BBC Sherlock Fan Forum - Serving Sherlockians since February 2012 » Question-- Just how long was Sherlock in the hospital?

Willow · January 27, 2014 10:52 pm

Swanpride wrote:
Just for the record, in Germany morphine is prescribed way less than in other countries. There are alternatives, after all.

Yes. Unfortunately the alternatives are usually just as addictive; heroin (diamorphine) was developed by a German company and originally marketed as the non-addictive solution to the plague of morphine addiction. It turned out to be a lot worse All opiates are potentially addictive but addiction is very rare when they are used as analgesia for severe pain.

There is another group of painkillers, non-steroidal anti-inflammatory drugs, but they are really not a good idea in someone who is bleeding, unless you want them to bleed even more, and the sort of powerful ones given to people in severe pain are regarded in this country as having an unacceptable level of adverse effects. Even mild NSAIDs can kill; anaphylactic reactions are not uncommon, particularly in people with asthma and other allergic conditions. I myself have life threatening reactions to them, a fact which is recorded in red ink on my armband whenever I am in hospital.

Willow · January 27, 2014 11:17 pm

SusiGo wrote:
Swanpride wrote:
Just for the record, in Germany morphine is prescribed way less than in other countries. There are alternatives, after all.
And to speak from my own experience - I got morphine after an operation and I realised how dangerous the stuff is. I felt great, like floating in my bed, not a care in the world. Then I asked what they gave me and they said it was morphine. They changed the medication as soon as possible because of its addictive effects (at least I suppose that was the reason).

Well, sort of; the entire point is to titrate the dose so that you have effective pain relief and then gear down as your body begins to heal. But you need to be mobile as soon as possible to reduce the risks of embolisms and pneumonia, and you can't do that if you are in a lot of pain, so anaesthetists are juggling all the balls in the air for the maximum of benefit and the minimum of risk.

Incidentally, the only thing which would happen to someone addicted to opiates after an operation is that they would be given much higher doses of opiates than a non-addict; sadism is not part of the practice of medicine, thankfully.

RavenMorganLeigh · January 28, 2014 2:06 am

Swanpride wrote:
Just for the record, in Germany morphine is prescribed way less than in other countries. There are alternatives, after all.

I'm coming from the US, where denying people health care has become an art form. I think you only get Morphine if it's dire--I hear more about oxycodone, etc, ... I think here, pain relief often comes second to --firstly, costs, and then doctor's attitudes towards patients is that they are potential drug seekers, and so will often do everything they can to keep people off higher priced meds.

Last edited by RavenMorganLeigh (January 28, 2014 2:11 am)

sj4iy · January 28, 2014 4:07 am

RavenMorganLeigh wrote:
Swanpride wrote:
Just for the record, in Germany morphine is prescribed way less than in other countries. There are alternatives, after all.
I'm coming from the US, where denying people health care has become an art form. I think you only get Morphine if it's dire--I hear more about oxycodone, etc, ... I think here, pain relief often comes second to --firstly, costs, and then doctor's attitudes towards patients is that they are potential drug seekers, and so will often do everything they can to keep people off higher priced meds.

Well, morphine is given sparingly but when necessary. It is VERY easy to become addicted to morphine, which is why doctors are keen to move a patient onto less addictive pain medication as soon as possible. Now, it's no secret that other pain medications such as hydrocodone and vicodin are very much overprescribed and have been responsible for numerous deaths (even high profile deaths) because people will accidentally overdose by taking too many drugs at once.

In the US, doctors are more apt to prescribe drugs instead of running tests to find out what's wrong because tests are expensive. I know, because I nearly died after 3 different doctors failed to diagnose me properly for over two months as I grew steadily weaker and sicker. I saw one doctor 4 times in a month, and the only thing he did was do a flu swab. When it came out negative 4 times, he said "Well, I don't know". I finally had to drag myself to the ER where the doctor on-call immediately diagnosed me with two life-threatening conditions: addisonian crisis and thyroid storm- and I was on the verge of having a deadly stroke at that point. After I spent a week in the ICU, I went back to the original doctor who had misdiagnosed me with the 'flu' and he said "Well, I guess I should have checked for that". That's the sad shape of our healthcare in the US, unfortunately.

