Kevin Huang, BSc Pharm Student
A prescription was presented before my eyes, an opioid. For a second, I stood there staring at the sheet. Another one. This is the fifth copy I’ve seen today, and like every other time, I couldn’t help but feel a little uneasy. We spent a good amount of time learning about the opioid crisis in class. It’s a complicated issue. On one hand, there are many patients who need these medications to function throughout their day. However, we know how difficult it can be to manage these medication’s adverse effects. On top of that, using these short-term treatments may put people at risk for long-term problems. Tolerance, dependence, addictions… I couldn’t but to help wonder if my next patient will have to struggle with these challenges.
“Excuse me, I would like to get this medication filled today.” Shocked, realizing I lost my focus, I brought back to my senses. Standing before me was a 40-year-old man. Back slouched, limbs weak, body fatigued. He had seen better days. Anxiously, I began to provide my service. One by one, we updated each section of his pharmacy profile. Before long, it was time to talk about the prescription. A high dose treatment of opioids, enough to supply him for months. Does he really need this much of the medication? This high of a dose can be dangerous. Has he tried anything else? Perhaps he is an addict… Nevertheless, I asked him what he was taking it for. “For pain! Can’t you tell I’m in pain?”
“Have you tried anything else to help with the pain?” “Nothing helps! Even this only takes off the edge.” I pulled up his medical file and froze. This man has tried all of the safer alternatives available, and yet he has found no benefit in any of them. In most circumstances, these agents should do the job, yet he is still dealing with pain. Confused, I looked back at my patient. Trembling in pain, lips pursed, my patient frustratedly looked back into my eyes. It was as if it was a cry for help. It was at this moment where I realized I forgot to ask the most important question. “Sir, can you tell me more about your pain. I want to understand what you are going through”.
The patient sighed with relief. Tears wiped from his face, it was the first time anyone asked for his story. Injured through a motor vehicle accident during his 20s, his knees have suffered permanent damage. He reached out to many physicians and specialists, only to find their medications making his quality of life worse. He clearly explaining he understands the significant risk of the opioids and wish he doesn’t have to take them; however, he was at the end of the ropes. Nothing helps, and he tried everything. During the night, he would wake up to the sharp sensations of pain. If it weren’t for the medications, he wouldn’t be here today. At this point, all he can do is wait for his elective knee replacement surgery – but that will take another year. Frustrated, all he can do is take these medications to bridge him to the operation.
I couldn’t help but feel ashamed. I was so worried about the risk of the medications that I completely forgot to listen to my patient. Stigma clouding my judgement, I failed to do my duty to help this man. After thanking him, I began to fill the prescription. Not everyone who is using opioids is an addict. In most circumstances, its just people in a difficult situation – a situation I’m sure no one would want to be in.
The world of medicine can be a strange place. New herbals, unconventional treatment, strange doses. These are all common to healthcare. And yes, there will be times where you scratch your head and wonder what you’re about to deal with. But remember this, clear your mind from all the preconceived notions and listen to a persons story. Don’t let your bias shape the reality of the patient’s life and take a moment to step in their shoes. Perhaps only then we will begin to understand what they are going through and learn how to express empathy.
