - but I had to go through a couple of bad doctors to get there. And I was in horrible pain for most of the rotation, operating at about 60% of my capabilities. All that severe pain, with no end in sight, eventually ended up making me seriously depressed, which didn't help matters at all.

And it REALLY, REALLY helps to be paired with a student who will actually work with you*. I wasn't, and I felt like one of the attending physicians that I worked with on inpatient was at times comparing the two of us (which they should not do.) Actually, I'll go ahead and stick a little story right here. I got to the hospital one Thursday morning by at least 6:30AM, in order to see my four patients and write a good SOAP note in their charts before 9:00AM prerounds. (And somewhere in there, I had to travel about 10 minutes to another hospital for a one-hour neurology conference, which was held at 8AM every Thursday morning. And I liked neuro, by the way.) Now, I had seen my first patient and was at least halfway through my progress note for her by the time my fellow student got to the hospital. I saw her head down the hall to the call room, where prerounds were held and where we would stash our stuff while rounding. She saw me, too. I saw two more patients and wrote notes on them, ran into the other 3rd year student a time or two as I rushed between floors, and (a little late, I'll admit) had to leave at about 7:55AM for neuro conference without seeing my 4th patient, who had had surgery and was in surgical ICU. I wasn't sure if we just breeze in and see her anyway - sometimes there are infection precautions and whatnot. So I thought I'd ask first. On my way down the hall to the main entrance, I saw my attending and I swear he seemed to glare at me. Maybe I was imagining things. Anyway.

I walked to my car (a meeeeeeellion miles away, because lowly medical students have to park a few yards past the moon at the hospital, so low on the totem pole are we) drove the 10 minutes to the other hospital, parked by the moon again, walked 18 miles to the building where neuro conference is held, went up the elevator, down the hall, and tried to enter as quietly as possible so I wouldn't disrupt ... my fellow Internal Medicine students, who were sitting there chatting. Huh? Note that the student who was on service with me was not there. All of the other students who was supposed to be there were there. There were no residents or interns, though, and no neurologist. So after a few minutes we decided that there must be no conference, and we dispersed back to our respective assignments.

I flew into the call room when I got back to the hospital, right at the beginning of prerounds. Late - huff, puff, huff, puff - drat! I explained to the team (attending, senior resident, other residents, interns, pharmacy resident, and the other third-year student) that I had been at the nonexistent neuro conference that no one told us didn't exist this week. The other student didn't say anything.

All the attendings have their own styles and quirks and such, and this particular attending would sometimes see patients on our list before prerounds, without the whole team. He happened to see two of my three patients, so I only had one to present, while the other student (who, remember, got to be at the hospital for an extra hour while I was being faked out) had seen four patients, none of which had already been seen and three of which happened to fall in a row on our patient list, so it seemed like she presented in her annoying "baby" voice forever. (She would present to the team - all guys except for me and the pharmacy resident - in this cutesy voice that sounds nothing like the way she really talks.)

I presented my one patient (although I did interject a little with my morning impressions when the attending brought up my other patients - an attempt to be more aggressive) - a patient that I had picked up the night before (when we weren't required to be there, mind you.) I checked the list and saw that he had just been admitted, so I went to his room and spent about 45 minutes getting a good history from his daughter-in-law, because the patient was a poor historian due to some head injuries. When we reached the end of the list, I asked the attending about my other patient - the one in surgical intensive care, and asked if I could still check on her. He seemed indignant and said that yes, we could - he had seen her that morning. I told him (and the team) that I would have checked on her this morning, but I was hurrying to get to the neuro conference that no one told me was canceled. The attending said, "[The other student] knew. [The other student] was here early this morning." Apparently, an intern had filled the other student in on the neuro cancellation and she hadn't bothered to page or call me to let me know (she did have both numbers.) Also, she knew I was there well before she was, but she didn't feel the need to point that out - she just let me look bad in front of the whole team. Wonderful. And one of my friends on the rotation told me later that the other student had told her during lunch that she had felt sorry for me when the attending pointed out in front of everyone that she knew about the conference and that she was there early that morning. Grrrr! I didn't need her pity, I needed her to speak up and say, "Actually, Kim was already here when I got here."

