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Since It’s The Appropriate Season…

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… I figured I’d repost a little blast from the past.

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Dear Ambulance Driver— I am 28 years old, and I work as a nurse in an Emergency Department. Some of my co-workers say there is no such thing as fibromyalgia. My ER nurse manager says, “If you see it in A Day In The Life Of An Ambulance Driver, it’s so.” Please tell me the truth, is there such a thing as fibromyalgia?

Virginia Monologues

Virginia, your co-workers are wrong. They have been affected by the skepticism of a skeptical age. They do not believe except they see. They think that nothing can be which is not comprehensible by their little minds, and excuse it by giving it high-minded names like ‘evidence-based medicine.’ All minds, Virginia, whether they be doctor’s, nurse’s or paramedic’s, are little. In this great universe of ours, man is a mere insect, an ant, in his intellect as compared with the boundless world about him, as measured by the intelligence capable of grasping the whole of truth and knowledge.

Yes, Virginia, there is a Fibromyalgia Claus. He exists as certainly as malingering and whining and perpetual victimhood exist, and you know that they abound and make your working life a living Hell. Alas! how dreary would be the world if there were no Fibromyalgia Claus! It would be as dreary as if there were no Virginias. There would be no childlike faith then, no poetry, no Reiki or acupuncture. There would be drastically decreased profit margins for the makers of Vicodin and Duragesic patches. Pharmacists would be reduced to panhandling on street corners. Soma, Xanax and Lortab would only be prescribed to sick people. Emergency Departments would become desolate, lonely places. Malingerers should have no enjoyment, except in sense and sight. The external light with which potent narcotics fills your mind would be extinguished.

Not believe in Fibromyalgia Claus! You might as well not believe in fairies. You might get your nurse manager to hire an in-house ER rheumatologist to screen patients for fibromyalgia, but even if only one in fifty of those purported fibromyalgia sufferers actually had the disease, what would that prove? Nobody sees Fibromyalgia Claus, but that is no sign that there is no Fibromyalgia Claus. The most real things in the world are those that neither children nor men can see. Just because I’ve never personally seen a legitimate fibromyalgia sufferer does not mean that they don’t exist. It may just be that they’re too busy living their lives to show up in an ER six times a month begging for a fix. Did you ever see fairies dancing on the lawn? Of course not, but that’s no proof that they are not there. If you have, then you likely have fibromyalgia and the Dilaudid you demanded is working wonderfully. Nobody can conceive or imagine all the wonders there are unseen and unseeable in the world, including the ever-elusive genuine fibromyalgia sufferer.

You tear apart the baby’s rattle and see what makes the noise inside, and you could try, and fail, to discover a disease pathology or objective set of diagnostic indicators for fibromyalgia, but there is a veil covering the unseen world which not the smartest epidemiologist, nor even the united strength of all the EMS and ER staffs that ever lived could tear apart. Only faith, poetry, love, romance, drug-seeking and shady pain-management clinics can push aside that curtain and view and picture the supernal beauty and glory beyond. Is it all real? Ah, Virginia, in all this world there is nothing else real and abiding.

No Fibromyalgia Claus! Thank Sumdood! He lives and lives forever. A thousand years from now, Virginia, nay 10 times 10,000 years from now, he will continue to make glad the heart of addicts and whiners everywhere.

I hope I answered her question.

Posted by Ambulance Driver on December 2, 2009 • Filed under: Uncategorized
  • T4
    Does he bring presents, this Fibromyalgia Claus? I love presents!

    The diagnosis criteria with the arbitrary number of tender points just ask for abuse. Yet, most patients with fibromyalgia (even those 'wrongfully' diagnosed) truly seem to suffer: it's no mere drug or attention seeking behaviour - at least for most. Thus, while I sincerely doubt fibromyalgia as a specific entity, I do like the 'fibromyalgia syndrome' way of thinking.

