Pain, first of many

Miracles You Don't See

Let's be clear about a few things.  If you are found outside the hospital in a car not breathing and we have to code you or call an ambulance because you took too much of your oxycodone, I'm not going to give you any more. Period. NO. You clearly are dangerous with that stuff.  Also, a minute ago you were driving.  And I have little kids.  And they were also maybe on the road.  I mean with their father, of course, driving.  So, to summarize, no.

And it was thus that I had the following discussion at least twice this week, with different people:

You:  So I need a refill of my oxycodone.
Me:  Oh, really? Hmm.  Well, I've been meaning to talk to you about this.  Actually maybe we should talk about that medication again.
You:  Well, it's the only thing that's helped.  I've tried everything.  Believe me.
Me:  Oh, like physical therapy?  And acupuncture? And OMT? And exercise? And weight loss? And an anti-inflammatory diet? And tricyclic antidepressants?  Or NSAIDS?  Or meditation? 
You:  I'm pretty sure I tried all of that.  I don't know what it all is, but I'm sure I tried all of it.  Because I've tried everything.
Me: (avoid eye contact, look at chart) Uh...
You: Once I saw a traditional Kazakh hypnotist who introduced me to my spiritual analogue, which is a unicorn.  Another time a Honduran pool boy recommended I snort some penicillin, which I tried.  None of that stuff works.  Oxycodone works.
Me:  Ok.  So I hear you saying that nothing else works but the oxycodone.
You:  Yep.
Me:  Ok.  But the thing is, you took too much recently and passed out in your car.
You:  Well, no one told me I shouldn't also take a Valium that a friend gave me.  So that was a mistake that now I will never do again.
Me:  Ok.  So I hear you saying you will never do this again.
You:  Yes.  Sure.  I'll take any drug test, doc. Every week. I need this. It's the only thing that works.
Me:  Ok.  But, wait, this is ridiculous.  I can't give you this medication anymore.
You:  What????
Me:  No. I can't give you this medication...I have a personal policy to not...I mean, you passed out in your car.  Like a week ago.  I'll lose my license.
You:  But it was a mistake!  Come on, you can't do this to me.  It's the only way I can function.  I'll go into withdrawals!  You just don't understand what it's like!
Me:  So I can't do it.
You:  I can't live without it!
Me:  So I don't know what to do then.
You:  So I don't know what I'm going to do!
Me:  There are some things, you know, like you could go to physical therapy again, or... like,
You:  Dude.  I tried all that.
Me: (Thinking to self: well, maybe actually this is the only thing that works.  Maybe I'm just not being empathetic.  Maybe you did learn your lesson.)
You:  Really, it won't happen again.
Me:  But.  I have kids.  You could have been out there on the road and crashed into my kids.  So, no.  Not going to prescribe this medication.  Anyway, studies show that this medication is no good for chronic pain anyway and I can work with you to find other modalities that...
You:  Fine.  I'll just find another doctor.

There is a lot of pain in the world these days.  And I'm extremely lucky to be not truly able to understand where folks are coming from when they talk to me like this.  I want to understand.  But probably I can't ever.  There's physical pain, chronic, gut-wrenching, raw, tear-your-eyes-out pain.  And there's what the Falcon calls "existential pain."  And it seems like narcotics help a little with both.  But only to a point.  They numb.  But, try doing anything with a limb, or lip, or mind that's numb.  Life can suck, and some folks get the brunt of it.  I honestly don't know how to help these people.  At least, not if all I have to work with is oxycodone.

These are the worst of clinic encounters.  No one is satisfied.  Nothing gets fixed.  We go around and around until someone leaves the room.  It makes me sick, it makes me sad.  They cry, I fight back the tears. 

Three years ago, a kinder, gentler, intern version of myself wrote this poem to describe this relationship.

To the unbeliever: miracles

do happen but tonight

your tired eyes cannot see

the pain that wraps me

like a child around myself

and collapses the universe

to a tiny point

your outstretched hand

offers me. I accept

your skeptic gift

and feel the miracle

of life wash over me.

maybe

tomorrow this agony will

be over, maybe tomorrow

never comes, but

please oh please

don’t stop

please don’t

stop

believing.