*If you're a third year (or fourth year) medical student and your modus operandi matches that of my fellow student - well, just don't. You make things twice as hard for the other students that you work with, you don't let them learn as much as they would otherwise, and you leave them with a bad impression of you. I think I'd rather work with almost anyone else in my class other than this girl. She was awful to be paired with.

All right, finally we get to my horrendous evaluation, the one that still has me questioning my choice of career even today. I went to the attending's office for a little "sit down" where I expected some constructive criticism (which I can take, by the way - and I realize this is a chip off of the iceberg of the yelling and the criticizing that I will get along the line), my strengths and weaknesses to be noted - that kind of thing. Instead, I was told that my first week with him was "difficult at best" and "a failure". The second week was "a little better" but "still not good". My presentations were just so-so. (For what it's worth, another attending in Medicine that I worked with for my first two years said that my presentations were excellent by the end of my 2nd year. Who to believe? Who knows.) My progress notes weren't good. My knowledge base wasn't there (isn't that what the USMLE Step One and the Internal Medicine miniboard test, both of which I passed by the grace of God? Hmmm.) He said that the assessment and plan portion of the note needed lots of work. (That was actually the only constructive part of the barrage of criticism that I could pick out. But here's the thing - I thought that the daily progress note should focus on the subjective and objective part - issues that had occurred overnight, how the patient was feeling this morning, that kind of thing. New complaints, resolution of old complaints, etc. Unless there was a new problem, I didn't see a need for the third year medical student to formulate a big detailed plan, when the patient had an attending, a chief resident, and an intern looking after him. Nevertheless, I tried to do my A/P better from then on - as redundant as I felt it was.) He wondered how I had made it this far, given the fact that I'm a terrible student and I suck so much. I told him that during the first two "classroom" years, that if I had a particularly painful day or days, missing class wasn't a big deal. And also, I was trying to find a new doctor and messing with my medications during most of this rotation. That didn't impress him much. He proceeded to make sure I didn't feel at all special - telling me about a resident that lost both parents suddenly yet continued to work, and how he lost a parent during his third year and pressed right on. At this point I was crying, out of frustration more than anything, because I was so tired of trying to get people to understand my illness and to understand that it's real. I felt like he was kicking me while I was down. At this point he said, "You cry a lot" which I'm not sure if that was an observation specific to me, or just a prediction for the clinical years and residency - like, "One will cry a lot." I don't know. My skin is getting thicker, though, believe it or not. Mom heard something on the radio the other day - Charles Swindoll, I think - about keeping a tender heart and a thick skin. Good advice for the physician and physician-in-training - have a tender heart for your patients and your loved ones, and a thick skin for superiors such as this attending. He suggested that I take some time off to get better. I said that I won't get better - it's in my genes and I'll always have it. But my talk with him turned out to be the proverbial straw that broke the camel's pancreas, and I decided to go ahead and take some personal leave - to get my medication straightened out and my pain under control (as much as possible, anyway) and to hopefully dig out of this super-deep depressing hole that I'd managed to fall in.

