Don’t Give Me Morphine!
By Peter Park, 4th year medical student, Plano TX
Like a knife in my gut, I feel the pain in my belly twist and turn inside of me. It’s midnight and I shout from the pain. I’m in my second year of medical school and I wonder if this is going to be the rest of my life. I start to cry because I know how this night will go. Another to the Emergency Room (ER). Another chance to defend my case. Another plea to doctors and staff to say, “my pain is real”.
It started when I was 16 when the pain first began. It would follow the same pattern every time. I would be under a lot of stress from an important test, a breakup, or family issues. Then suddenly within a few hours, I would develop severe pain, and then no bowel movements for several days. First time I went to the ER, I was diagnosed with small bowel obstruction. They would stick the dreaded nasogastric (NG) tube from my nose to my throat. Give me some morphine. Then we wait for the first bowel movement. Go home after some intravenous (IV) fluids and call it a day. Doctors said it was a one-time thing at first. Then when I kept coming back with the same pain, they suspected me of opioid use.
From then on, quarterly trips to the ER in high school. I suddenly became an emergency regular. My favorite cocktail: IV saline, an NG tube, and a vial of morphine. I would be out in a few days. This went on for nearly ten years. Some diagnostic workup including abdominal CTs/MRIs, endoscopies, colonoscopies, small capsule endoscopy pill studies, balloon gastroenteroscopy with biopsies. All for “indeterminate”or “inconclusive” findings. For years, I would push for myself suspecting I had inflammatory bowel disease (IBD), Meckel’s diverticulum, complicated irritable bowel syndrome (IBS) or a whole differential of items to pursue. Still, I would be met with, “what’s your drug history, again?”
But this time, I know it’ll be different. I mean, I am a medical student now. I have presented my patients to doctors before. Now as the patient, I feel ready to present my case.
After waiting in the ER for several hours, I am checked in and situated in a room in the ER. Still in severe pain, the ER nurse and I go over my history, symptoms, medications, social history, etc. Then, I ask for something for the pain. I can’t bear it. The ER nurse looks back and says “Let me ask approval from the doc for morphine”.
Medical knowledge rushes into my head with a fact stating, opioids (i.e. morphine) cause constipation. Don’t take morphine when your bowel is obstructed!
I turn to the nurse and tell him, “Please don’t give me morphine. I need a strong Tylenol or Tramadol. Just don’t give me an opioid.” And I will never forget the look he gave me, stared at me in the eyes and said,
“All we have is morphine. Take it or leave it”
What?
I’m suddenly so confused. I’ve worked in ERs before and I know what he’s saying is not true. Every neuron in my brain is fighting on what to say between the medical knowledge of other non-opioid alternatives to the supply and demand of medications that could allow for this situation to reasonably happen. Stuck between a stricture in my stomach and ever growing imposter syndrome, I cave and submit.
“Fine just give me whatever you have”
Following stabilization, I stayed in the hospital for a total of five days, where the last three days the whole medical team was just waiting for me to pass a bowel movement before discharge. So what if I had to stay in the hospital a few more days, who cares?
And you would be right. The outcome didn’t affect my life in the grand scheme of things, but what I cared more about was the lesson I took away which was that:
Knowledge is power until you’re powerless.
That previous system did not ever officially diagnose me with Crohn’s disease. In fact, I went about my own way to seek out two different Gastroenterologists from two different hospital networks to compare different opinions, run multiple different tests, and was finally diagnosed almost a year after my last emergency room visit.
Now, I am stable on a biologic and have not been in the emergency room for over a year. My final takeaway is this: Don't take no for an answer when it’s about your medical health. If you're confused, speak up. The only one that suffers from your silence is you, so stand up for yourself.
Peter Park is a 4th year medical student at TCU Burnett School of Medicine. He is pursuing Psychiatry and set to match in 2025 with hopes of treating mental health in patients with chronic disease.
Featured photo by Pixabay.