Last edited by sj4iy (January 28, 2014 4:08 am)

RavenMorganLeigh · January 28, 2014 4:46 am

sj4iy wrote:
RavenMorganLeigh wrote:
Swanpride wrote:
Just for the record, in Germany morphine is prescribed way less than in other countries. There are alternatives, after all.
I'm coming from the US, where denying people health care has become an art form. I think you only get Morphine if it's dire--I hear more about oxycodone, etc, ... I think here, pain relief often comes second to --firstly, costs, and then doctor's attitudes towards patients is that they are potential drug seekers, and so will often do everything they can to keep people off higher priced meds.
Well, morphine is given sparingly but when necessary. It is VERY easy to become addicted to morphine, which is why doctors are keen to move a patient onto less addictive pain medication as soon as possible. Now, it's no secret that other pain medications such as hydrocodone and vicodin are very much overprescribed and have been responsible for numerous deaths (even high profile deaths) because people will accidentally overdose by taking too many drugs at once.

In the US, doctors are more apt to prescribe drugs instead of running tests to find out what's wrong because tests are expensive. I know, because I nearly died after 3 different doctors failed to diagnose me properly for over two months as I grew steadily weaker and sicker. I saw one doctor 4 times in a month, and the only thing he did was do a flu swab. When it came out negative 4 times, he said "Well, I don't know". I finally had to drag myself to the ER where the doctor on-call immediately diagnosed me with two life-threatening conditions: addisonian crisis and thyroid storm- and I was on the verge of having a deadly stroke at that point. After I spent a week in the ICU, I went back to the original doctor who had misdiagnosed me with the 'flu' and he said "Well, I guess I should have checked for that". That's the sad shape of our healthcare in the US, unfortunately.

My heart goes out to you, 'cos I totally know what this is like-- and quite a few of my freinds have had to deal with this kind of crap, as well. It's heartbreaking. Good thing Sherlock is in the UK.

The same thing happens with handing out psych meds like candy, rather than actually working to figure out what's actually wrong. :-)

Last edited by RavenMorganLeigh (January 28, 2014 4:49 am)

sj4iy · January 28, 2014 5:00 am

Swanpride wrote:
In my experience, is not really practice here to drug the patient up unless he really can't stand the pain. As long as the pain is on a resonable level, a lot of doctors prefer to keep it that way instead of accidentially surpressing symptoms. (Plus, the attitude here towards medication is very different. A lot of the stuff you can easily buy in the US is here only available with a receipt, and self-medication is frowned upon).
Though I bet that a gunshot wound would be serious enough to warrant pain medication.

Oh? What is prescription there that is OTC in the US?

clareiow · January 28, 2014 6:54 am

I could be completely wrong here, so anyone with first hand experience can correct away but...
I believe if someone has surgery in the UK, you get morphine administered through a drip at a considered dosage which you can administer yourself by the click of a button, but once you've had your limit it doesn't give you any more. My hubby had this when he had major bowel surgery and my sister when she had a hysterectomy.
My grandfather had terminal lung cancer and only agreed to give him as much morphine as he wanted about a week before he died! Up until then, he was on strict dosages of an oral liquid morphine.
So the fact Sherlock can change his up and down, at will, seemed like a little poetic licence to me. Unless Mycroft pulled some strings to stop him being too difficult with the nurses?

besleybean · January 28, 2014 7:01 am

I took it he was merely switching the drip back on, that Janine had switched off.

belis · January 28, 2014 7:12 am

RavenMorganLeigh wrote:
I'm coming from the US, where denying people health care has become an art form. I think you only get Morphine if it's dire--I hear more about oxycodone, etc, ... I think here, pain relief often comes second to --firstly, costs, and then doctor's attitudes towards patients is that they are potential drug seekers, and so will often do everything they can to keep people off higher priced meds.

Oxycodone is basicly a synthetic form of morphine. The main advantage is that it comes in a slow release form so you only need to take it twice a day instead of every four hours. It has the same potential for addiction and abuse as morphine. There are plenty of new opioids available on the market, each with their own adventages. People often freak out when they hear morphine, not so much when you offer opioids by different name.

belis · January 28, 2014 7:37 am

clareiow wrote:
I could be completely wrong here, so anyone with first hand experience can correct away but...
I believe if someone has surgery in the UK, you get morphine administered through a drip at a considered dosage which you can administer yourself by the click of a button, but once you've had your limit it doesn't give you any more. My hubby had this when he had major bowel surgery and my sister when she had a hysterectomy.
My grandfather had terminal lung cancer and only agreed to give him as much morphine as he wanted about a week before he died! Up until then, he was on strict dosages of an oral liquid morphine.
So the fact Sherlock can change his up and down, at will, seemed like a little poetic licence to me. Unless Mycroft pulled some strings to stop him being too difficult with the nurses?

