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The job of the human being [in the digital age] is to become skilled at locating relevant valid data for their needs. In the sphere of medicine, the required skill is to be able to relate the knowledge generated by the study of groups of patients or populations to that lonely and anxious individual who has come to seek help. (Grey, 2011)
The letter needs a context and solutions to make it meaningful. There are questions that cry for a response. Why is the husband not better equipped with take home injections or other interventions that can be administered away from the emergency room? Initially as material for an invited commentary I received only the follow up letter to comment on. I can’t help but wonder if this is indicative of the family story that is fragmented by the crisis of pain. Perhaps no one has looked at the whole picture along with the values and desires of the family and the patient to map out a plan that works (Glasziou & Haynes, 2005).
What do they do before finally sending her home and what is she herself doing to amend the situation (Tayabali, Agarwal, & Price, 2011)? If he is at the hospital can he not make himself useful caring for others and delivering comfort or quietly getting what his wife has need of and delivering the same with dignity and compassion. A relationship born of understanding the limits of urgent care and being gracious could make this happen.
It appears she has not been told how the medications work in her system and she waits as long as possible before she takes anything for fear of being classified as an addict or abuser. Many of these interventions work best in small dosages that remain in the blood stream. Further to this individuals can have borderline high or sticky platelets and a simple drug like baby aspirin used every day can resolve years of torment. This is something she could possible investigate with her physician. It would take a six-week trial costing less than a bottle of multi vitamins.
As a physician her husband could show her how to track and journal when the headaches happen and note what she is doing during and prior to the headaches (Biswas, Price, Chandra, Datta, & Biswas, 2012). It appears that because of the pain her husband is speaking for her. She will need appointments outside of emergency where she is free of the migraine and can speak for herself to become an agent in mapping her own treatment. As she shares her life, compassion will come from others and maybe an idea untried will spring up and bring the promise of healing.
I have not seen any reference in the letter to neuro-feedback, acupuncture, heart rate variability training, neuro-specific physical and occupational therapy or sleep hygiene. These interventions are relatively inexpensive, non-invasive and are unlikely to do harm. Some individuals find help in simple solutions like targeted diet and exercise.
There is no evidence that this patient has enjoyed the care of an endocrinologist, physiatrist, spinal physician or specialized migraine neurologist and counselors. Even as I start to read I see her cervical vertebrae compressed just enough to affect her central nervous system when inflammation or hormonal surges are present delivering the kind of pain nothing but unconsciousness can touch (Biswas et al., 2012). I think about solutions others see but have no freedom to share. Is the answer in any of them or could even the power of reassuring this couple that they are special persons in a bad place and that others do care plant a seed of healing. They need to know this is an event it is not their destiny.
If her husband is immobilized because he is too close I wonder if he could trade favors with a colleague and get them to go with his wife and search for information he may have missed (Kahneman & Klein, 2009).
Hopeful sharing of information is needed here, not even a wise physician is beyond learning. The door is shut tight blocking information because answers escape leaving futility and hopelessness to breed unfettered. We as reviewers of the letter are put in the position of the uninformed with no tools but the frustration of a physician husband who sees his wife in pain and is forced to deliver the vulnerabilities that he and his wife share at the doors of urgent care. It would be challenging to return to a place where domestic brutality is queried repeatedly and in such an inefficient and insensitive way. It does make one consider that other aspects of ethics and patient safety may be compromised. I cannot imagine a less suitable place (Grey, 2011).