Briefly, On The Universal Sucktitude of Painkillers
English: Petty Officer 2nd Class Jesse B. Awalt, Public domain, via Wikimedia Commons
There’s this thing that happens right before the morphine hits — or maybe as it hits, it’s hard to tell, sort of all runs together. But in that space of time between the nurse pushing down the plunger to send however many milligrams of medical grade dope intravenously coursing through one’s system there is a clarifying moment. Brightly contrasted between rational, cognitive thought and the wave that announces you are now higher than a bad haircut on a giraffe. You know what is about to happen, that it is happening, and that it happened, all in some immeasurable amount of time that seems like nothing and forever both. Painkillers…what a stupid term for medically trying to trick your brain into thinking something that is not is so.
I utterly hate and loathe that feeling.
It scares the hell out of me. I don’t like my mind not clear. The more time I spend in the hospital, and the times my providers usually strongarm and insist on me taking the pain meds I religiously avoid at all costs, the more my hatred grows. It has reached the point that during a procedure when I need to be put under the medsurge team has written doctor’s orders that they have to expressly tell me when they start pushing the Propofol to knock me out so I don’t get twisted in my own mind. It wasn’t for no reason when on the ventilator and they couldn’t bring me “back up” for some time I was restrained, and fortunately I don’t remember why though I can read the vivid notes in the medical file as to what I was like. Mindlessly lashing out, violent, untethered from any thought or emotion or response other than the most primal to MAKE IT STOP.
Dope it until it behaves is some shoddy ethics and questionable medicine, but it is what it is. Civilian hospitals you almost have to fight to get pain meds. At Veteran Affairs, its the opposite and you have to fight them from giving you morphine for every little thing. I almost busted out laughing last time, the nurse just rolls in, asks your pain level, and then a blunt “you want morphine?” as if you were adding a large fries to your nuggz order at Mickey Ds. You’re not really healing anything of course, but the patient sure does lay in the bed better and take suggestions without so much backtalk. Not that we are accusing anyone of anything of course…”pain management” is science, you see, and we must believe the science. We’ve all learned that, right?
My primary care provider calls me his outlier. How I never want painkillers, regardless how bad the pain gets. This latest visit he didn’t even ask, just reading down his list he muttered “Nothing I can give you that won’t knock you out, and you won’t take it, so anyway…” before moving along to the sad state of my medical affairs, making sure the follow-up in 8-12 weeks is in order. Making a six-month with him as form demands while knowing he’ll see me well before that, especially if things go as badly in two months as we think they will. He mostly just shakes his head and mutters to himself, 5 years of treating me doing all the work for him. Out of options. Limited effectiveness. More harm than good. Medical necessity. Terms. Nomenclature. Numbness. Routine. Lather. Rinse. Repeat.
Leaving him, it’s off to the lab for more bloodwork. The tech earns her pay. The splotchy bruise on my right arm is still there from the blown IV a week earlier. You can clearly see the red dot where the 20 gauge IV had been in my right hand. She finally uses a butterfly to get a blood draw out of my left hand. My arms are too shot up to get anything anywhere else. If a cop stopped me and accused me of being an addict, I’d be in trouble proving him wrong, which would be a hell of an irony since I hate painkillers, and hate the very feeling those poor souls are chasing. Rather makes me wonder who has the worse mindset, them or me. It’s not like I don’t have the addictive personality, and my own demons with alcohol that, while managed, 12-stepped, and white knuckled for the last 18 years, always looms just past the right now to ruin everything again. Another reason I hate pain killers. Too close to the old ways, too close to losing control, too close to life as I know it gone in an instant, of all the hard work, toil, suffering, to be for naught.
The snap noise grabs my attention. Those new butterfly needles are spring loaded, hardly feel them pull back out of the skin on the back of my left hand. I hold the gauze for her while she wraps it up, the four vials of blood she took tagged, bagged, and ready to be processed. More science in action, an assembly line of modern medical marvels, all to tell us stuff we mostly already know.
I lurch and grunt and move myself out and about and leave, for today anyway, having done enough doctoring for the moment. The COVID checker person at the door looks up from Candy Crush long enough to notice me limping past her.
“You should really have them give you something for that, sir.”
They already are, lady. That’s the problem…
I’ve had morphine twice. Right after my motorcycle wreck, when I had two shattered arms and a destroyed knee. And again after I tore my ACL in the bad knee. I was thankful for them after the accident (although I stopped when they told me to), I tolerated them for precisely as long as I needed to after the ACL (wound up with maybe a third of the bottle left after I stopped taking them).
