Pain management and puddings

/

I suspect that for most people, the first couple of days of hospital recovery are largely a blur. You’re doped up and constantly interrupted for one thing or another—let’s take your vital signs, let’s go for a walk around the ward, let’s change your sheets, let’s suggest that you suck in some deep breaths because your blood oxygen level has dipped below 90 and sets off an alarm when you’re trying to sleep, and, most frequently, let’s talk about your pain level.

I haven’t been hospitalized for well over a decade and the last time I was, there were no white boards that listed the day’s cast and crew—doctor, nurse, floating nurse, night nurse. That’s changed. In addition to the list of personnel responsible for your care, there’s a space for daily goals. For the six days I was hospitalized, goal number one was “pain management.”

Highly curable though this cancer may be, scooping out half your tongue base and rummaging around the inside of your neck is going to, at the very least, sting. Prior to having surgery you’re told that you will experience a sore throat for the two weeks following the procedure. Having gone through several rounds of strep throat, various viruses, and a tonsillectomy in my 20s, I felt I knew what was in store.

I was misinformed. Deliberately, I suspect.

Because it’s not until after you’ve had the surgery that you get the full story, courtesy of your very own nociceptors. Describing the pain as a “sore throat” is like suggesting that a Category 5 hurricane produces a bracing breeze. Thankfully, similar to women who’ve gone through labor, I’ve mostly blocked out the discomfort I felt. Looking back at email contemporary to the time, I characterized that pain as someone setting off a staple gun in my throat with each swallow.

In the past several years we’ve heard a lot about the horrors of narcotic addiction, particularly addiction to oxycontin. To help address the problem, the medical establishment has reversed course and no longer loosely flings this stuff about. But, as far as I can tell, it remains the go-to pain medication when you’re suffering the Big Hurt. 

But here’s the thing:

It’s not for everyone.

Specifically, me. 

Experience from a past big surgery taught me that my body isn’t particularly responsive to opioids. Oh sure, as with so many other people, they make me sick and constipated, but pain relief, not so much. While this is a great data point for those fleeting moments when I consider a career in heroin addiction, it’s something that can be difficult to communicate to medical professionals. There are people who really, really like narcotics. And if they can move from Brand X to The Good Stuff, they will make efforts to do so by suggesting that what they’re on isn’t really doing the trick.

This is a valid concern for healthcare providers. Narcotics are dangerous things and addiction is no picnic. Plus, again, medical professionals are rightly examining how freely they give out this stuff (though they may now be erring on the side of parsimony). I just wish there was a way to separate the malingerers from those who honestly answer “Eight! A solid eight!” to the “How would you describe your pain on a scale from one to ten?” question that’s tossed your way every four hours. I eventually got bumped up to dilaudid for breakout pain, but, as it’s another opioid, it was only marginally better.

My second daily goal was simple: Eat.

Your success in this area almost entirely determines when you get your walking papers. Shortly after my diagnosis I was told “You need to consume a lot of calories because you’re going to lose weight. And we don’t particularly care where you get them.” 

I like to eat as much as the next guy, and, like some of those next guys, I enjoy nothing more than eating and drinking things that are found at the “use sparingly” peak of the healthy eating pyramid—beef, pizza, sausage, fried foods, milkshakes, martinis…. Yet here you have someone in a white coat—a professional who presumably knows how many beans make five—telling you that you are hereby ordered to take in truckloads of fats and sugars if they’ll pack on the pounds. What’s not to like?

The rub, literally, is that after your surgery, your throat screams “No Entry!” Much as those who care for you would love to see you order and consume the hospital’s very fine milkshakes, puddings, smoothies, and ice cream, your glare in response suggests that they’re damned lucky you’re willing to attempt a popsicle.

And so, for awhile, it’s a standoff. You’re in pain, you’re pouting because you’re in pain, and the narcotics help ensure that you have no appetite. When you relent and attempt items from the menu of pureed foods, they recall the glop you fed your infant.

But the staff keeps track of what you eat. And they remind you—gently—that if you ever want to breathe the sweet air of freedom again, you must get a couple of thousand calories inside you each day, pain or no pain.

Just about the time you start examining the fine print in your health plan to see if you can stretch your hospital stay to a month or more just to avoid swallowing, one piece of hospital equipment provides that extra bit of incentive to be on your way.

Sores and clots are a concern for patients who spend a lot of time in bed. And then there are the aches you develop from an unforgiving mattress that doesn’t adapt to your contours. Wouldn’t it be great if someone developed a smart bed that automatically provided support to needed areas as you shift positions?

Yes, it would. But 9 out of 10 patients agree, whoever came up with the current implementation of the hospital bed should spend a week confined to one and, in the unlikely event they’re able to walk afterwards, hobble back to the drawing board and take another hack at it.

The sentient hospital bed is anything but subtle. Comprised of something along the lines of 3,600 moving elements, the mattress inflates or deflates or shifts or shimmies or jims or jams whenever you move more than half an inch. This i/d/s/s/j/j is accompanied by a sound similar to a forklift elevating a crate of smaller forklifts. Lie down or sit up, the thing constantly undulates. And while this may be amusing during your first conscious hours, even when you’re well under the influence of powerful narcotics, it wakes you up when you most need your rest.

“Sorry to call you, but nurse, can we stop this bed from doing the hokey-pokey when I’m trying to sleep?”

“We’ve had complaints about that.”

“I imagine. Is there anything you can do?”

“Well, we could unplug the bed.”

“Okay, that sounds like…”

“But we’re not allowed to.”

“Then, speaking purely as an interested client, I might strike that from the list of solutions.”

If I was ever to again lie on a bed that didn’t buck and shudder I’d have to down the painful calories I needed, which I proceeded to do through liquid, pureed, and finally, soft foods. 

15 pounds lighter, graduation day finally arrived and, after thanking the staff for the really excellent care (and, despite the gentle ribbing I do here, it absolutely was), I walked out of the hospital (no wheel chair for me, thank you!) and was chauffeured home to begin the real healing.