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Revision: November 2004
Jill Osborne
Created: June 1999
Jill Osborne
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Network > Patient Handbook
> Pain Management - Dr. Dan Brookoff
Pain Management and IC
"What's True is What Our Patients Tell Us"
On Friday and Saturday, September 26 & 27, 1997, Dr. Daniel Brookoff appeared
at a very special gathering of IC patients in California. Dr. Brookoff,
an Oncologist with Methodist Hospital in Memphis Tennessee, is undeniably
the United States leading champion for compassionate pain care for interstitial
cystitis patients. Blending medical fact with patient support, advocacy
and spirituality, his presentation was riveting, insightful and, in some
cases, shocking. As one physician offered afterwards, "In just an hour,
he changed everything I had ever thought about my chronic pain patients."
This list is a summation of Dr. Brookoffs key quotations and/or points.
The Judgement of Others
- "Patients who suffer from chronic pain also suffer from the judgement
of people who call them names. Pain patients have suffered the moral
judgement of those who treat them. It is scary that those who suffer
are also judged by those who should be treating them."
- "The worst thing I ever heard a doctor say to a patient is 'there
is no hope.' There is always hope. There may not be a cure, but there
can always be healing. Chronic pain can always be healed."
- "The bible says 'No ill shall befall the righteous.' Do some believe
that because you are ill, maybe you aren't righteous?? That's a terrible
burden for a patient to bear... that you might not be good because you
are ill. Everyone faces illness at some in point, but does that mean
that they aren't righteous?.
About Dr. Brookoff
- "I come from Memphis, a very spiritual city. We are connecting to
God and sources of hope and strength. I'm a cancer specialist. Twenty
years ago, we discovered that pain in cancer patients stops them from
healing. It stops them from living. Living is our (the doctors) business.
Sometimes the pain of cancer deprives them of living their lives and
we found that if we give them pain meds, they heal. They get
better. They connect. They get hopeful. That's our job on this earth.
If you leave people in pain that is untreated, they lose hope and that's
the worst thing that you can do. We want to restore their lives and
their hope."
- "Some physicians feel they can't use pain medications. They're afraid
of them, afraid of causing and addiction. But at the same time, they
love their patients. They hate to see them suffer. They're torn. It's
an awkward position."
Dr. Brookoff receives rave reviews for the stories
that he tells and the most remarkable story belongs with a slide of a
rock climber clinging to a sheer rock face. It's a picture that he took
of his roomate in medical school who grew up in Colorado and later became
a cardiologist. Dr. Brookoff calls it his "cardiologist on a rope"
picture and he has it hanging in his office.
One day, a patient came in, walked over to the
picture and then said "Dr. Brookoff, that's me." And Dr. Brookoff replied
"No, that's a cardiologist on a rope." And the patient repeated "That's
a picture of me.. hanging onto my life by my fingernails. But its missing
something. It doesn't show the doctors and nurses standing up at the top
and looking down at me.. spitting." It is true that some people who are
supposed to offer healing, actually treat their patients with contempt.
If they don't offer you healing and hope, find someone who will.
The Pain of IC
- "The pain of IC is totally different than the pain you feel with a
normal bladder. And when you say that your bladder hurts, they won't
understand. To them, a sore bladder is something that happens at a football
game when they have to go the bathroom.. and the line is too long..
but they really have to go. So.. they go have a few more beers, watch
the game .. and then their bladder is uncomfortable. It's not the same
physical experience or pain sensation as an IC patient."
The First Time I Heard of IC
- "The first time I heard of IC was in medical school twenty years ago,"
offered Dr. Brookoff. "A famous professor was lecturing. At the end
of his speech he said 'Oh.. there's this disease called Interstitial
Cystitis. It's little old ladies and they have to urinate alot. They're
always in pain and they will drive you nuts. It's a psychiatric disease..
it's all in their heads and don't ever give them pain meds. If you do,
they'll want more.' and someone asked.. 'well.. what do you for them?'
And the Dr. responded 'You run some tests and then, eventually, remove
their bladders.' And then another student asked 'But, if it's all in
their heads, why remove their bladders?" Doctors were trained that IC
patients would drive them nuts.
What is pain, anyway?
- "Those not suffering from chronic pain
(and interstitial cystitis) have never felt what you feel. It is a physically
different experience. If you tell someone about something they've never
had, they have trouble believing it. If you can't believe your patient,
you shouldn't be taking care of them. We're starting to learn that everything
our patients have told us for the last 100 years is the truth. That's
scary though because we've called a lot of people liars and have distrusted
them. Our most important teachers are our patients."
- "The medical definition of pain is that
it's an unpleasant, emotiona; condition, in the presence or absence
of tissue damage. I call that 'word salad.' The nursing definition of
pain is far more interesting and says 'If your patient says they're
are in pain, they are in pain.' Nurses are the visionary leaders in
pain treatment today."
Dr. Brookoffs definition of pain:
"Pain does not have a moral value.
Drugs do not have a moral value. Life is good... to be cherished, promoted
and supported. We, as physicians, should not be moralizing about pain
or it's treatments. We should be asking 'Has pain changed the lives
of our patients?' If it has, we have to work to restore their lives."
A Model or the Truth?
- Biochemistry is the truth to doctors. If it has a biochemical explanation,
it must be true. Yet, we know that it's just a model and it will change.
What we learned in medical school is outdated in five years. What's
true is what our patients tell us.
A few closing notes
- When the caregiver tells the patient he's bad.. that's the worst thing
we can do. Who are they serving when they accuse you of being an addict..
or that it's your fault that you are suffering? There is hope, strength
and healing for everyone. Don't let anyone separate you from your hope
and strength. Anyone who tries to is not on the right side.
- Find people who will help you restore your life. Find the treatments
that will help you restore your life. Life is good. We can heal the
pain. We have medicines that work.
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