My elderly relative Helen was in a hospital for three days – six 12-hour nursing shifts. Most of the nurses were terrific. But on one shift, it was different.

The orthopedic surgeon who replaced Helen’s broken hip had ordered 650 mg of Tylenol, every four hours as needed.  Around 9:30 a.m., more than four hours after she’d had pain medicine, Helen’s body was jerking and she was grimacing.  Acting as Helen’s health care representative, I asked the nurse, Gloria, to give her Tylenol.

Gloria glanced at Helen and said, “If she’s not screaming, she’s not in pain.” 

“Helen never screams,” I objected.  “Look at her face.  See how her body is jerking.  She’s in pain now.”

“No, if she were really in pain, she’d be screaming, believe me!  Besides, I want to wait to give her Tylenol until just before the physical therapists get her out of bed.  That’s when she’s going to need it.”

Gloria implied that the drug would take effect immediately.  Later, I contacted the manufacturer, who told me that it takes 45-60 minutes for 650 mg of Tylenol to start working.  

Every 15-20 minutes, when I repeated the request for pain medicine, Gloria told me to wait just a few minutes longer, for the physical therapists to arrive.  Hours later, I found out that Helen wasn’t even on the physical therapists’ schedule until the afternoon.  She could have been on her second dose of Tylenol by the time they were slated to come.

Why didn’t I go straight to the nursing supervisor? First, Gloria kept telling me that Helen would get the pain medicine in “just a few minutes.”  Second, I didn’t realize how big the problem was until later, because I didn’t know that Helen’s PT appointment was about four hours away, or that it takes up to an hour for the drug to start working.

Third, I didn’t know how to reach the nursing supervisor.  Was there one for the hospital? Different ones for each wing?  If I asked at the nursing station, I was afraid that the secretary would simply tell Gloria, and Gloria would say that the supervisor was coming in “just a few minutes,” like the pain medicine.  If I called the operator, I wouldn’t know who to ask for.

Fourth, I was afraid nothing would change and Gloria would retaliate and hurt Helen more. 

Red flags in this situation include: dismissing relatives’ knowledge of the patient’s behavior; indifference to the patient’s pain; refusing to give medicine ordered; repeated delays in promised actions; and failing to provide readily available information that the family requests, such as an appointment’s time.

Next week’s column will give examples of more red flags; the next one after that will offer solutions.