Pain Management.

There’s time where life imitates art, and there is time where it absolutely does not. Tuesday, 11 February was the latter.

Once again I parked the trusty Corolla in front of the entrance of the hospital where I’d go in and have another procedure done, but this time escorted by my fresh-off-the-plane mother instead of Rena.

I already knew that shows like ER and Grey’s Anatomy took tremendous liberties with hospital life and the medical profession, but they still do a tremendous amount to provide a framework to what you think something is going to look and feel like, and how your doctors or other medical staff behave. I still couldn’t help myself in believing medical doctors are our best and brightest, empathetic, and exercise excellent judgement- that’s my fault and I own that. However, when you have those, “ah fuck these guys are human too” it can be a little jarring. After all, up to this point I’d had world class care from my team of doctors.

Interventional Radiation (IR) is the department at the hospital that is largely responsible for implanting medical devices into people’s bodies. It earns this name because they perform their procedures under live radiation imaging. I checked in at the window and was brought back by the IR nurse who looked like one of my old NCOs from my PL days at Fort Bliss. That NCO was not particularly intelligent so my anxious subconscious assigned those traits to this nurse. Fortunately, later he proved to be a highly competent professional, as I also perceived the entire IR department until I got into recovery.

I was sat down and told to take my shirt off and put on a gown, but that I could keep all my other clothing, even my shoes, on the entire time. I put the gown on but thought better of the shoes, as I wasn’t going to put my feet into coffins for my entire 24-36 hour stay. Remember that I am wearing a gown: this will be important later.

A nurse came in and pulled out an ultrasound and began talking to another nurse, “Yeah I want the 20 instead of the 22.”

The double edged sword of spending some time in medical settings is that you learn things that you’re better served not knowing. I know, for instance, that those numbers meant needle gauge given she was running an ultrasound on my arm to find the biggest vein she could for my IV. I also know that the smaller the number, the bigger the needle. I felt the difference, and it wasn’t pleasant.

I met with the IR resident doctor, who went over the procedure and what to expect after, and then waited to be brought into their operating room. I once again reminded my mom what the code to the safe was and where to find the spare keys if she couldn’t get it to work, and the same instructions that I gave to her prior to my biopsy. I wasn’t getting put fully under for this, but they were gonna goof around near my heart and that was enough to give her that information again.

After being wheeled back I was fully awake and alert for their prep, but as they began to administer their local anesthetic and the sedatives in my IV, I began to drift in and out of consciousness. I remember there were times that the drugs being administered caused my breathing to slow tremendously, and I know this because one of my few memories of it all was being told to breathe by the nurse several times.

I began my slow ascent to full consciousness in the recovery room. Immediately, I hated everything about what was happening to me. The pain was unbearable. I felt like my abs were being stabbed from the inside and underneath my ribs. I was sore, thirsty, hungry, tired, and restless all at the same time.

See, I wasn’t allowed to eat after midnight, or drink any clear liquids after 0500 for the 0700 report time and 0800 surgery. They also said they would not be feeding me for 24 hours after the procedure. Fun times ahead, folks, stay tuned.

Writhing in pain is something the IR staff did not anticipate. As I found out later, many of these doctors do not see young, healthy, in-shape 38 year olds get feeding tubes often enough for them to accurately predict what will happen when they do and thus, were caught off guard by what happened.

I was told by the lead IR doctor that people in my demographic typically have it “harder” when getting a feeding tube because our nerve endings are all woven into our abdominal muscles. If you don’t have particularly strong abdominal structures (read: fat) your nerves typically don’t get as pissed off as mine did.  My nerves were absolutely letting me have it.

Another fun fact about me? I’m resistant to narcotics, as in, anything less than fentanyl my body casts aside as it would a placebo. They gave me short-acting pain killers to my IV to try and solve the immediate pain problem but their longer term answer was Oxy. This was a bad idea for two reasons: One, they gave it orally to someone who had an empty stomach (that recently had a hole punched in it), and two, they were fully warned, by me, that I have a high tolerance for narcotics. It was not effective. Wow, who could have possibly predicted that?  Oh, wait, I did. Yeah. Me. I predicted that. Strike one.

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The Red Pill.

The pain didn’t subside much despite their stunted efforts at it. It would ebb and flow from within me the second one of the short-acting pain killers subsided. They were powerless to give me another dose of fentanyl because of what it did to my breathing, so they had no real choice but get my pain under control just long enough to wheel me up to Internal Medicine.

Internal Medicine is a bit like the hostel of the hospital. Rooms with four beds a piece with people under observation from other departments, or overflow recovery. Internal doctors are basically general practitioners whose job it is to keep the lights on and the patients alive on this floor of the hospital until they are discharged or collected by another section of the hospital.

My bed was wheeled up, and I still wearing my gown and a couple warm blankets over me, to my spot in the room. Four large men struggled to slide me from one bed to another, with each jolt and jerk shooting massive pain through my abdominal region. They didn’t think put a blanket or any kind of sling otherneath me, despite these options being readily available as later found out, and they actually insisted I help them fumble-fuck their way through transfering me into my new bed. The gown impeded the process every step of the way as it bound around me with every movement. I was in pure pain. Strike two.

The 2LT nurse looked at me with concern after being largely responsible for this disaster and its consequences; at least he felt bad. He managed to inject some high-power Tylenol to slow down my pain, but only bought us time to figure this out. They administered another dose of oxy and friends by mouth on my still-empty stomach, perhaps in hopes that I’d miraculously lower my narcotics tolerance. I did not.

The shooting pains from under my ribs did manage, on their own, become less and less and settle into a dullness. It was around this time that LTC Sierra and her deputy MAJ Flood came by to see me at my request to talk about what just happened, and to examine the lump. I was complaining that the pressure it was exerting on my jaw was becoming more noticeable instead of latent or only present when turning my head to the right. They speculated my second lymph node was likely growing in size but that I shouldn’t be concerned. We talked over referrals, more questions of treatment, and they went on their way. I was in a better mood after they left- I’m always glad to see them now.

Remember the famous scene from the Matrix where Neo can take the blue pill and return to being oblivious in the Matrix, or he can take the red pill and “wake up”? The rest of this stay was going to rip off whatever illusion I had left that hospital staff had it together more than the rest of us. I guess they snuck the red pill in with the rest of them.

My pain was a concern for a secondary reason to the doctors and staff: I had to have an MRI later that evening to examine the mass the PET scan caught in my liver. They began to scheme ways to make me as comfortable as possible prior to going down for the MRI.  The answer they came up with was only slightly more inspiring as the sun disappeared and the MRI appointment approached: more oral meds and an injection into my IV port (I’d been without an actual IV line since morning) to keep my body calm just long enough to complete the MRI. Strike three. The last scraps of “this person is a highly trained professional and has surely thought through all of this” was discarded as soon as I arrived at the MRI suite.

The views and opinions presented herein are those of the author and do not necessarily represent the views of the Department of Defense or the U.S. Army.