Wednesday, December 9, 2009

Migraining ER Visit: Not Fun

Well, I've popped my migraine er visit cherry. And it sucked, as was expected.

The adventure started the previous evening, with a follow-up visit in the urgent care. I left the appointment exhausted and sore. My head started in something fierce when I got home, so I was reduced to medicating with narcotics, which didn't do anything. I took a pill to help me sleep and was lucky enough to find some rest.

I woke the next morning in decent spirits. My head was still achy, but not too bad, but I was feeling a little more spaced out than was normal. I started moving around, doing breakfasty things, got a look or two at the morning sunshine, and it was over. It started with the light, but then noise and of course then something smelly happened and the avalanche was coming down all around me so I laid down, slapped an ice pack on my dome and took one of the muscle relaxants I'd had to beg for the day before. 30 minutes later, no change. I took another. 30 minutes later, no change except for the crazy throbbing and stabbing and gnawing. I took two more. 30 minutes later I was sobbing hysterically with my head in my hands wishing for death. I was suspecting that the pill was a placebo, a cruel trick by a sadistic doctor. I checked, and I was already at the maximum daily dosage for my only medication on hand. My heart sank. Normally at this point, I am stressed by the pain, but I have an emergency remedy I can call in for relief. In this case, I had nothing. No pot, no muscle relaxants (that worked), no valium, no painkillers. How did I let this happen? Well, I'm poor, you see. I'm on disability and my boyfriend is on unemployment which pays our bills and not much more. I am on a waiting list to see a doctor who is "allowed" to prescribe me anything real. So, I currently have to settle for whatever the urgent care people will give me, which, so far, has been nothing effective.

Enough of the bitter. The healthcare rant is for another day.

My boyfriend got me breathing and moving enough to take me to the er. I walked out of the first one we tried in a panic; crying babies, and coughing people packed into a standing room only stiflingly hot waiting room that was ripe with the scent of suffering and cheap perfume was not my idea of a good time. We hoped that the next one would be better, and it was. It was 20 minutes away but it could have been another country. It was cleaner, quieter, and clearly had better ventilation. I waited with a blanket over my head to avoid the lights. I kept my 30 decibel earplugs in the whole time. They called me back and instructed me to put on the gown, open in the back. I raised an eyebrow at my boyfriend and put it on over my clothes. I had a migraine, not a bullet wound. They never said anything about it, so I guess it wasn't a big deal. First, they gave me a benadryl/reglan cocktail. Made me feel ill, but my head still hurt. So they gave me dilaudid.

Immediately, I knew it was bad. I was nauseous and cold, sweaty and shivering. Then I started throwing up and didn't stop. I alternated dry heaving and drugged sleeping for 3 hours before they sent me home. "Why am I so sick?" I asked, "Am I allergic to dilaudid?" "No," the doctor assured me, "you are not allergic, but I've never seen anyone react this way." How reassuring. He wanted to give me steroids and I refused. They've never worked for me before, and I just end up sick and miserable. More. So, no thank you. He looked at me like I was an idiot and I dry heaved a little more for him. They finally sent me home and I dry heaved while being wheeled out of the hospital, through the lobby and all. Poor other people. I was probably a vision.

My boyfriend got me home and tried to get me in bed, but I felt sicker lying down and kept heaving, so I stubbornly refused. He tells me that he even tried pushing me over when I'd inevitably fall asleep between heaves. My sleeping self put my hands at my sides and braced against the couch, refusing to topple, scowling at him and possibly growling. I don't know if I believe that last part, but I laugh every time I imagine it, so let's go with it. He did take a picture, which he has promised never to show anyone. But it's funny. My lower lip is stuck out a mile, I'm all bundled up in my hoodie and blanket and slouched over my barf bin, which I am holding loosely in my hands. (Everytime someone tried to take that thing away from me, I'd snatch it back and retch some more, maybe glaring at them a little as if to say, "Get your own barf bucket, bitches, this one is occupado!" Maybe that's why they let me keep it. I seemed so attached. (Or maybe it was that they were sending me home uncontrollably vomiting up my own bile.)

Sorry. I really need to write that medical care rant.

So, my boyfriend rigged me a pillow system so I could sit up in bed, then sat with me until I nodded off. He set up a makeshift table for me with a hamper, leaving me easy access to water and my barf bucket.

I woke in the middle of the night to pee, stumbled through my house on legs that weighed a thousand pounds, swaying with every step, disoriented enough that I couldn't tell if the seat was up or down when I sat and I nearly launched myself through the shower door when I jumped and swiveled to check. I woke in the morning still feeling heavy and weird. It faded by late afternoon. I have a weird rash on my hand and arm that had the IV, like broken capillaries.

They sent me home with a small amount of valium, which I will be hoarding obsessively since I have no idea when I'll get my next bad attack or when I'll get some more drugs that actually help. So frustrating.

This definitely wasn't my worst ER visit ever, and I even learned a few things. I have a sensitivity to dilaudid. If I ever allow someone to give it to me again it will be in small doses. The side effects were obviously horrible, but the drug itself may have merit. I think where it all went terribly wrong is that dilaudid is indicated for those who have an opioid tolerance. I have no tolerance. It was a simple miscommunication, I think. When they asked me what I had taken in the past 24 hours, I said that I had taken narcotics, a small handful of muscle relaxants, and a few sleeping pills and it hadn't touched my pain. I think they thought this was a regular treatment for my head. In fact, it is not. I so rarely take any narcotics that I tend to fall asleep after looking at a half of a dose. But this pain ignored the drugs completely, wouldn't even let me sleep it off. So, lesson learned, my pain has a drug tolerance, I do not.

Sidenote: Apparently, the worse I feel, the more polite I am. I was pleasing and thank youing everyone in the hospital and I think I ma'amed a nurse who was younger than me. I told my boyfriend how wonderful he was and how much I loved him so many times, he was really worried. Not that he doesn't normally know that I think he's great and loved and all, I just express it more vehemently when I am really sick. Like most people do when they are drunk.


Heather said...

I appreciate the detailed description of your ER visit. I've never had to go to the ER for migraines but I've always wondered what it would be like if I ever have to. Now I'm thinking I will continue to avoid it at all costs! Sorry about what you went through.

WinnyNinny PooPoo said...

dilaudid makes me nauseous too, and reglan or zofran doen't help - I have to have phenergan. Fetanyl is a good alternative to dilaudid.

So sorry your headache decided to take over completely for a day! Hoping it behaves itself for awhile.

Sue said...

Oh my. That was a really bad one. I've never had dilaudid. The first line of attack at our local ER (we only have one) is stemetil/benadryl which I cannot take ever again. I've had two miserable reactions to this combo, so I avoid the ER as much as I possibly can.

I love that part where you said "my pain has a drug tolerance, I do not." I had never looked at it that way, but it's entirely possible and could explain a lot about why narcotics never worked for me.