I took one for the team a few weeks back. MC and I were doing the long 12 hour transfer days that make up our weekends and 20:00 brought us a transfer down to the Big City, just over an hour away. We get the page, ALS transport with IV for a bowel obstruction. Bowel obstruction being transferred?!?
Checking in with the nurses on the unit gives us some more information about the patient's condition and surgical history (she's being transferred because her surgeon is in Big City). Sounds like she's been through a lot of stuff, but she's not too thrilled with being taken off her PCA pump and not afraid to tell us about it. Her nurse had promised that we would be able to give her pain medication en route, but the doctor (or PA) had neglected to leave written orders for pain medications and MC doesn't give narcotics on transfers without written orders. So, nurse decided that the percocet given as we walked in would be sufficient for the hour long ride down. Since it was my turn to tech and there were no longer any paramedic skills required, I was the lucky winner of the "who gets to piss off the patient" contest.
Nobody brought up the whole pain medication issue right away, the nurse didn't want to make a scene and I was hoping to postpone the complaining as long as possible. As long as possible turned out to be about five minutes into the transfer.
"You're going to give me something for the pain, right?"
"No. The doctor didn't leave orders for pain medicine and the nurse gave you some right before we left."
"WHAT!?!!! She promised me pain control. I'm never going to make it, I'm in pain already. This is unbelievable."
It went downhill from there. Thankfully, it is fairly easy for me to say no because there is absolutely nothing I can do. The pain medications are in a locked cabinet. No amount of explaining was good enough to convince her that I wasn't out to deprive her. No amount of explaining was enough to indicate that it makes no difference whether I thought she was a drug-seeker, I just don't have drugs to give her.
Finally, she demanded to seek her paperwork. I'm a big fan of informed patients, so I happily gave it to her. She wanted to know where it said that she couldn't have morphine. I pointed out where it should say she could, and that it didn't. Then she went through EVERY SINGLE PAGE, reading, questioning and demanding. For those who don't know, reading or writing in the back of a moving ambulance is an acquired skill, especially on the ruts and bumps of some of the roads in this area, so I got to enjoy her complaints about not being able to read easily too.
I've never been so glad to see the end of a transfer. There are only so many ways my tired mind can come up with to say N-O at the tail end of a twelve hour shift.