I’d rather deal with the pain than the feeling of being on opioids.Report
Ditto. I got a morphine drip at 18 when I broke my back. They weened me down to Percocet when I left the hospital. I gained significant respect for drug addicts with those tow and the detox process.Report
I got off lucky when I had pleurisy the summer I was 16. They only gave me three days of whichever opioid it was, to use while a bazillion units of penicillin did its thing. (“On the fourth day you’re addicted,” said the doc.) The first scary thing was losing big chunks of those three days. The second and scarier in hindsight was that it still hurt like hell to breath, but I just didn’t care.
Luckier still to have gotten through the ensuing half-century without need for that kind of pain killer again.Report
After the accident, I gained respect for the addicts, because when you are in that much pain, the bliss of morphine…
But once the pain began to come down, it was less bliss and much more… I guess frustration is the best word. I was severely frustrated at the way morphine interfered with my ability to think. I could think through pain, especially if I could take the edge off of it. I could never think through an opioid fugue.Report
A friend of mine was going in for knee surgery. The doctor told him that he’d have to be on painkillers afterwards, and my friend said embarrassedly that he’d been on Percocet before and that seemed to work (he didn’t want to come off as asking for it). The doctor laughed at him and said, “Percocet won’t be nearly strong enough. We’ll put you on Percocet to carry you through between dosages of what you’ll be taking.”Report
It’s truth. The first few days after knee surgery… I can’t begin to describe it. It’s sharp, it’s dull, it’s aching, it’s under pressure, it burns – all at once, all the time. It was 5 days post-op before I stopped needing the morphine to sleep, and maybe 10 days before I could stop the Oxy and switch to OTC meds.Report
My somewhat younger sister has had both knees replaced, both shoulders, and one ankle rebuilt by rearranging existing parts. When she wants to make me feel bad, she accuses me of hogging all the good cartilage genes. I have no idea how she’s avoided being addicted to pain meds.Report
She doesn’t have the right kind/amount of receptors?Report
I read this as the knees, shoulders, and ankle all being rebuilt by rearranging existing parts. Like, an ACL being hooked up to the left shoulder, a kneecap in the ankle, et cetera. The computer spit out the patient’s name but all of the procedures scheduled for the day.Report
They gave me it when my gallbladder went bad. That’s how I knew it was serious.Report
I’d rather deal with the pain than the feeling of being on opioids.
Quoted for truth!Report
Something I wonder is whether there’s something genetic about opioid reception, like it’s the whole “wait, bananas aren’t supposed to be spicy?” thing but for drugs. Because I’ve heard plenty of people say “you know, I took one Vicodin and it did nothing except stop me crapping for the next fifty-four hours”, but there also seem to be plenty of people who gobble the things down like Skittles.Report
Or maybe the amount of receptors in the brain? I mean, for me morphine worked as advertised, as long as the pain was above my threshold. Once the pain dropped below my threshold, it just pissed me off. Same with the Oxy drugs, a tiny bit to take the edge off was fine, but once it started to make me foggy, it just made me frustrated and angry.
Whenever I torque my knee these days, I just start alternating Tylenol & Motrin every 2 hours and that’s usually enough to make things manageable. And this is not some kind of tough-guy humble brag, if there was a painkiller that didn’t piss me off, I’d be happy to use it (knee pain is no joke).Report
A casual search of Google Scholar suggests the medical research has concluded that yes, there’s a fairly wide range of reactions to different opioids, and yes there’s a genetic component to it, sufficient that they’re starting to talk about genetic screening to set dosage and such.
When the doc and I decided that it was time for me to take something to make my blood pressure more stable, I recall her saying that there were so many BP drugs because for any given molecule, a noticeable percentage of the population didn’t respond, or was allergic to it.Report
My opinion on painkillers changed. Let’s see, when was that…before my kidney stone? Maybe sometime after it? No, I remember, it was during my kidney stone. Incomprehensible pain that lasts less than 8 hours: that’s the wheelhouse for opium. I was still in pain after it wore off, but I didn’t want to take another pill. I think DensityDuck is right about different people’s reactions. I wasn’t high, but it felt very unpleasant. Addiction can sneak up on you in two ways though: how good you feel when you take it and how bad you feel when you don’t.
Andrew, I didn’t realize how rough things have been for you. Prayers your way.Report
I’m sorry you’ve had so much trouble Andrew, all my sympathies. If it is any help the post was so viscerally written I winced along with you through every paragraph.
As for painkillers? I have rarely been in a circumstance where I needed them but I have experienced it in dentistry. The numbing cold sensation is horrible and I dislike it but one time they didn’t numb me up and the pain popped through to say “hello”. Pain, of course, is on the other side of that horrible painkiller wall. I generally understand their value.Report