Pain Management

It turns out I know a bit about this.  It started in 2006 when I came down with appendicitis at the end of March, and had to have an appendectomy in the middle of the night.  That was the worst pain I ever had.  Once I woke up sufficiently to focus, I read this pamphlet in my room in the hospital that said, If you’re in pain, we believe you.  Tell us and we will fix it.  What was so revolutionary about that to me is that I worked my way through college in the early seventies, working in a hospital for three years.  The nurses were stingy with pain medication, and considered people who begged for it to be budding addicts.  Of course they were reflecting the attitude of doctors at the time. 

The whole attitude of the medical profession about pain management has done a 180 degree turn. 

After my appendectomy, I spent 4 days in the hospital and got two pain pills every four hours.  On the third day, I asked to back off, taking one pill instead of two.  Because I was hoping to go home the next day, and thought it would be a good idea to get used to a little more pain (and a little more being alert and conscious seemed like a good idea too.)  The nurse said, “This is not a good idea.”

“Pain”, she said, “is something you have to stay ahead of, because by the time you feel it, we can’t give you enough to fix it.”  I insisted.  Sure enough, two hours later, I was in pain, but they couldn’t give me anything else for two more hours.  I didn’t quite get the logic of that…since you only gave me one pill instead of two, two hours ago, why can’t you give me the other one now?  It’s all still a mystery. 

After that experience, I never again rejected pain medication anybody wanted to give me.  I’m not about to be addicted to anything…I like being alert too well. 

And after that experience, 2006 turned out to be the year from Hell.  Probably as a result of the appendectomy, I developed an inflammation in a nerve in my left shoulder, which was seriously painful.  In the course of having first an MRI and then a CT scan to investigate that, they found out I had breast cancer in the right breast.   I had a lumpectomy on a Friday.  I was back at work on Monday.  Three weeks later I had surgery to investigate whether or not the cancer had spread to the lymph nodes, called a sentinel node biopsy.  After both those surgeries, I was given a minor type of pain medication which I maybe took for a day.  A month or so after the sentinel node biopsy, I started radiation therapy and almost at the end of that, I found out I had broken a rib.  At that point I got really serious pain drugs, which when you think about it is kind of funny.  Nerve damage, breast cancer, surgery, whatever.  But broken rib?  Please allow us to help you. 

Perception is everything.  But I have become accustomed to doctors who will anticipate your pain.  Who will do anything in their power to prevent it.  Who know that pain, in and of itself, will cause elevated blood pressure and interfere with your ability to heal.  Another point to remember is that studies show that when you leave pain medication administration to the person themselves, they use less. 

Now we come to the point.  By popular request, people want to know what happened when I had to have my eye injected Wednesday.  It was painless.  But they refused to give me anything for pain to take home.  I asked for something to numb my eye once the numbing medications they gave me wore off, and they said, We don’t do that.  I just wanted something like a drop for my eye.  It wasn’t like I was asking for heroin.  They said, numbing medications for your eye are bad for your cornea.  They told me it would not be unusual to have some pain and reddening of the eye, and that if it was extreme, I should call them.  I said I didn’t expect it to hurt.  The nurse said, “It will”.  Take Ibuprofen. 

So by the time it became extreme, their office was closed.  Apparently opthamologists (or the one I saw anyway) haven’t gotten with the program of anticipating pain and getting a head start on it.  I still can’t get over their refusal to give me something to numb the eye after the procedure.  I mean, did they think I would shoot up some Lidocaine?  What were they thinking?

To Have and Have Not

Apologies for borrowing the title to Hemingway’s 1937 book.  Some interesting points have been made in comments on my blog entry “Jeff the Mechanic” http://fakename2.wordpress.com/2008/10/24/jeff-the-mechanic/

At issue both there and in many other blogs and forums is this basic question (as I see it):  Why should I be my brother’s keeper?  Ptfan1 makes the point that he has worked and raised his family, and that he has given ”in good will and by law and duty my entire life. I do not want government telling me I need to do more.”  I can both understand and respect that.  Let’s see, this year I have voluntarily made donations to the Obama campaign, NPR, and a veterans’ group that alleged it would use my money to provide food baskets to homebound disabled veterans.  In the past I’ve donated to the Humane Society of the U.S. and to a local animal rescue organization.  All my donations were meager, but the point is, they were voluntary.  Suppose, however, that someone made it mandatory that I make “donations”, which would be used for causes I don’t support?  Um, we call that “income tax”.  But lucky for all of us, me included, the government doesn’t make its decisions based solely on my personal desires.  In the early seventies, if the government spent my tax dollars only on what I approved, I would have disbanded the military. 

Anarchist makes the point that taxes should be used only for programs which benefit everyone in society, therefore, he states he supports Social Security, since it will benefit everyone who lives long enough.  He’s reluctant when it comes to supporting public education, because kids (or the people who have them) are a “special interest group”.  (Correct me if I’m mis-stating your position here, Anarchist.)  The “right” to education is enough fodder for an entire other blog, but I can say that in my view, education–or more properly, the opportunity for an education–benefits all society, if only for the practical reason that it reduces crime. 

The real issue is how your money is spent by your government.  What makes me crazy are the stereotypes put forth about the Haves v. the Have Nots.  The Haves are those who worked hard, saved, and made sacrifices, and who believe that they are “entitled” to keep every penny they earned.  (As long as we’re talking about entitlements.)  The myth here is that this “class” of people did this all by themselves–no charity, no manufactured opportunies, no benefit from government intervention.  (Anarchist makes that point very well in his comment.) And the reality is, in many cases the Have Nots have worked a lot harder than Haves, it just hasn’t done them any good.  And it’s doing less and less good.  But the sterotypical Have Not is someone who works four hours a day (if at all), while you (a Have) works for 12 hours.  Then the Have Not calls you up on his IPhone and demands 39% of the money you made.

“Spreading the wealth” is, I believe, an inappropriate way to characterize what needs to happen in this country.  What needs to happen is a massive shift away from the trickle-down theory, which in practice was a trickle-up theory.  Anybody notice Exxon-Mobil’s profits for last quarter?  I think it’s time for a massive, Big Government program, a new New Deal, a WPA for the times, which infuses money into infrastructure rebuilding and alternative energy innovation.  These are not my ideas, but the ideas of people like Paul Krugman and Thomas Friedman.  This is not socialism.

Again, Why should you be your brother’s keeper?  Because it’s in your best interest and the interest of the country to do so.  If you don’t agree, see:  Revolution, French.  We’ve been living too long under the Let Them Eat Cake motto.  The natives are restless.