I'm still not out of the hole - and now I'm anxious about starting Family Medicine on January 7th, because I'm afraid it will be a repeat and I'll come up short, again. My talk with the attending is as fresh in my mind as it was that day - I replay it daily to myself and question, "Am I going to be a horrible doctor? How *have* I gotten this far?" I know it's the Lord holding me up because medicine is my calling, but is it? Did God send this attending to tell me to go down another path? I don't know. I'm praying about it. I'm still bumfuzzled, though, as to how my fellow student got rave reviews (I know she got "Honors" from one resident while I got only "Pass", because I happened to see it.) She may have talked more during rounds, but her answers were completely implausible sometimes (The attending asks, "This patient has just returned from a heart cath - why am I going to ask her about back pain?" to which the other student blurts, "Aortic dissection!" I knew that it WASN'T aortic dissection (that's a stupid answer - sorry) but I didn't know that it's to assess for retroperitoneal bleed. I do now, though, and won't forget it!), and I'm not the type to blurt answers just so I can allow everyone the privilege of hearing my fake cutesy voice. I want to think about the question first and try to give at least an educated guess, but she didn't give me time. She may have seemed a tad more enthusiastic than I did, but it wasn't much - I would have ran past her in the enthusiasm department had I felt well, because I love medicine and it continually interests me. She didn't spend more time at the hospital than I did. I often went in in the evening to pick up a couple of new patients, and spent time talking to them and reading about their illness, and to check on the patients I was already following. I am truly interested in the patients - I would wake up each morning wondering what kind of night they'd had. She may have felt up to doing more reading than I did - I'll freely admit that. Sometimes the pain wore me down to the point that I could do nothing but hit the couch and sleep for a couple of hours when my day was finished. But still, I fought it out until the end and I managed a B in the rotation. Thank You, Lord.

And then I heard from a very reliable source that the buzz in the Medicine department was, "Kim's performance is not up to par." That's just fantastic. I'd wanted to leave a good, lasting impression on the Medicine faculty & residents, and instead I did just the opposite. It makes me so sad.

Criticism of medical students from preceptors is a tough thing - preceptors either don't give it when it's necessary because they're afraid of hurting the student's feelings or getting a bad evaluation from that student. Or, they criticize TOO much, to the point where they've beaten the student down. I actually like constructive criticism and a discussion of strengths/weaknesses from preceptors/mentors/attendings/residents that I have worked with for a substantial amount of time - because geez, there is so much to learn and so many procedures and tactics to pick up, and knowing what I really need to focus on would be GREAT. Having someone bluntly go after my character, though? Not so helpful.

Good GRIEF. Sorry this is so long, for those of you who are still awake. It feels good to get it off of my chest, though. Any thoughts?

I may be climbing out of my pit

It's been a rough couple of months, y'all. I can barely talk about it without crying, because it was just so full of disappointment and sadness and pain, and it was like I was someone else entirely that I didn't even recognize nor did I like very much at all. (I do have horrible self-esteem and can't find much at all that's good about myself - except for Christ in my heart, of course, but that's Him, not me - but over the past couple of months, I *really* despised myself.) I'm sorry the posts have been so sparse lately, and I'm sorry that when I did post, that it was all about doctors and so on and so forth. Interestingly, my traffic has gone up quite a bit over the past 2 months. Figure that.

Anyway, I hope you, dear readers (I first typed "deer readers" - heh. Scott would be proud - that's what's on his mind at this time of year, too) don't have the idea that I'm some sort of drug-seeking pill-head. Instead, I'm a chronic pain patient struggling to learn to be a doctor, a good one - working 70-80 hour weeks in addition to trying to study in between, and also trying to spend time with my Scott, my family and friends, and some MUCH needed time at the Y. Oh, and sleeping, sometimes. It's hard to do that when it feels like someone is stabbing you in the gut, and pulling the knife around to your back. And then when you go to your doctor or to the ED for help, they instead berate you and you end up sobbing because of their jaded lack of compassion, it's discouraging.

Being in severe pain all the time, all the while being expected to perform in a superhuman manner (and getting bad evaluations when you don't - more on that later) and having more doors slammed in your face - it made me feel more hopeless and sad than I have felt in a long time. I didn't know if I was ever going to get help, or if this pain was going to become a part of my daily life. A Google search found a lot of information on depression resulting from chronic pain. I don't know what the answer is, fellow members of the healthcare system, but we have an underserved population of people here. I don't know how we weed out the true sufferers from the addicts and the dealers. But something needs to be done. And the way I heard other providers refer to patients requiring pain medication was less than encouraging.

