Yesterday I had an appointment with a consultant who specialises in pain management. I’ve been treated in this clinic, by the same consultant, for several years, and really appreciate his input and expertise. If nothing else, it reassures my other specialists, as they know that I’m not just wandering around on huge doses of strong medications, totally unsupervised!
I was greeted by the receptionist in the Pain Clinic, “You must be Joanna”
“You’re the last patient on Dr Painclinic’s list. Make yourself comfortable in the waiting area. Can I get you some water?”
I was taken aback by this wonderfully warm, kind and efficient receptionist, who chatted to me while I waited, at the same time as preparing paperwork and tidying the reception desk. It would have been so easy for her to ignore me once I’d confirmed my name, and I wouldn’t have blamed her if she had wanted to hide behind the desk by the end of a long and busy clinic.
Getting to the hospital had been stressful. I had missed several buses because the wheelchair space was being used by pushchairs, and had the same problem with the lifts at the hospital. By the time I got to the clinic I was feeling thoroughly unwell after sitting up for so long: I was cold and shivering, in pain (appropriately), dizzy, nauseous and exhausted. The receptionist made me feel so much better. Nothing she (or I) could do about the symptoms, but she was kind, which helped everything else.
I really like my consultant in the pain clinic. He has been on my Dream Team (the specialists that I see regularly and who really get to know me, as opposed to those who offer their expertise from outside the inner circle) for several years, and feel that he really ‘gets’ my complex medical history.
We have a plan to continue increasing one medication very gradually. I have a target dose and a rough schedule for increasing the dose over the next six months, along with a Plan B if the side effects are problematic. I’ve been gradually increasing the dose for several years, so this schedule is nothing new, but it’s reassuring to have someone in charge.
We are also increasing the dose of the medication that I take for breakthrough pain, and Dr Painclinic wrote a prescription for a two week supply of the new dose (6 kg*),for me to collect from the hospital pharmacy. I’m currently on a dose of 4 kg, so this is the next dose available.
When I take a prescription for this medication to my local pharmacy they have to order it from their wholesaler and I collect it the following day. I was quite pleased that Dr Painclinic had given me a hospital prescription, rather than asking my GP to start the medication, so I could get the new dose straight away.
I took the prescription to the hospital pharmacy, showed my medical exemption card, took a number and waited. Worryingly quickly a pharmacist came out to talk to me. She told me that “basically your doctor has written this wrong.”
The prescribed medication is a controlled drug, so there are lots of specific rules about how the prescription should be written, so I wasn’t totally surprised, but I had watched Dr Painclinic write the prescription by hand, and it looked alright to me.
I asked the pharmacist to show me the problem, and she pointed out the dose.
“Basically your doctor has written this wrong because the dose should be 2 kg, and he’s written 6 kg. I’ve been trying to call him so he can change it.”
Slightly taken aback, I started to explain that Dr Painclinic had written 6 kg because he wanted me to be on a dose of 6 kg. I currently take a dose of 4 kg, and it’s being increased from 4 kg to 6 kg. He hadn’t written 2 kg because he didn’t want me to have 2 kg (the type of medication and the way it’s administered means that I can’t just take three of the 2 kg dose each time).
The pharmacist told me that she would ask ‘next door’ (the inpatient, rather than outpatient, pharmacy), which sounded promising, but she came back to tell me that she still couldn’t get in touch with Dr Painclinic, even on his personal mobile, to change the dose to 2 kg.
Stifling giggles/tears, I asked the pharmacist if they could perhaps order the 6 kg dose, rather than asking the doctor to prescribe a different dose. She looked doubtful but went off to ‘call downstairs’ to order the new dose. On her return, she told me that no-one had ever ordered such a high dose (the highest available dose is 16 kg). The pharmacy would hear from ‘downstairs’ tomorrow as to whether they can order the dose I need, and how long it would take. She offered to give me the 2 kg dose to ‘tide me over’.
I gave them my mobile number, so they can keep me updated, and left in a cloud of indignation.
Almost immediately I realised that it might be easier to get an outpatient prescription from my GP, so I had to go back to the hospital pharmacy for a photocopy of the paperwork, trying not to look like the same person that had just whirled out of there in a huff.
There is almost nothing worse than a failed exit.
*I don’t really take 4 kg of this, or any, medication, though it sometimes feels like it. I’m not sure yet whether I want to specify the names and doses of the medications that I take, so this is a deliberately ludicrous dose