by Glenn Panzer, MD, CMD

After practicing as a physician for 34 years with a strong interest in post-acute care, I recently had the opportunity to be a patient in a post-acute rehab facility.  This occurred after a fall in the shower of the gym where I fractured the right L2-L3 transverse processes. This triggered pain with any movement of the abdominal or back muscles. I could not stand, sit, turn, take a deep breath, or have a bowel movement without pain.

I tried to play doctor. I discussed my meds with my attending physiatrist.  He gave me choices such as which muscle relaxant I wanted.  I requested Flexeril and then refused to take it when it was dispensed because I had trouble urinating. I "knew" it was going to constipate me also.  I also made the mistake of asking him to cut out the routine pain and anti-inflammatory medications in the middle of the night to allow me to sleep.  As a result, I kept waking up with increased pain.

I became obsessed over pain management and constipation.  I realized that patients who requested pain meds with a pain level 1-2 because they knew it was going to get worse were not necessarily "addicts."  Also when I got to day 3 without a bowel movement I was so paranoid that I would never poop again.  I tried to get every laxative I knew ordered.  I also begged the nurses not shower me until after the enema (which I never needed).

The nurses and staff at Palomar Health Acute Rehab Unit were great.  They were very patient with this demanding patient who was chair of the medical staff's Palliative Care and Ethics Committees and former medical director of the affiliated SNF.  My wife had to point out to me that I made requests without please and thank you's and I changed my ways. I realized that this could make one appear to be a demanding patient.

As a result of my experience as a patient, I have learned a few things.  Among them is to imagine myself in the shoes of the patient.  They might not be able to advocate for themselves as well as I did and their demands for pain meds might be more than just "drug seeking behavior".  Some of their demands could also be situational anxiety and fear of loss of control.

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