I am doing all of the "alternative" stuff that the Interwebz recommends for pancreatitis - an antioxidant blend (the one I take is by Nature Made, with Vitamin A, 100% as Beta-Carotene - 10,000 IU, 200% RDA; Vitamin C: 250 mg, 417% RDA; Vitamin E: 200 IU, 667% RDA; Zinc: 7.5 mg, 50% RDA; Selenium: 15 mcg, 21% RDA; Copper: 1 mg, 50% RDA; Manganese: 1.5 mg, 75% RDA), and I'm also taking an additional selenium supplement, my trusty enzymes (amylase and lipase, aka Creon 10), and a couple of doses of Advil a day for anti-inflammatory properties.

I'm still hurting, though - I do have a new pain doc, and I'll talk about him later - I think I'm going to like him. He and his office staff are already a billion times kinder than the other Pain Clinic Which Shall Not Be Named.

I just didn't want you guys to think that I was an addict who was obsessed with getting my fix. Is that what you think? What DO you think? Let's have it, I can take it. It's why I have comments on my blog - I want to know what people think about what I write, and I appreciate and consider them all. Except the trolls, of course, which I just kick back under the bridge; and the potty-mouths, who I edit and *then* consider. :-)

I'm sorry that this is all about me lately, but ...

... my stupid and evil pancreas (and the pain thereof) has kind of been the focus of my life over the past couple of weeks. So, I posted about ER visits #1 and #2, and left you hanging about ER visit #3, which my GI doctor's office told me to make, right? Okay. Scott came to my apartment and picked me up, and off to the ER we went. (Incidentally, while we were there we ran into someone that goes to his church, so we were talking to her while her dad was back with the 0%-compassion ER doctors. Her dad's caregiver was there too, and when she came in she told us that people were coming out of the ER with prescriptions for Lortab and such, and selling them right outside in the parking lot. Nice. So the 0%-compassion ER doctors, who walk around with soap boxes for shoes and who think they are waging personal wars on drugs, are - uh, not. Instead they're making chronic pain patients cry.)

Anyway, we had to wait for hours and hours, and Scott read an article called "Dendrimer-Functional Self-Assembled Monolayer as a Surface Plasmon Resonance Sensor Surface" to keep him occupied (he's a peach - I kept trying to make him go home, but he stayed until I left, at 3AM. He's also such a science dork. I love him.) When I went through triage, the nurse looked at my chart from earlier and said, "Oh, so you don't have pancreatitis, huh?" I said, "I wish." He said, "Well, your enzymes aren't elevated, so they have here that you don't have pancreatitis." I said, "I have CHRONIC pancreatitis. The enyzmes don't go up anymore because my pancreas is a shriveled, calcified, fibrotic nugget." Don't have pancreatitis. I wish. And then when I saw Dr. 0% Compassion, he determined that I take narcotics. Well, duh - I have a chronic pain condition that I'm trying to manage. Then he says that he called my GI doctor twice and that the GI doctor told him that he was concerned about addiction and tolerance. (Again, duh on the tolerance - I've had to take pain medicine on and off for years - I'm sure I have mu opioid receptors galore. It also happens with steroids, and TOLERANCE and physical dependence have nothing to do with ADDICTION.) Incidentally, I think I love Dr. Jennifer Schneider, MD, PhD, and I almost want to travel to Arizona to see her. She says something great in this interview about addiction, that tells me that I'm NOT an addict:

Opioids also can, and usually do, cause physical dependence. The body makes changes to adapt to the opioids and if you stop suddenly, you get this unpleasant withdrawal syndrome.

