Friday, March 17, 2017

Pain, drugs, halucinations, and other facts of life at Harborview's trauma center

I am not an addictive personality, . . . haven't gone through periods of being obsessed by certain foods, music, or people.  From my teenage years through college, I drank socially, occasionally to excess, but never got hooked.  I smoked socially as well when out with friends, and never got hooked.  Thankfully, I hadn't been exposed to lots of heavy-duty medicines throughout my life.  Pretty much just over-the-counter pain meds (Tylenol, Ibuprofen, Asperin) for head-aches and muscle& joint pain.

Then this accident happened.  While at Harborview intensive care and going through numorous surgeries I was medicated intravenously with several strong & potentially addictive pain meds.  Finding the correct dosage seemed to be mostly trial and error.  The nurses and doctors would frequently ask "what is your pain level right now 1 to 10?"  and very soon it became apparent that my pain-level rating was different than most, in that most everyone else reported higher levels than me. 
I had to explain to the nurses & doctors that a “10” for me was so severe that I would use a weapon to end it.  A “9” was excruciating pain with uncontrollable writhing and being strongly tempted to use a weapon.   An “8” was extremely uncomfortable but with an ability to control physical movement, but likely with groaning/grunting/whining.  A “7” was very uncomfortable with control of both physical movement and utterances.  A “6” was uncomfortable and still very much needing pain management.  A “5” was uncomfortable with a preference for using some pain management.  A “4” was annoying and distracting but able to manage without pain management.  A “3” was distracting but manageable without pain management.  A “2” was noticeable.  And a “1” was virtually no pain.

Bottom line is that most people’s “8” is my “5” and so the nurses and doctors tended to under-prescribe pain meds for me.  The good news is I can count on one hand the number of times I was at an “8” (extremely uncomfortable but able to prevent writhing, but with groaning), but the bad news was I found myself in the “6” to “7” range too often.  There were only a couple of instances where I was over dosed on pain meds and had wild dreams and hallucinations.

Getting the right level of meds was often challenging.  Quickly you understand the hourly cycle time for each pain medication and you ensure the nurses are timely in providing the meds.  Most of the time the nurses arrived timely, but because Harborview is a trauma center and my bed was in the burn section there were times when the nurses were busy with more important/urgent activities, and hitting the nurse call button didn’t always result in a visit.  More frustrating was when the call button would slide to a position that I couldn’t reach (recall I was in restricting casts up to my shoulders and was instructed not to attempt to roll or twist to prevent back damage), and I had to wait for someone to walk by the room or drop in to check up on me.  Calling out for help into the void seemed so pathetic!

Also, when the prescription wasn’t working, going through the routine of explaining my pain levels took time, and the nurse would then need to convey the information to the doctors so they could adjust the prescription, and sometimes the doctors would need to come and talk with me in person, going through the same routine as with the nurses before they would change the prescription.

Probably the most frustrating medication problem while at Harborview was when I was prescribed a self-administered pain medication that would be effective for a couple of hours.  Great you say, self-administration means no pain, right?  Yes, that’s true, . . . until bed time and then you get to choose between sleep and staying awake to press the button, because if you don’t hit the button on time then you wake up extremely uncomfortable. 

Gaining an audience with the right set of doctors and convincing them that I wasn’t exaggerating my pain in order to feed a nascent drug habit took a great deal of constant hounding of the nurses to ensure the doctors would show up, and then a high degree of persistence in stating my case.  Even then the doctors were extremely reluctant to adjust dosages, and as a result, while at Harborview I never slept through the night, choosing to stay awake to ensure the proper doses of pain meds occurred on time.

What does one do to stay awake in a trauma center hospital bed in the middle of the night?  My sister gifted me a small portable Sony MP3 player, but because of the state of my hands it was too small to hold and the buttons were too small to manipulate, and I couldn’t reach my ears to press in the ear buds in any case.  She also purchased a Samsung tablet for me but I couldn’t keep it balanced at the right angle to see the screen and the on-screen buttons were too difficult to manipulate.  Another sister gifted me an Amazon Echo device“Alexa,” but it was such a new concept and I didn’t have the emotional/psychological resolve to have someone open the box and help me figure out how to set it up and use it.  Finally, there was no way I could use a notebook PC keyboard because my arms were fixed in place with casts.  All that left me was TV late night movies, . . . really bad TV late night movies, . . . and for that to work I had to have the TV remote taped to one hand so that I could reach it and adjust the channel and volume with the other.  Miserable!

About the only thing that allowed me to remain reasonably lucid while at Harborview was taking naps during the day while Marijane & Marie visited (they could rouse me just long enough to hit the pain med button), and when nothing else was going on like the never-ending series of x-rays, doctor & nurse visits, and other interactions with hospital staff.
I'll share one "G" rated (and yet bazaar) hallucination.  Coming out of a particularly deep anesthetization after yet another surgery, I was unable to rouse myself more than being aware of a completely blank white state/place.  Nothing. Zip.  Eventually I found I could barely move within the space, and so I very gradually crawled along until I arrived at a corner/edge where boundaries converged.  Sigh.  Can't go forward, . . . don't want to go back, . . . so I tried harder to discern anything other than blank white.  Looking very carefully, I noticed a slight variance in the blank white space closest to where the boundaries converged.  Looking closer still, I discerned small movements.  At this microscopic level I saw incredibly tiny "things" manipulating space/time to create something other than blank white.  I sat their transfixed as these things very gradually created just the tiniest beginnings of a reality.  It became apparent that these tiny things manipulated space/time in order to create entire realities that we experience.  I realized that scads of these tiny things do nothing other than constantly adjust space/time to seamlessy "stream" our reality.  As I continued to watch and comprehend, I learned that these things "specialized" in their space/time manipulations, . . . a gazillion of them combining their efforts to create the reality of one of the door knobs where you live, . . . and only that.  It goes on, but you get the picture.
More on de-escalating pain meds and consequences there of another time.

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