Armed & Dangerous

That's me, I'm talking about: The Armed and Dangerous Caregiver.

So, this week, we were back at Pain Management. You might remember that last month at Pain Management, I was read the riot act because Fentanyl did not show up in Bob's urine drug screen. Since then, I have done some research on this subject. And I was prepared for battle. I was, indeed, armed and dangerous. And it was a good thing, too.

Because, instead of seeing the physician's assistant, which is the normal case, who do you think comes walking in through that door? The Big Cheese, himself. The Doctor. Who we never ever see, because, you know, he's too busy to see us.

And the first words out of his mouth were "I hear Robert is not taking his Fentanyl patch!"

Then, he turns to Bob and says, "Are you selling those patches? Or are you giving them away?"

Of course, Bob, with his aphasia, just sat there with a sort of shocked and confused look on his face. Then, the doctor turns to me and says, "Or are YOU using them?"

Jeepers.

But I had come prepared and, after that initial moment of shock, I took a deep breath and presented him the following.

"You know, I was pretty bewildered about those test results, because I put those patches on Bob every 72 hours as directed. So the first thing I did, when we got home, was call Watson Laboratory, which is the maker of the Fentanyl patch. I got transferred around to three or four people and they were all pretty much as bewildered as I was, but the consensus seemed to be that the laboratory which ran the test must have made a mistake, because if the Fentanyl patch was faulty, if it was not absorbing into my husband's skin, my husband would have suffered withdrawal symptoms.

"So after that I contacted the laboratory, I called them seven or eight times, and each time I was told that I could not be connected with the laboratory but I could leave a message and someone would call me back. No one ever returned my calls. I did do some research on the internet and found that Fentanyl cannot be detected in an ordinary urine drug screen, that a special test must be run strictly for Fentanyl and that test is called gas chromatography mass spectrometry or GC/MS. I did not get a detailed billing from the laboratory, but when I looked back through my records, I found that this is a new laboratory your office is using and the old laboratory, Millenium Lab, had sent me a detailed billing last year. You will remember that that urine drug screen did show that Fentanyl was in his system. And that bill shows that the old laboratory ran 16 different tests including the GC/MS," At this point I held up the billing from that lab, "and the explanation of benefits from the insurance company indicates that this new lab only billed for eight different tests, unfortunately it does not tell which tests were run," I held up the Explanation of Benefits, "but that makes it seem to me that they skipped some of the tests. Did you order the correct test for Fentanyl?"

By now The Doctor has a rather shocked look on his face and he says, "Yes, I know there is a specific test for Fentanyl. I don't know if it was ordered."

So I say, "Well, so there is that possibility which would explain the test results. The only other thing that I could think that might have skewed those test results is the fact that this was the first time we used a urine sample which was taken from a catheter bag. Would that have skewed the results? Do you think?"

The doctor says, "I don't know. Hmmm... Maybe something in the plastic could have made a difference..."

And I say, "Well, anyway, the people at Watson suggested I bring in the packaging and used patches to show you that, indeed, we are not selling these or giving them away, " I hold up a zip-loc bag filled with Bob's used patches and packaging, "But I guess this doesn't prove I'm not using them. Though if I was, I tell you, I'd be quite loopy and you can see that I am not. However, you are welcome to check me over for patches and also, you can check Bob, his patches are on the left side under his shirt."

And the doctor says, "That won't be necessary. I will make a point, next time, to make sure they run the test for Fentanyl."

Then, he handed me Bob's prescriptions and we fled.

All in a day's work.