... that's what physical dependence is — it has nothing to do with addiction. Addiction is not necessarily a physical thing. Addiction is a psychological phenomenon consisting of three elements. One is loss of control, which means you intend to use only so much but when you have access you keep taking the substance. The second is continuation despite significant adverse consequences, which means even if the substance – let’s say alcohol -- is causing liver damage, you’re arrested for a DUI, or are fired from your job, you still take it. In fact, one of the major differences between chronic pain patients and addicts is that the opioids expand the life of the pain patient. They make things better — they improve the patient’s functioning and pain whereas with the addict, their life constricts and they become more and more focused on the drug that they are misusing. So you have the opposite effect, and that’s what I’m talking about when I say addicts continue to use it despite adverse consequences. Pain patients on prescribed opioids don’t have adverse consequences — they may have side effects from opioids but they don’t have these types of adverse consequences (eg, loss of a job, organ damage). The third element of addiction is the preoccupation or obsession with obtaining, using, and recovering from the effects of the drug.

The thing about expanding your life is so true - when my pain is controlled, I feel like eating, exercising, spending time with Scott/family/friends, enthusiastically getting through my rotation assignment for the day, and studying at night. Oh, and I can sleep without having to wake up in the middle of the night in pain. When my pain is undertreated (like I was on the q8hrs prescription from the pain clinic) I can barely get off the couch, I have to lie in the fetal position to try to squish my intestines together, I find it hard to concentrate on anything because the pain is so bad, and I'm in a bad mood. It's not withdrawal, it's pancreatitis pain.

Back to the ER. Dr. 0% Compassion, after telling me that my doctor thought I was an addict, said, "You addicts lose the high from your Lortab or whatever, and come in here for your IV Dilaudid fix." Yes, he called me an addict. I said, "I haven't been to the ER as a patient in SIX YEARS." That didn't interest him - he went on to tell me that I was not going to make it through the rest of medical school, and by this time, I'm so humiliated and beaten down and sad (not to mention in pain) that I'm just sobbing. And then he said that he was going to order an abdomen/pelvis CT and if he didn't see acute pancreatitis, he wasn't admitting me. (If I hadn't been crying so hard, I would have told him that he wouldn't see ACUTE pancreatitis - I'm way past acute.) "I'm telling you this as a friend," he said, and left - I didn't see him again. They gave me a shot of IV fentanyl, told me that I didn't have acute pancreatitis after my CT results came back (surprise!) and discharged me, so I left feeling worse than when I came in.

Yesterday, I went to see my GI doctor (who told me that he told them that my pain was not being managed well and that I needed to see a pain specialist.) He also told me that I wouldn't finish medical school if I was taking the medication that I've been taken throughout medical school (and throughout my life, for that matter) and that if I did, that I'd be fired from residency. Great. So part of my breakdown last night was the idea that the past two years of my life have possibly been for NOTHING. That I've cried and basically given up my life, and sacrified so much, and spent so much money and borrowed so much, for NOTHING. That better not be the case.

Y'all pray for me, please.

Aaaaaaugh.

Just so I can keep track of this - feel free to scroll if health stuff bores you. I'm feeling SarahK when she complains that she knows more about her celiac disease than her doctors do. As y'all know, I have chronic pancreatitis (the hereditary kind, not the alcoholic kind - the only drink I've ever had is one drink of champagne at my cousin's wedding. Yes, I am Sandy from Grease, without the leather pants.)

I was part of a genetic study in the 90s that mapped the gene to chromosome 7. The molecule that keeps trypsin inactive until it leaves the pancreas (the molecule is called PTI, if I recall correctly) is messed up, so trypsin gets activated in the pancreatic duct and chews up the pancreas. Not fun. And I'm convinced that mine is exacerbated by stress, because I've been in constant pain since I started medical school, the most stressful time of my life.

