And Now Something Completely Different

Depending on the time of day it is that I happen to have written what it is you're reading, it may seem more or less coherent than other times of the day. I think I'm fairly lucid at the moment, but that's the tricky part about very powerful opiates - of all the people in a given conversation, I'm the person least likely to able to recognize if I'm making sense.  I feel pretty good that what I'm thinking is sensible. That doesn't seem to resolve the issue of whether I am in fact making good sense, or not.  So, I wanted to write while I'm feeling fairly lucid and my ability to recognize my keyboard by touch seems to be fairly unmolested. (I'm not getting a bunch of green and red squiggly lines underneath what I'm typing right now).

For the sake of completeness,  I have in my system right now some paracetamol, hydrocodone and oxycontin.  I take the oxycontin twice a day because it's time-released. At lunch (well, lunchtime since food isn't on my menu for obvious reasons) today, I took 60 miligrams, which I will repeat at about midnight, unless I seem to feel less ouchy, in which case I'll take 40. If that holds, I'll stay on that dose for a couple of days, or titrate up and or down as feels better for me. My doctor has allowed for me to take up to 80 at a time. If that fails to trivialize the pain along with the hydrocodone, I have morphine available to take if I want (and have used it some, particularly the first day, less so the following days. I've resisted taking any of it since I've been up today - a good sign which I hope persists).  I took 15 milligrams of hydrocodone about an hour and a half ago.

Plus, there are after effects of some of the shit they gave me while banging around inside my body. I understand that memory loss is not an uncommon consequence of this type of sedation.  I also understand that memory and cognitive problems are commonly attendant to taking the types of pain medication that I'm on now. I don't know if this is true since I can't remember things I've forgotten, and my current ability to properly order events in my mind is, well, less than ideal.


Valium. I don't like it one bit. Not at all. It makes me dizzy and ditzy and amused of things in a way I find otherwise personally uncomfortable.  Yet even while I'm finding something completely amusing and realizing that it's absolutely stupid, I can't stop myself being amused by it. This is disagreeable to me on so many levels, but I think could be a very useful strategy in marketing.  Fuck piping in the smell of popcorn into a theater section. Or oversalting bar nuts to increase one's thirst.  Just have a valium salt-lick in any theater, and even the most horribly written, boring movie will become a blockbuster if my experience with valium at all generalizes.

Hydrocodone.  I've taken a lot of this in my life, and it's not really a big deal. It makes me sleep somewhat more soundly (which I don't know if that's because of taking the edge off of the pain for which I'm taking it, or if it's just a property that mid-grade opiates have on my system. Perhaps I should squirrel a few away and test this when I have no pain going on to see if it just puts me on my ass without being related to the stress that being in pain brings.)  Otherwise, I don't mind it much after a day or two when the itching on my face stops. This is clunky since you wait until pain is starting to come up to scratch, and then react. Its benefit is that it's a low dose that lasts only a few hours so if the pain I'm in, say, now just naturally settles down in a few hours time, then my time being medicated beyond what is necessary is slighter than with longer lasting agents.  But since it's a surgical thing I had done, this just seems ungainly, and I wind up taking these more often than I probably absolutely need to because I know once it wears off, the pain is going to spike again.

Some better system than this is easily devised, but many doctors seem to have a hesitance to appropriately dose patients to control the actual pain their patients are in instead of the amount of pain a doctor decides for their patients they should be asked to bear for no good reason.  As a result, I am fairly confident that many people prolong putting off preventive and elective procedures at an early stage for far less financial cost until they're at a level some asshole doctor decides is bad enough to adequately manage.  Then the person can get the thing taken care of and have their pain adequately managed. (When I say pain, I should really say something like symptoms - pain is one instantiation of discomfort; there are others. But I had surgery, so my big issue at the moment is actual pain the kind of which but for the drugs I'm on would be absolutely crippling to me.)


Morphine:  this makes me feel like I just can never take an adequate breath. And this causes me some panic from time to time because even though I know I'm in no danger of suffocating or stopping breathing at the low dosage I'm on, it feels like that and that sometimes scares me. I think it's also strong enough that I don't feel itchy when I take it.  No clue why that is though - that's just my guess.

Oxycontin: I can understand why people would turn to this as a recreational drug addiction worth the cultivating. It's insidiously pleasant to take. I know it's just a time released version of oxycodone, equivalent, in my current dosing scheme, to taking a standard percocet tablet once an hour, but without limiting factor of Tylenol toxicity in my liver. It does a good job at normalizing the level of pain I feel without the clunky mechanics of having to take individual tablets on a busier harmonic scale to achieve the same result. The overlap period in its dosing is twice a day instead of once every couple of hours results in less stress for me by equalizing the level of pain in a way that's not ad hoc like taking the vicodin is.  The pitfall here is that it's a long-acting agent and isn't amenable to addressing the so-called "break-through" pain (see my write up on vicodin for that).

The euphoric effect these give me doesn't last long. After about two days of being on opiates, I don't really feel that anymore.  However, the downside is that also after a couple of days, they no longer work as well at alleviating the pain I'm in. I develop a tolerance to drugs fairly quickly, and it originally takes a fair bit beyond a standard dose to actually achieve the desired, therapeutic result.

But doctors and surgeons tend to think they know better than patients know how a given patient will react (or fail to react) to a given treatment protocol. 3 milligrams of vicodin might work well for one patient while 7 milligrams may not work much at all for another. Splitting the difference and giving them all 5 is no way to address individual patient issues while working within the confines of drug protocols writ large for economic reasons. That is to say, it's much easier for each tablet to be made assembly-line style, than to create a whole slew of formulations to be handed out on an individualized basis. So, if you need 7 milligrams of something to treat something I only need 3 milligrams to treat, doctors should do the math on that and write a prescription sufficient to account for the total needed, and then instruct patients how to cut pills to take a full tablet plus a partial other tablet for the necessary dosing to take place. Or, if you only need a third or of the pill, how to cut that and then take what's necessary.

