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[cancer] Pain, discomfort and the discontents of the insulted body - Lakeshore
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Jay Lake
Date: 2010-05-30 07:22
Subject: [cancer] Pain, discomfort and the discontents of the insulted body
Security: Public
Tags:cancer, health, healthcare, personal
I woke up this morning with my scars hurting and decided I wanted to make a post about the physicality of cancer, surgery and chemotherapy.

I suppose this is as much for my own benefit as anyone else's, but this might be of interest to you if you're a caregiver or relative, or if you're writing about a character with cancer. Or if you're on my journey, but in a different place than me. Also, I invite questions.

FYI, I'm focusing on somatic and sensory details, some of it may be medical or digestive TMI depending on your sensitivities and preferences.

First, a note about pain. Through this process, one thing I've learned at a very visceral level (speaking both literally and figuratively) is to make a very clear distinction between discomfort and pain. Outside of my various surgeries (two major and one minor so far), there has been almost no pain. Discomfort has reached epic proportions at times, and is essentially always with me these days.

When you go to the hospital they always ask you that goofy pain question. "On a scale of one to ten, how would you rate your pain?" The fifteen year old me would have rated a stubbed toe as a four or a five. Now it wouldn't even make the scale. The twenty-five year old me who wiped out his bike and slammed all four funny bones at once had a different answer, but ultimately, that was just discomfort on a world-spanning scale, and it passed within the hour. True pain is an unmediated abdominal surgical wound, as I experienced in May of 2008, and that reset my one-to-ten scale profoundly.

In the spring of 2008, I presented at the OHSU ER with copious rectal bleeding. To be blunt, I was having diarrhea the color of red raspberries every fifteen to thirty minutes. I've talked before about the intake and medical processes, and the fact that I lost 25% of my blood supply internally over 15 hours due to the tumor ulcerating. It never hurt (which is one reason I spent about 5 hours in the ER waiting room while losing pints of blood). It was intensely uncomfortable, in the way that any extreme lower GI phenomenon can be. The fifteen year old me would have been howling that it hurt like crazy, though. Even before my cancer adventures, I'd had enough bicycle wrecks and other mishaps to change my definitions.

That all led to various misadventures which I've documented on this blog, but basically, once I was on IV fluids and painkillers, I didn't feel a hell of a lot. The original tumor was removed via colonoscopy, but cancer cells were found in my colon wall and suspected in my lymph.

The pre-surgical consultation resulted in an unscheduled rectal exam, for which they did not have time to give me a Valium, and that was distinctly uncomfortable, to put it mildly, and more than a little weird, but also not painful. The implement they used resembled a caulking gun, and it sure felt like one going in, but stranger things happen in bars in NE Portland every weekend, and somehow everyone walks away intact.

Can't tell you much about the abdominal surgery, other than to remark that I dissolved into shrieking, babbling terror while being rolled into the OR. It was not one of my finer moments as an adult human being. Getting the epidural placed prior to that dissolution of my character was a very strange experience. We had a discussion about the risks of that procedure which was sobering. The anesthesiologist then fingered my spine for a while, found the spot he wanted, injected some local anesthetic with a small needle, then slipped the epidural in.

Having had them twice (spring 2008 and autumn 2009) I can say I intensely dislike epidurals. I can feel the needle and the head behind it against my back no matter what position I'm in, and the line they tape up to my shoulder is a constant irritant. Again, not pain, but discomfort.

Post-operatively, things grew nightmarish. I've been told colon surgery is comparable to a bad c-section. We did open incision both because of the excess abdominal fat I carry due to my weight, and to provide the surgeons with the best possible access to the cancer site. They pretty much unpack your lower abdomen of whatever lives there, then go fiddling. In my case, 22 cm of sigmoid colon was removed, from the colo-rectal boundary up to the central section.

As I had been blessed with "an excessive and redundant colon", per a rather witty radiologist (I took this to mean I was a long-winded asshole), they had a lot of material to work with. Unfortunately, even though I am a relatively big man (5'10", 270# at the time of the surgery) I have an unusually small pelvis, and much of the surgery was done blind.

Among other things, I was given the interesting information that after they had sewn the remainder of my colon to my rectum, they pressure tested me to 150 psi to see if anything leaked.

The nightmare wasn't the surgery, it was the recovery. Even with the epidural pumping liquid Dilaudid into me like motor oil being poured into a 1973 MGB, I was miserable. Again, not so much pain as deep, deep discomfort. My GI was completely shut down for obvious reasons. This leaves one with a deep ache inside, like a fist clenched around the gut. My entire body was out of whack from the anesthesia, to which I have some idiosyncratic reactions. I believe the issue is that I'm fairly drug resistant, so it takes a lot of stuff to put me all the way under. Then I have to get back out of it. Every time I've ever had surgery in my life, my recovery time from the anesthesia has been 2x to 4x what I've been advised.

