Wednesday, March 19, 2008

Take the meds

What I really wanted to say below was: take the meds. Ask for them if you have to — though it's always nice if a nurse comes to you and asks you. There's no shame in it, and the risk that someone who has never had trouble with substances before will develop an addiction to pain-killers in the hospital is very slight. Stoicism — here defined narrowly as not taking drugs that can make you more comfortable when you need them — is bad for body and mind and, ultimately your recovery. You'll cut them out when you feel better.

Now I'll reinforce this point with an excerpt from the New York Times and then undercut everything with a short story about my own recent hospitalization.

First let's take a whack at the addiction argument with an excerpt from the Times, from an interesting article about a pain doctor:

Virtually everyone who takes opioids will become physically dependent on them, which means that withdrawal symptoms like nausea and sweats can occur if usage ends abruptly. But tapering off gradually allows most people to avoid those symptoms, and physical dependence is not the same thing as addiction. Addiction — which is defined by cravings, loss of control and a psychological compulsion to take a drug even when it is harmful — occurs in patients with a predisposition (biological or otherwise) to become addicted. At the very least, these include just below 10 percent of Americans, the number estimated by the United States Department of Health and Human Services to have active substance-abuse problems. Even a predisposition to addiction, however, doesn’t mean a patient will become addicted to opioids. Vast numbers do not. Pain patients without prior abuse problems most likely run little risk.

With this is in mind, and lungs agonizingly encased in concrete, my initial attitude to pain medicine after the pleurodesis was similar to James Brown's approach to funk: bring it to me.

Patient-controlled analgesia? Check. IV narcotics, check. Oral stuff for breakthroughs, check. I took what they gave me, and they gave me a lot because I was in really difficult pain and the hospital staff from attending physicians down believe strongly in keeping patients, especially cancer patients, comfortable.

This regimen, indeed, made me hurt a whole lot less. 

But it also melted reality. 

I talked little. I had few coherent thoughts. When I lifted a glass to my lips for a quick sip of water, I'd fall asleep mid-rise and wake when the cold water splashed all over. Instead of being "behind the pain" with the medicine, I was ahead of it – and it took a disconcertingly long time to back the drugs off and catch up. At one point, I was possessed with an overwhelming desire to sleep and a sense, possibly accurate, that if I let my head drift down the six inches or so to my pillow and stopped straining to keep my eyes open, I would awaken surrounded by a resuscitation team. It was a creepy sensation, feeling like I had to stay awake to stay alive.

So, yeah, we'll call this episode a pain management failure. I ended up alive, straight, and with a budding pneumonia in one of my lungs; courtesy, probably, of aspirating a little food or water into the lung during one of my junkie nods. Annoyingly, a few of the staff were a little punitive about the whole thing, a little finger-waggy.  Our reaction was, "Hey, we weren't begging for this stuff. You urged us to manage the pain." But despite the shocking news that taking a lot of narcotics in a short period of time has a downside, my experience and reading tell me that almost everything about medical culture in the US is still geared to undertreat pain rather than take it too seriously, and that making the hurting stop (or, more realistically, slow down) has few practical downsides. So take the meds, tough guy or gal, just silence your inner James Brown.

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