You are right. It's called patient controlled analgesia and it's the best thing since sliced bread. There are different ways to set up those infusions. You can have bolus only when you get a bit every time you press a button or a bolus plus a low level continous infusion. It's quite complicated to change the rate of the infusion and the control panal is normally either locked with a key or password protected to stop patients and relatives from messing with it and killing the patient by mistake. So there is an alement of dramatic license with them being able to fiddle with the infusions rates like that.

Morphine is not that adictive in a grand scale of things. In fact nicotine is more so. There are a lot of missconceptions amongst general public and some doctors as well resulting in people getting substandard pain relief.

It's actualy quiet rare for people who take opioids for pain relief to become addicted. Particularly if their are used short term. If opioids are used for weeks and months they develop physiological dependence and will get withdrawals if you stop the medication abruptly but they are not addicted in a strict sense. They will be able to temper off the dose and stop when appropriate without much of a problem.

The main reason why we are keen to stop opioids asap after the surgery is the side effects associated with it. To enhance recovery we need patients eating and mobilising. Being nuseaous, constipated and dizzy doesn't help with that so its better to try and swich to a different pain relief. At the same time though being in pain doesn't help you moving about either so undertreating pain is associated with increased surgical mortality associated with penumonias, blood clots etc I think we tend to get the balance right in the UK with use of PCAs, which deliver just the right amount to keep patient pain free without oversedation.

I will better shut up now. I have an academic intrest in pain and addictions so I could go on about it all for hours. lol

TeeJay · January 28, 2014 7:44 am

besleybean wrote:
I took it he was merely switching the drip back on, that Janine had switched off.

What Sherlock was fiddling with is called a perfusor or syringe driver. It's a pump that you adhere a syringe to, which then controls the dosage, i.e. the rate at which the medication is delivered to the patient (which I assume was intravenous for Sherlock, but I think it may also be used for subcutaneous delivery).

I don't really know for sure, but I think a perfusor is used rather than a drip when you want to make sure a patient gets a precise dosage of a medication that you can easily and more accurately adjust than a drip. And of course patients are not supposed to fiddle with the dosages themselves. Usually they put the perfusors out of reach of the patient, or least somewhere where the patient would have to make a considerable effort to get to it.

Also, I don't think Janine had switched off the morphine. If you look closely, he just ups the dosage from a low to a rather high setting. Either he reduced it himself while Janine was there to make sure he wasn't loopy, or the doctors did that, and Sherlock just increased the dosage because he was in a lot of pain and didn't want Janine to see it.

Last edited by TeeJay (January 28, 2014 7:47 am)

RavenMorganLeigh · January 28, 2014 8:05 am

belis wrote:
clareiow wrote:
I could be completely wrong here, so anyone with first hand experience can correct away but...
I believe if someone has surgery in the UK, you get morphine administered through a drip at a considered dosage which you can administer yourself by the click of a button, but once you've had your limit it doesn't give you any more. My hubby had this when he had major bowel surgery and my sister when she had a hysterectomy.
My grandfather had terminal lung cancer and only agreed to give him as much morphine as he wanted about a week before he died! Up until then, he was on strict dosages of an oral liquid morphine.
So the fact Sherlock can change his up and down, at will, seemed like a little poetic licence to me. Unless Mycroft pulled some strings to stop him being too difficult with the nurses?
You are right. It's called patient controlled analgesia and it's the best thing since sliced bread. There are different ways to set up those infusions. You can have bolus only when you get a bit every time you press a button or a bolus plus a low level continous infusion. It's quite complicated to change the rate of the infusion and the control panal is normally either locked with a key or password protected to stop patients and relatives from messing with it and killing the patient by mistake. So there is an alement of dramatic license with them being able to fiddle with the infusions rates like that.

Morphine is not that adictive in a grand scale of things. In fact nicotine is more so. There are a lot of missconceptions amongst general public and some doctors as well resulting in people getting substandard pain relief.

