Map of life expectancy at birth from Global Education Project.

Thursday, August 12, 2010

Sister Morphine

As promised, I'm going to try to organize this particular retelling around problems and issues, rather than chronology. So today's topic is analgesia. But you need a bit of chronology for context. There is a gap in my memory between the recovery room and my bed on the surgical ward. Whether I passed out, or they knocked me out again, or I just don't remember, I cannot say, but the next thing I knew I was in bed, unable to move my torso or my legs. I could not sit up or roll onto my side. There was an IV line in my arm. There was a tube going up one nostril and down my throat. It was connected to a machine that constantly sucked yellow brown fluid out of my stomach. Another piece of plastic tubing with two little nozzles blew oxygen into my nostrils. Another tube emerged from my penis, and it ran off to something on the floor. Wrapped around each of my calfs, from the ankle to the knee, was a long plastic cuff attached to a machine that inflated it every thirty seconds or so, squeezing and releasing unrelentingly.

As I wrote just a little bit later:

Thanks to morphine, I didn't care much about anything. My pain was still everywhere, now settling more and more into my throat and belly, but my body was scarcely my own. Let it be in pain, it was none of my concern. I would think for a moment that I cared about my drifting thoughts and dreams, but they would float away and leave no trace. Understand: this was not liberation from the illusion of self. It was exile in a solitude of polluted fog.

I could give myself an extra shot of morphine, as often as every ten minutes, by pushing a button pinned to my smock. I pushed it a lot. If I waited too long, the pain I always felt would start to matter. That was more than enough reason to wrap the fog around me. I very quickly got to dislike the morphine, however. It caused unbearable itching. It made me sweat. It made me stupid. It gave me weird, pointless, elusive dreams. They wanted to get me off of it too because a priority was to get my bowels working again and the morphine prevented that.

So, I asked them to stop it after a couple of days and I quickly felt a lot better. I am quite typical. The vast majority of people who receive morphine or other opioids for relief of acute pain simply stop taking it when they no longer need it. Whether I am typical in finding narcotics affirmatively unpleasant I don't know, but I'm certainly never tempted by them. I got a prescription for Vicodin after a tooth extraction a couple of years ago and all but two of them are still in my medicine cabinet. After minor surgery a few weeks ago, I got a prescription for 20 Tramadol and I never filled it.

But -- Prescription drug abuse is a large and growing problem. Lots of people get hooked on pharmaceutical opioids, and they are the most common path to heroin addiction for young people. (Heroin is actually much cheaper than diverted prescription narcotics, thanks to our heroic invasion of Afghanistan.)

This does pose a bit of a quandary. Opioid addiction is actually not nearly as harmful intrinsically as it is generally portrayed. That's why methadone maintenance works. Addicts suffer because a) they are continually going through incipient withdrawal; b) it is difficult and expensive for them to obtain the drugs so they end up devoting much of their time and effort to that single purpose, and often end up committing petty crimes to support their habit; c) if they inject, they are at risk of blood borne infections and other physical harm; and d) they are violating the law by possession and use and often wind up incarcerated and unemployable as a result. But otherwise, the worst actual physical side effect of habitual opioid use is constipation.

So yes, we could greatly ease this problem by decriminalization, expanded treatment and harm reduction approaches, but still, it's highly undesirable to create a lot of addicts. On the other hand, opioids are just the only thing that does the job when you're really hurting. Morphine is a double-edged sword that cuts both fair and foul. It's completely unacceptable to deprive people who need them of relief. But if they're around, they're going to get diverted and misused. There are technical fixes to reduce that risk, but it's always there. And, my own story aside, there are some people who receive prescription opioids for pain relief who do become addicted. That is the only point on which I will give Rush Limbaugh a break, except that he's a total hypocrite about it.

I was once addicted to nicotine and I may be a bit overfond of ETOH, but I don't have to worry about junk. I suspect that susceptibility has a lot to do with pain, of the psychic variety. Morphine isn't actually any fun, but it does make you indifferent to your pain. If you're desperate for escape, it's a way out.


robin andrea said...

Morphine seems to do the trick right away after surgery. It certainly took the edge off for Roger. I also watched my step-daughter decide she'd had enough, after she broke two vertebrae, and was on a morphine drip. The nightmares were definitely too much after a few days of morphine. I think we must be lucky, those of us who do not relish the "high" of these narcotics. What is ETOH?

Cervantes said...

ETOH is the way doctors abbreviate ethanol. I.e., hooch, booze, sauce.

roger said...

your experience sounds like mine, tubes, leg cuffs and all the rest. except that i could press the magic button every 6 minutes and didn't have itching or bad dreams. stupidity yes. i agree with your description of the effect of morphine.

i got the same contradictory stuff too. "take all you need for pain. but watch out for constipation."

downers are not at all interesting to me either (except ETOH). nor uppers.

C. Corax said...

A couple of us at work were talking recently about Vicodin. We agreed that we didn't like it at all--made us dizzy and nauseated. I used some of my prescription after surgery, but ended up dumping most of it. One pill screwed up my sleep pattern for several nights. Just awful stuff. I ended up just using acetaminophen for the rare times I needed pain relief.

Reading about your surgical adventure is like watching a head-on collision in slow motion. Not only is there the question of consent, but a friend of mine is a pathologist. She is occasionally on call. If someone is under the knife and the surgeon finds something that requires a biopsy, Diane will go in and do the pathology immediately and get back to the surgeon immediately--only when he has the path report back does the surgeon decide whether surgery is necessary.

robin andrea said...

Oh, ETOH! Like our wine with dinner. You should come by some time and have a glass of ETOH with us. A fine time is promised!

Cervantes said...

I was beat up far worse than you were Roger. The surgery was unplanned, I wasn't properly prepped, and they took out a bigger chunk among other reasons. I was in surgery for almost 7 hours.

And it was downhill from there . . .