Will Prince's Death from a Fentanyl Overdose Change Anything?

To say that the death of Prince a few weeks ago was a shock to the music community would be an understatement. To be honest, I wasn't all that familiar with his music - or so I thought. As I read the ensuing articles and Facebook posts, I came to appreciate the impact this man had on our collective musical soul, a man who was taken much too early.

It's a familiar story, his cause of death - an unintentional drug over dose. In this case, it was the pain killer Fentanyl. Too many people have been killed by unintentional drug overdoses. And every time it's someone famous or influential, there is hand wringing and there are calls for greater control of these potentially deadly medicines, and that things need to change. But what things?

When I worked as a nurse in hospice, Fentanyl was the drug of choice for many of my patients to help relieve the severe pain that end-stage cancer can cause. I saw the difference in my patients before and after they received the medication, misery before, relief after. My mother was on Fentanyl for chronic pain for many years, pain from spinal stenosis. It was the only medication that provided any type of relief and the fact that it was a patch that could last days, not hours, was a huge bonus. But, like many such drugs, there's a dark side to Fentanyl. It is addictive. Very addictive.

So, we have a medication that can help a person live life with less pain and a drug that can destroy a life. Where do we find a balance? And is there a balance?

It's already very difficult for some people with pain to get adequate pain relief. Some doctors are afraid of prescribing such powerful drugs, preferring to err on the side of caution, so they think. So the patients suffer, or look for another doctor. They run the risk of being accused of doctor shopping.

When patients do have a prescription, seeking renewals can be a nightmare; they may be treated like drug-seekers. If these patients present at emergency departments because they are desperate, some staff members don't believe that the pain is real. Some pharmacies don't even carry adequate amounts of the pain killers, if at all.

If we "tighten up" access to these drugs even more, where are those who need the drugs going to get them? Yet, we can't deny the seriousness of the issue of drug abuse. We can't ignore that people are becoming addicted to these drugs and lives are being destroyed because of them.

So, will Prince's death change anything? It's doubtful. If it does, I fear that it will make these medications even harder for people to obtain to relieve their pain. Is there a solution? There has to be. But what?

Old News: Noise in Hospitals Disturbs Patients

If you've ever been a patient in a hospital, you know that hospitals are not where you go to rest. And if you happen to have a room next to a nursing station or the entry to the unit or floor,  you're even worse off because of all the noise.

Even as a young nurse, I was aware that noise was an issue, particularly during the night shifts. I tried to speak at a lower level and not move around the rooms as much if I could avoid it. But, patient care still needed to be done and I found myself often waking patients so I could do certain procedures or give medications. I would feel so bad for the patients who had just finally fallen asleep, only to have me wake them up.

I had my three children at the same hospital, and the first two times, I was placed in a room right across from the nursing station. That experience opened my eyes. I got no rest. People were constantly walking past my room, rolling noisy carts and chatting with others. Some people would be calling up the hallway to colleagues as they asked or answered questions. The phone would ring all day long and staff members of all stripes would gather at the station, particularly at the change of shift. It was N.O.I.S.Y. Even with the door closed, I was disturbed. Night time was quieter, but there was still chatter and the noise of all the call bells that would go off all night long. It was anything but restful. I lucked out with my third child though - I was given the last room at the end of the hall. It was so quiet, it was like I was in a different place altogether.

The thing is, we already know that hospitals aren't restful places and that they're noisy. Researchers have been studying this - although they really just needed to speak to some patients to find out. But at least now, they're taking the noise seriously. There was a study presented at a conference earlier this month, showing how loud an intensive care unit can be, Quiet please in the intensive care unit! As a former ICU nurse, I could relate.

What does this all mean? It's hard to say. Patients are limited in power. They could ask to have doors closed, but they can't do anything about the alarms and the need for healthcare staff to communicate with each other in the halls. They also can't do anything about room placements or if they are near a hub of activity.

Hopefully continued research like this ICU one may change some policies - changing how alarms are used and instituting quiet times, when noisy activities stop and patients are encouraged to rest are a good start. Some facilities are already doing this. We know we need sleep to heal, to get better. The thing is figuring out how to provide it in the hospital environment.