It's actualy quiet rare for people who take opioids for pain relief to become addicted. Particularly if their are used short term. If opioids are used for weeks and months they develop physiological dependence and will get withdrawals if you stop the medication abruptly but they are not addicted in a strict sense. They will be able to temper off the dose and stop when appropriate without much of a problem.

The main reason why we are keen to stop opioids asap after the surgery is the side effects associated with it. To enhance recovery we need patients eating and mobilising. Being nuseaous, constipated and dizzy doesn't help with that so its better to try and swich to a different pain relief. At the same time though being in pain doesn't help you moving about either so undertreating pain is associated with increased surgical mortality associated with penumonias, blood clots etc I think we tend to get the balance right in the UK with use of PCAs, which deliver just the right amount to keep patient pain free without oversedation.

I will better shut up now. I have an academic intrest in pain and addictions so I could go on about it all for hours. lol

This is awesome-- I'm trying to write a story, and want to have my facts straight. So, thank you!!!! :-D

belis · January 28, 2014 9:34 am

RavenMorganLeigh wrote:
This is awesome-- I'm trying to write a story, and want to have my facts straight. So, thank you!!!! :-D

I'm glad you found it usefull. I have typed all that up and then realised that I have started with Sherlock and moved to a mini lecture on post-operative analgesia. lol If you have any questions related to your story feel free to PM me.

RavenMorganLeigh · January 28, 2014 9:35 am

belis wrote:
RavenMorganLeigh wrote:
This is awesome-- I'm trying to write a story, and want to have my facts straight. So, thank you!!!! :-D
I'm glad you found it usefull. I have typed all that up and then realised that I have started with Sherlock and moved to a mini lecture on post-operative analgesia. lol If you have any questions related to your story feel free to PM me.

Thanks! I'll take you up on that! :-)

Davina · January 28, 2014 10:16 am

Valerian is quite effective though. It is a banned substance under FEI (equestrian) competition rules. Although, of course, just because a substance is 'natural' it does not mean that it is not potentially harmful or addictive (tobacco as an example).

As for the misdiagnosis or otherwise...please believe me the NHS is definitely not fool proof!!

Tinks · January 28, 2014 10:32 am

This might be the wrong thread to post this in, but did season 3 end with Sherlock back on drugs?
There were references throughout the episode right from the start, even though it was "just for the case he was working on"
He let his guard down emotionally, CAM had referred to him being a "junkie" - present tense, and Janine said something about it being handy for him that the drugs were being pumped straight into him, referring to his drug habit - how did she know about it?

Davina · January 28, 2014 10:47 am

Hi Tinks. Maybe this thread Drugs: do you believe Sherlock. It is in this HLV section of the forum.

Willow · January 28, 2014 12:12 pm

Swanpride wrote:
The NHS would have tried to kick out Sherlock out of the hospital as soon as possible, right?

The NHS strives to kick people out of hospital as soon as it is safe to do so because hospitals are nasty dangerous places where you can catch all sorts of deeply unpleasant bugs. The difficult bit is defining the optimal point, because if you discharge people too early they will be back and frequently they will be a lot iller than if they had stayed in for a few more days in the first place.

Tinks · January 28, 2014 12:37 pm

Davina wrote:
Hi Tinks. Maybe this thread Drugs: do you believe Sherlock. It is in this HLV section of the forum.

Thank you
And sorry - didn't spot that thread before!

TeeJay · January 28, 2014 12:44 pm

Willow wrote:
Swanpride wrote:
The NHS would have tried to kick out Sherlock out of the hospital as soon as possible, right?
The NHS strives to kick people out of hospital as soon as it is safe to do so because hospitals are nasty dangerous places where you can catch all sorts of deeply unpleasant bugs. The difficult bit is defining the optimal point, because if you discharge people too early they will be back and frequently they will be a lot iller than if they had stayed in for a few more days in the first place.

We should also consider Mycroft's government connections. I'm sure he'd pull strings to make sure Sherlock stays in the hospital as long as is warranted. I'm sure he already had a say in Sherlock's choice of hospital room in HLV. It looks like Sherlock has a private room to himself. If the NHS is anything like the German government-mandated health insurance, you'd be staying in a room with at least one other patient, usually two, unless you had private or additional medical insurance.