Saying, well, your pain just has to deal with the limits I'm willing to treat by under-medicating you the whole time for the fact that others are responding great to this scheme is the sign of a doctor who cares not about patient care and actually reducing a patient's difficulty. That's a doctor who's more concerned about his ability to cash a check. Find a new doctor who will listen to you and work with you to adequately treat the symptoms you actually are experiencing.

Further, it is no argument of any kind that people who are legitimately suffering pain should have to suffer because some people abuse prescription medication.  That some people will go out commit credit card fraud is not an argument that people who will not should be nevertheless not be able to use a debit card. We recognize this; why is it different when we're dealing with actual human suffering?

Fortunately, I have it within my means to pick what doctors I want. Other than skill and personality (this is a big factor for me in picking a doctor. After all, I do pay considerable sums of money to my doctors for their expertise, and if I'm spending that kind of money, at the very least I'd like not to be treated as an inconvenience, or as something the doctor must just endure as necessary to cash the very large checks their time forces me to write), and the quality of their work as well as how willing they are to manage my concerns both in the office and after I leave.

These are not only factors on a personal level, these are also legal requirements imposed on doctors. It is against the law for a physician to fail to adequately manage his/her patient's signs and symptoms on any basis other than medically indicated propriety.

As an example of how little many doctors care of the actual discomfort/pain/fear/nervousness their patients experience, I had to have an emergency root canal some years ago. Just one of those freaky things where I got hit in the just right way that one of my teeth split right down the middle. It hurt, quite a bit. So, instead of going all the way up from south Tacoma to Seattle where my then dentist's office was, I convenience shopped for a dentist.

That is to say that there was a dental office on the same block, so my bloody mouth and I walked over and had a root canal done right then and there. During the procedure, the dentist in question anesthetized one half of my gum (the outer, not the inner side where the roof of the mouth is), which he begrudgingly, finally did after I stopped the procedure to let him know I could feel the whole fucking thing. He said that I shouldn't be able to (which I agreed - I shouldn't have to sit through a root canal with insufficient analgesia, and that is indeed a professional ethics violation for a physician to do, as well as a cause to lose one's license for malpractice, and can potentially result in criminal prosecution as a bonus). Finally, he anesthetized the whole area (which I could still feel, but within a manageable range of discomfort).

Afterwards, he wrote me a prescription for Tylenol and Motrin.  Neither of these requires a prescription to get, and I was certainly unimpressed with being "prescribed" something I had lying around the house.

So, I paid him the over $4,000.00 bill he was due for services (poorly)rendered. On the spot. In full. And then I went straight to my regular dentist's office for a.) pain killers and b.) to take the imprint for the crown and to have the crown work done.

This other hack dentist is no longer practicing in my state having lost his license for malpractice.  I am simply not a patient who tolerates ineptitude or the shirking of one's legal, ethical responsibilities. If you have some trepidation about fully treating a patient's condition to include not only managing the physical signs but as well as their symptoms (how they are experiencing it all in the first person context - if a patient tells you they're hurting while you're cutting into them, take their word for it. Don't decide on their behalf you know better than they know what they're feeling, which is, incidentally, in my state a professional obligation of all physicians, as well as being a criminal statute for inadequately managing the condition), then do not go into that field.  Study something else where your work doesn't harm people.

Plus, I have the resources, patience and determination to see things through until their resolution. A lot of the cases about this do not get successfully resolved because the people filing the complaint fail to see the complaints through. You just don't file a complaint and consider the work done. Complaints generate investigations. Investigations open up lines of questions. If you don't continually force those questions to be asked and then answered (including the questions that will be asked of you), then you've done no work at all.  Like when I was a police officer, I showed up to every hearing at whatever relevant state agency that took place and might have even required my presence (sometimes my state allows this "showing up" to be handled over the phone, like with adminstrative hearings through the Department of Licensing for DUI hearings) to make sure that the facts are represented all the way through, in service of fleshing out a.) the objectively true issue, and b.) how to address those with compassion towards particular people who happen to have made a significant error. The process has several ends, one of which is justice. A part of that is mercy while still punishing someone for their misdeeds.

You better believe that the same is going to be equally true if I'm actually personally injured or made to suffer by the actions (or lack of actions required of someone by virtue of professional ethics and/or legal duty imposed on their profession) taken by another.

And no. I don't take settlements from insurance companies. I didn't initiate action against the good doctor to get a settlement. I took action because if he's going to do that to me even when I can out of pocket cover the full expense of the medical procedure and treatment, then people who are ill-able to handle that kind of expenditure are most probably being treated at least that poorly. People who are by definition without redress attendant to financial security and ability to hire a lawyer to represent them through the whole of the process.

Not having to shop around for an attorney on a contingency basis which determines what, if anything, they'll be paid out of the likely best possible court award a case like mine would get (and let's be frank, failing to manage one person's pain after a root canal is fairly low level malpractice compared against wrongful death cases where the verdict is less than the cost of litigation or surgical procedure bill) isn't an incentive to attorneys to take up those cases. So, it's kind of in the hands of people who can afford to piss away that kind of money on the exclusive grounds to grind an axe. People who can't afford that, aren't going to be a serious concern for a doctor who knows that through sheer disparity in financial privilege, he's going to remain largely immune from having to consider the poor person on public assistance much more than just a passing nuisance.


Well, this one certainly ended in a direction I didn't aim to make it.  I guess I'm not in fact as lucid as I feel that I am.  Fortunately, I recognize the difference between feeling something is true and knowing if something is true; they aren't the same thing.