Hospitals advocate the use of narcotics for pain management with an unconscious zeal, and very carefully refuse to look at the long-term consequences for patients and their families.
"We do not properly appreciate the absence of pain."
That is a quote from a book I read a long time ago, when I wasn't much older than my son is now. I rather blithely read over those words then, thinking how wise and pithy they were! I had no real context for the meaning in them, no idea of how deeply pain carves into body and soul, the channels, troughs, and runnels it leaves echoing hollowly behind. I really didn't know that coping with pain takes internal resources, and that chronic pain uses them up faster than almost anything. Nor did I know how to manage long-term pain, or even any idea that long-term pain could be managed.
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Age and experience go a long way in acquiring wisdom -- even if it's wisdom most of us would prefer never to have. I know a lot more about pain now than I did then, its grim shades and bitter flavors. The modern medical establishment thinks it owns the wisdom on pain management these days, though what they were giving my son for his pain during that hellish hospitalization reminded me more of tranquilization than it did real pain control.
My son was on morphine within ten days of entering the hospital, the repeated surgeries to drain MRSA from his knee and shin causing him almost constant pain. He had already gained a reputation among the nurses and doctors as a "whiner" and a "pain sissy" because he did not (and still does not) deal well with pain. From what I could tell, the morphine wasn't doing much to help him -- it seemed to make him simply not care whether he was in pain or not. I tried to teach him a few of the techniques I've learned over the years for managing long-term pain, but they require a level of concentration and focus that were simply not available to him due to morphine dosing. He went from regular injections of morphine to a "PCA" (pain control ??) pump, which in addition to dosing him with 2mg every hour, rewarded him each time he pushed a button with another milligram or two of morphine.
He could, and did, push that button about every ten minutes. I grew more and more horrified each time I witnessed it. My sole previous experience of morphine had been as a hospice caregiver for a very elderly lady whose body was simply giving out on her. She dosed herself with morphine regularly. The case workers said it couldn't possibly matter whether she got addicted or not, for she was obviously dying. This was not a good context to bring to my son's hospital bedside, and I mentioned it to one of the nurses.
"People using morphine for pain don't get addicted," he said curtly, shutting down the conversation as completely as if he'd walked away. So I then asked, "Is my son dying?"
At that time, very early on in the ordeal, no one could give me any comfortable answers for that.
I've since discovered that I used the wrong term for my concerns, and no one bothered to correct me. Instead of addiction, I should have asked about physical dependence. "Addiction" is defined in the medical community as a dysfunctional psychological and behavioral
syndrome, having little to nothing to do with the physical reality of what happens to the body. "Physical dependence," according to The World Health Organization's Cancer Pain Release Newsletter, is defined as "a normal and expected response to continuous opioid therapy." Normal, and expected....? It further goes on to say that "Physical dependence may occur within a few days of dosing with opioids, although it varies among patients. Physical dependence (indicated by withdrawal symptoms) does not mean that the patient is addicted."
Withdrawal symptoms included agitation, insomnia, diarrhea, sweating, and rapid heart beat. Not that I learned this from anyone inside that hospital, mind you -- I had to research it myself, late at night, in an attempt to arm myself with some kind of hope before I returned to my son and the medical staff the next day. The knowledge that this kind of insult was knowingly being added to the already extensive injuries my son had endured was just unconscionable. I'd already learned the futility of trying to introduce alternative or complementary therapies to most of the staff, even here in the "Alternative Medicine Capitol" of the US. Instead, I tried talking directly to my son while we were alone in his room.
I found that, by that time, I was talking to Morphine.
Perhaps they are right and there is no real danger of addiction while taking morphine for pain management, but the physical dependence is real, and I will still swear to this day that it possessed a kind of consciousness that overlaid my son's. Getting through to the real human was difficult; the excuses, rationalizations, and denial coming out of his mouth were simply not congruent with the young man he used to be. I've had some experience in navigating this kind of thing, whether it's called "addiction" or not. After another week of watching him tear into his own skin from the itching, I was able to convince him that at this time he really didn't know how much pain he had, or didn't have. The morphine itself masked his true physical state, and was inducing secondary symptoms that weren't helping. The itching was one, but more difficult was the fact that being drugged up on morphine allowed the doctors, nurses, and other health care professionals to abrogate my son's right to say "NO," or to refuse treatment until he had it better explained to him.
Not that any of them did this with malicious intent, mind you. It's just a consequence of the choice-sequence that's so natural no one even notices it, anymore. Patient is in pain, and difficult to manage. Drug patient with "pain-killers," in an attempt to eradicate pain -- and more importantly, make patient, much, much easier to manage. A patient on drugs is by definition "not in their right mind," so it's easy for a nurse or other therapist to convince himself that he understands the patient's best interest more than patient does, or can. A patient on opiates is more relaxed, less likely to object or get in the way of hospital procedure, easier to be convinced. A patient on opiates is, in fact, no longer a person in the eyes of the medical establishment -- no matter what they try to tell you to the contrary. Their words and actions don't match up, as was proved by the night nurse who, against his objections, jabbed a syringe of Atavan into the tube of IV saline dripping into his arm in an attempt to get him to "calm down."
He didn't react well to the Atavan. He was agitated, confused, and upset when he woke up. They wanted to give him more of it. I was there by then, thankfully. I tromped on it, and the nurse -- hard -- while continuing the process of talking my son down from the aftereffects of their legal narcotics, which took about an hour.
Any person entering a modern medical facility for any reason is best advised to arrange for friends and family to be by their bedside for as many hours in the day as possible, because once you are inside those bedrails, you have a snowball's chance in hell of having your objections heard.
Of course, the next discussion about pain management came when I wasn't there -- lots of these important discussions happened while there was no other responsible adult in the room to advocate for my son. You can imagine the horror I felt when I came in to visit a few days later to find that he'd been prescribed Oxycodone (OxyContin) for pain. This is very much like jumping out of the frying pan and into the fire. Every reference I found cautioned that oxycodone "may be habit forming." And I know well that withdrawal symptoms can occur afterward, for one of our friends almost died from being "stepped down" from it too abruptly. It is a federally controlled substance.
In my discussions with my son about this change, it quickly became evident that he wasn't fully informed about this new pain killer, nor its side effects, nor its potential to be "habit forming." What he had noticed, almost right away after our earlier talk about it, was that it did allow the staff to continue to ignore and talk over him when it suited them to do so.
I could go on and on about this, for it went on and on, even after he was transferred to that specialized clinic in San Francisco, even after he returned to this local hospital after the MRSA recurrence. They push those pain meds as a type of "pain management," with an unconscious zeal, and very carefully refuse to look at the long-term consequences for patients and their families.
From all this, I have concluded that the modern medical cabal's solution to any problem is to add another medication. Oh, any individual hospital professional can be enormously sympathetic to your wishes and needs if they differ from established medical procedure, but as a collective? They don't want to talk about whether you've taken much of this kind of thing in your life. They don't want to hear that you'd like to explore alternatives. They don't like it when their patients (or their families) make waves. They'd really rather you just cooperate with them -- and, sad as it is to say, it is entirely possible they will drug you against your will to make that happen.
The stars, angels, and heroes we encountered during this ordeal are going to get their turn too, for they did exist and they deserve to be held up to their peers as examples of what true, caring medical professionals can be. I only wish there had been more of them.
The fourth in an ongoing series of attempts for the author to make sense of the expensive, inefficient, and nightmarish health care system, and her family's experiences while trapped in it.
(Crossposted from Metaphors For Life -- and Living)