I needed the distraction, because I got in the middle of a (white American) poster telling a (black African) poster that her reaction to the blanket descriptor of "Africa" in scenarios where the European country would probably be specified was prejudiced and problematic.

I do wish I had edited at least the headline, because really, isn't the more amazing point that they are teenagers? I think so. (Like I did change the headline on the elephant who can say words, because it's not more impressive that they are Korean -- the elephant is in Korea!)

I am composing a letter to my neurologist. I'm not sure if it needs tweaking:

They are admitting me again today, the second weekend in a row, because the single dose does not get me to a level where I can start the week. And I'm being told that the admitting doctor will not administer the regimen either, so I have no idea what is going to be done so that I can work five days next week.

I need a new plan, and I need it today. Just when I thought the botox might be able to make things more bearable, I have no breakthrough pain remedies, so I'm further back in the hole than I've been in months if not years.

I don't know how else I can make my plight more clear, and I don't know how I can find people who are willing to help me cope in the short to middle term, I am entirely at a loss.

Please help me.

Oh god.

If you're looking for feedback, I might reiterate that you're talking about the regimen that the neurologist (?right?) developed and put in your file, because it's the only thing that's shown to help.

Jesus, ita ! I am thinking you should go ahead and bring a medical lawyer with you to the ER each week.

This is Stoppardesque levels of absurd.

I don't think you're describing an affair.

You're right -- it sounds awful, and not exciting or erotic, which is why I wouldn't do. It would be fun in other instances, though!

Damn, ita !, what has the neurologist said about the refusal to follow his prescribed regimen in the past? What is his relationship in the hospital/ER powers that be hierarchy? If your treatment can only be administered in the ER would it possibly have more likelihood of being successfully administered on a weekday, perhaps in the evening, thus avoiding weekend staff?

Sorry, more questions than answers, but just trying to explore potential solutions. It is so insane to have to deal with the pain and the bureaucracy at the same time.

I've heard zero from the neurologist in the past couple visits. I need to check and see when the next appointment is.

Now, the ER doc came in and said it would be one dose, gave me the dose, and then discharged me. Instead of signing those papers I said I would like my pain treated, and whatever they needed to do to get me going was fine, but I'm not leaving until then.

She left and came back and told me I'd be admitted, but no IV pain meds there either. At which point I wrote the above email.

The admitting doctor just left. She, like the resident I just saw, is new to me. She took my history, AND THEN SAID SHE'D GIVE ME THE RECOMMENDED DOSAGES WITHIN THE EFFECTIVE TIME PERIOD.

Why did the ER resident tell me that wouldn't happen? Why did she come back and tell me a doctor had decided on a course of treatment for me without talking to me and assessing me her herself?

I don't know. But I have no flattering way to describe that. At best it seems mildly spiteful behaviour to put drugseekers in their place. Sometimes the second doctor does do what the first said they would. Sometimes they don't. But I was clear to the ER doc--I'm just here to get back on my feet, and whatever effective breakthrough treatment they have is fine by me.

I don't feel I overreacted by sending that email to my neuro/migraine specialist. The way the doctors in the ER are acting should be on record--being admitted more often than not is ridiculous--no one is treating me, then. They're just reading off a piece of paper, and I don't know where that paper came from.

So, flat out, that's it.. I'm here, each time, until they do a good faith effort (based on doctor recommendation and information in the file) to help my pain. I know it doesn't always work well. But it pretty much *never* works if you don't try. That's why I'm here. The graham crackers are good, but overpriced.

I don't think the weekday would be any better, and this day gives me the most work days in good condition. I get about 5 days of good behaviour out of this, so I have to start that as late as possible. But I also can't always work (certainly can't drive) for 6 or so hours after being discharged.

ita, I think it might be worth contacting the social worker at the hospital again, just to have someone who's supposed to be advocating for you aware of what's going on.

I don't feel I overreacted by sending that email to my neuro/migraine specialist.

Not at all! Not knowing what kind of ordeal you will have to endure each week is not acceptable. A solution that does not involve having to go to the ER each week would be much better, but if that is the protocol at the moment then the treatment needs to be consistent. I hope the doctor has some thoughts on compelling the ER to follow his orders.

You definitely did not overreact -- this is appalling.

ita !, I would incorporate some of what Laura mentioned, about their refusal to follow the regimen your neuro has prescribed and explained in exhaustive detail, and also mention their consistent refusal, when they have all the neuro's contact information, to call and discuss your history, your regimen and his recommendations instead of simply privileging their own judgment over all that history.

They've consistently, profoundly disrespected his judgment and experience as a physician. Their refusal to follow his prescribed regimen or to question him directly about it rendered the Botox trial useless. Their actions have materially increased your physical suffering and are now endangering your livelihood; do they think you made him up? Do they think he's a weak-willed patsy to a cunning drug-seeker, or do they just think he's an idiot?

(eta: So some of them, sometimes, follow his recs to the letter, but that still isn't good enough. It's torture to you to not know which it's going to be until the moment it happens or doesn't happen, and it's still deeply insulting to him to have the respect accorded his knowledge of you and your history entirely dependent on who happens to be on call at the moment you walk in.)

Most of the doctors I know would be (and have been; it's happened before) livid at another medical team on whose cooperation they depend so thoroughly undermining their medical plan for their patients and endangering their patients' wellbeing (and their own standing in the community). If you can get your neuro good and pissed and spoiling for a righteous evidence-based fight with them on his own behalf as well as yours, it should end up helping you.

Mind, I totally and completely think the absolute most important thing is that you're in intractable pain that SHOULD NOT BE intractable, and your neuro's professional reputation is extremely small potatoes compared to your pain. But if those small potatoes can get a righteous fire lit under his ass, then use 'em.