For some reason, for the past couple of days, my pain isn't even controlled with my Vicodin HP (hydrocodone/APAP 10/660). As an aside, my GI doctor sent me to a pain clinic, and I went with a current dosage of the 10/660 as 1 tablet q6 prn. (One every six hours, or 4 per day, as needed.) The pain clinic (at which I saw a physician's assistant, not a doctor) gave me a lecture on taking pain medications (I think that in order to work in a pain clinic, you should have had chronic pain yourself. You know? I don't WANT to be on pain medication, and I usually hate when people pull "rights" out of nowhere, but I believe that people have the right to be comfortable and functional if possible. I think it's part of the "pursuit of happiness" thing.) So after the lecture, at which point I felt like crapola, the PA gave me a prescription for a 25mcg/hr fentanyl (duragesic) patch. This is what my GI doctor and I thought might be a good option for me, along with something short-acting for breakthrough pain, because it would work well when I was at the hospital working for hours and hours without time to eat, drink, or pee - and it also provides a constant, steady medication level - no more peaks and painful troughs, and no more chronic ingestion of liver-munching acetaminophen. Everybody wins.

So the first day that I wore the patch was painful, because they didn't give me anything for breakthrough pain and the patch takes about 12 hours to get into systemic circulation. But once it was in - MY PAIN WAS GONE. I woke up the next morning with no pain, no grogginess - it was so great that I thought I was dead and in heaven. And then I saw that I was still fat - no glorified body. But anyway, later that day, I started feeling weak, dizzy and lightheaded. The next morning was even worse. I couldn't get through to a human on the pain clinic's line, so I just went there (and got scolded because they usually ignore walk-ins.) LUCKY FOR ME, they said, they weren't busy. So they removed the patch, told me to bring the rest of the patches back, and gave me a prescription for the 10/660, 3 per day. The pain clinic gives me less pain control than my GI doctor. Great.

Like I said before I got on the pain clinic tangent, for the past couple of days, I've just been in horrible, intractable pain. I didn't know what to do besides go to the ER, so to the ER I went. (And I'm not a revolving door patient - I haven't been to the ER for at least 6 years.) The first ER visit, on Wednesday afternoon, didn't work out because there were approximately three million people waiting, and I didn't want to wait there for the rest of my life. They told me that it clears out in the wee hours of the morning, so at the wee hour of 3AM, I went back. This time I saw a doctor, but it went horribly - the doctor was an evil man who missed the day that they taught empathy and compassion in medical school. He also wouldn't listen to me when, after he told me that my amylase and lipase weren't elevated (translation - "You're a lying, thuggish drug-seeker"), I told him that when pancreatitis is chronic, the cells are so damaged that the enzymes don't usually go up anymore*. They did give me a shot of Dilaudid and Zofran which was heavenly considering I've been in miserable with no relief for 2 days. I thought they'd admit me to let me be NPO and let the evil pancreas rest for a day or two to possibly break the pain cycle, but since the doctor could tell that there's obviously nothing wrong with me because the magic enzymes didn't say so, they didn't. I left there crying because they made me feel like a liar and I knew I'd be hurting again in several hours. And I'm beyond worried about missing clerkship days. I hope I don't get kicked out of medical school, and I hope I don't end up with a different class (no offense to the c/o 2010, but my class is just so awesome and I ::heart:: them. Except one. He knows who he is.)

I called my GI doctor when I woke up from the lovely Dilaudid fog, and told them that the experience had been horrible. They told me that I should call my primary care doctor, who I should have given the ER as my doctor (what do I know? I was there for a GI problem, so I gave them the GI doctor's name. Oh well.) Problem is, my primary care doctor is not in the office today, and the doctors on call for him are all, "Her enzymes must be elevated or she's a malingerer. A MALINGERER!" I'm likely to leave with a diagnosis of Munchausen's Syndrome, but I'm headed back to the ER. I want a couple of days to be NPO, with an IV so I don't get dehydrated, and pain control until this thing breaks. I've got things to do, y'all. I have the weekend to get better, and I hope I'm still a medical student on Monday.