    As such, mizmooze's example of not fitting the required number of fibromyalgia diagnostic criteria seems a bit off (though I completely agree with you, mizmooze!). Surely someone with 10/18 tender points can experience just the same pain and disability as a patient with 11/18 tender points?
  • The best part is that now they're running fibromyalgia commercials on the TV. My favorite line is when the woman says "sometimes you want a hug but you know it will hurt." I cannot help laughing whenever I hear that, because it's just such an over the top melodrama. Plus, I think if I was actually one of the few people that really has it, I'd be kind of pissed.
  • Divemedic
    I don't think it is possible to type a post about drug seekers and fibromyalgia without at least one indignant rebuttal in the comments.
  • The cure to fibromyalgia is to d/c enabling family members as well as to administer employment, ibuprofen, and SSRIs.
  • Antibubba
    Clever, but just because a causative agent has not been found does not mean that the illness is imaginary. It would be more accurate to call it "Fibromyalgia SYNDROME, which, like Chronic Fatigue and Irritable Bowel, are a collection of symptoms which lead a diagnostician to that conclusion, which in turn suggests a possible means of treating those symptoms.

    There are a great many fakers, malingerers and addicts who clog up the health system, but there are many more who would much rather never see you or a doctor ever again, if their pains and afflictions were to go away. My mother has suffered from migraines since the age of 12. Now in her seventies, she has gone from 3 or 4 a week to 1, if she's lucky. She's been treated by countless physicians, pain specialists, and even alternative medicine practitioners. She even had sinus surgery. The only thing that helps is Imitrex, which basically knocks her out for a day or two, which she hates. I had migraines in my teens, and if there is anything that hurts more I don't want to know (and I say that as someone who suffered a broken pelvis in a car accident). Doctors still haven't found a cause for her headaches, and she isn't making them up (because, yes, she's also gone to therapists and psychiatrists to find an answer), Sumdood plays no part in this.

    So while you have every right and an obligation to watch out for junkies and frequent fliers, I hope you'll remember that just because the source of a pain can't be located does not mean it isn't real. If KatyBeth were suffering in pain, and no cause were found after months of seeing doctors, I know you wouldn't ever tell her that she's faking it, or conclude that she's just whining to get drugs, or was mentally ill. You have "seen it all", but remember to distinguish objectivity from hardened cynicism. Remember that compassion and empathy are not weaknesses but strengths.
  • Ambulance_Driver
    To quote Foghorn Leghorn, "It's a joke, son. A joke."

    I believe there is such a thing as fibromyalgia, Antibubba. Some of my readers and their loved ones have it.

    But I also know that, much like ADHD, it is vastly overdiagnosed, so much so that the physician who originally identified the syndrome no longer believes in it as a legitimate diagnosis.

    The vast majority of fibromyalgia patients aren't seeking my services as an EMT, nor are they seeking potent narcotics in the ER. And when they do, it's fairly uncommon and easy to spot the fact that they are in pain. And for those patients, they get my compassion and as much narcotics as my protocols will allow - even when I have doubts.

    But when I see patients ten or more times a month, who seem to be allergic to everything but potent narcotics, I know a drug seeker when I see one. Fibromyalgia makes a very handy diagnosis to accomplish that, since no one short of a rheumatologist can disprove the symptoms.

    And unfortunately, at least among the ER patient population, they greatly outnumber the legitimate sufferers.
  • Antibubba
    Thank you for clarifying; it did seem out of character.
  • Ambulance_Driver
    Another point on that same line of thought:

    Usually, when I blog a a story from work, only the patient details have been fudged to protect privacy. Pretty much everything you see in quotes is what was actually said, and I do have a knack for getting away with saying some outrageous things.

    But some things I can't say to patients, and some ways I can't behave, no matter how much I wish otherwise. This blog is my way of saying those things I'd never say to patients in real life.

    If I didn;t say it somehow, I fear my head would explode. ;)
  • mizmoose
    I firmly believe that fibromyalgia is like "ritual" sexual abuse -- I'm pretty sure it exists but it's far, far more rare than some folks would have you believe. I could almost lump ADD/ADHD in there, too, except that I think they may be more common than the other two. The one thing all 3 share? They are now or at one time have been an "easy diagnosis" for lazy doctors or people who self-diagnose.

    I once had a doctor dealing with my multiple health issues randomly throw out, "Oh and you probably have fibromyalgia, too" {followed by frantic scribbling in my chart}. Rather than go the "I don't have ADD either" route I calmly pointed out that no, I didn't fit enough of the "diagnostic criteria" for the condition. Thankfully, she agreed.
  • hydrogeek
    This sounds a lot like what an ex-co-worker of mine used to say. He was a veteran and had been shot at by several nations. He said "There ARE some disabled Vietnam veterans out there, but they are NOT the ones saying they are disabled Vietnam veterans."
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