Under the Influence

At the end of medical school I still viewed benzodiazepines and opiates as miracle medications that we are lucky to have access to. Midazolam allows people to relax before and during a procedure with no memory of the events.  Morphine and its family members take acute pain away after surgery or while healing from a fracture.  And both benzodiazepines and opiates have had tremendous impact in improving comfort in end of life care.

Three short years of residency training later when I read Vicodin, or Ativan, or Percocet, or worse yet MSContin, on a patient's medication list, I shudder.  I scan the patient's problem list, hoping to see  'fracture,' 'metastatic cancer,' or 'recent surgery' but that only happens 1 out of 100 patients that I see.  Instead, like so many other patients, this next patient has 'chronic pain syndrome.'  The commonly used western medicine diagnosis that explains the use of opiate medication for the long term.

I brace myself before I enter the examining room reviewing the scenarios:  is the woman actually taking the medications or selling them? I have been fooled several times.  If she is taking the medication, is she fully informed about the risks (messes up hormone levels, causes depression, can't drive safely, efficacy wanes overtime as our body gains tolerance)?  Has she tried other things to live with her pain with fewer side effects (acupuncture, meditation, writing, gentle yoga, swimming)?  Where is her pain?  Often time the answer is 'all over.' I remind myself that Dr. Flinders wisely responds "unfortunately these medicines don't help with psychic pain" in such a situation.  I consider the threats I may confront before I enter the exam room with a patient.  "Well, doc, if you don't give me more (fill in the blank benzo or opiate) I will just have to go back to drinking alcohol. I don't want to go back to the booze but I will if I have too."  This happened to me more times than I can count during my residency training.

Now I look at the orange plastic pill bottles with childproof white lids lined up on my dresser. Ibuprofen, Bactrim, Ondasetron.  These words do not bring back distressful patient stories.  The remaining two, oxycodone/acetaminophen (Percocet) or lorazepam (Ativan), brought back the proceeding paragraphs.  Now after having those bottles in my possession for 2 days, those two bottles stare back at me almost as a friendly joke.  My full name in bold printed on each. Several pills already missing from the total count.  I think how much I enjoyed each pill, what comfort it afforded me.  Two more hours of sleep with tolerable pain, a slow walk around the block with David with both dogs to get some fresh air.  Less muscle spasm so I could dress myself more easily.  All the misuse associated with those medications, the deep sorrow my patients carried, my involvement in propagating their use with grave misgivings.  All that darkness slid away.  And again I was thankful.

Nitty Gritty:

1. I am home from the hospital and doing well.

2. I took two short walks today.  Slow walks while David wrangled Luna and Olive himself.

3. I am very sore but it is manageable.

4. I am not nauseous!

5. I have two drains coming out of my arm pit. They will be in for awhile.

6. My surgeon removed two sentinel lymph nodes.  Neither showed cancer during the quick testing they can do during the surgery.  Final results will be ready in about two weeks along with the rest of the tumor results that will help determine what further treatment I need.

7. Friends are taking turns making delicious dinners for my parents, David and I. 

8.  A hummingbird flew into the dining room during dinner tonight.  It left some tiny,tiny feathers then flew back out the door.