This is where I discovered pain. After two or three days, the attending wanted me off the epidural and onto oral pain killers, so they could prepare me for discharge to convalesce at home. They put me on Oxycontin. In my case, that turns out to be a fine painkiller, but it makes me higher than a kite, and I sweat like Old Man River. I was trying to dance in my bed, singing away, and generally having a fine time.

Medical science swiftly and correctly deemed this to be counterproductive.

I was prescribed a single dose of oral Dilaudid, while the epidural remained installed but inactive. The day shift went home. The oral Dilaudid began to wear off. My chart had no orders for further painkillers, because the day shift docs had wanted to be sure I wasn't going to react negatively to the oral Dilaudid. The night shift doctor didn't want to interfere with the existing orders. As my one dose of oral Dilaudid wore off, I went from discomfort to mild pain to the screaming pain of an abdominal surgical wound, unmediated by any painkillers whatsoever.

Ten had a new definition on the pain scale. Raw, red agony from an eleven inch incision in my gut, dislocated organs, and a new suture in my colon. Not to mention the efforts of my GI to restart. I'm talking shoot-me-now pain. The night doctor was a complete chickenshit and wouldn't even come see me, but kept telling the nurse she couldn't override the day doctor's orders. My family, there as my medical advocates, were going nuts. So was the nurse. I was screaming myself hoarse. The nurse finally called the day doctor at home (probably at some risk to her career), waking him up to get him to prescribe further doses of the oral Dilaudid.

It took them a day to stabilize me from the pain crash, which probably kept me in the hospital an extra day. And that hurt in ways that still make me wince to think about, two years later.

The other ugly thing that happened was when the nurse came to remove my neck line. I'd had three IV points in my arm, the epidural in my back, the bladder catheter in my urethra (ie, up my cock) and this metal tube in my neck. She tried to extract it and got stuck, because apparently my skin had begun to grow over the sutures. Unfortunately she got stuck partway through the procedure, and couldn't step away to go for assistance or re-approach. She wound up digging, and cursing under her breath. From my point of view, that was roughly the equivalent of being stabbed in the neck, as we were doing this without local anesthetic. I would say the pain spiked to a 9, about comparable to the pain crash of a few days earlier, but it only lasted a couple of minutes instead of several hours.

The recovery process from abdominal surgery is pretty brutal, simply because all the muscles you use to roll over, sit up or stand have been sliced open, then sewn back together. For a while it took two people to get me out of bed. But the weirdest piece was the ride home. Normally all your organs are packed together in a pretty stable way. The body kind of glues it all together. When your organs have been unpacked for surgery, it takes them about a month to become stable again. On the ride home, every time we turned a corner, my organs were subject to Newton's Laws, and being essentially detached from their environment, attempted briefly to continue moving in a straight line even though the outside of my body was cornering with the car.

It is one of the weirdest sensations I've ever experienced. Not painful, not even discomfort in the medical sense, just freaky. One's guts don't normally communicate their somatic experiences directly to one's consciousness. I've been told that women who've had c-sections experience similar sensations riding in cars.

As for crossing railroad tracks... Oh. My. God. Toad-in-a-blender.

I did recover from all that, though the aching in my abdominal scar continues to this day. I know from the PET scans of last summer and fall that the abdominal incision continues to actively heal.

The surgery in 2009 was a completely different experience. It was a far less drastic invasion of my body, for one thing, though not much less painful for that. Where in May, 2008 I underwent a partial colectomy, what under went in November, 2009 was a partial thoracectomy. They went in between my third and fourth left ribs, excised a portion of my left lung about the size of a Dorito, taking with it a metastatic tumor about the size of an olive. The surgeon then examined my entire lung visually and tactilely to ensure that no other anomalous masses existed, and removed about a dozen small, calcified masses which biopsied neutral. (He eventually suggested I'd swallowed too much snot over the years.)

When I came around post-operatively, I had a drainage tube in my left chest, along with a horizontal incision about four or five inches long. Ie, the size of a surgeon's hand. The drainage tube was perhaps half an inch in diameter, and resembled aquarium tubing. It felt very strange coiled around inside my chest. (The point of the tube was to drain my pleural cavity so I didn't come down with pleurisy or some opportunistic infection as a result of the various surgical breaches.) I was astonishingly short of breath, but my lung didn't hurt. Felt weird, with the lower lobes partially collapsed from surgery, but not painful.

My ribs were another matter entirely. Nothing in this process ever approached the unmediated pain of the abdominal surgery, but they surely ached. Oddly, much of the pain was referred to each anchor point of the rib — sternum and spine — where the rib's nerve trunk was also anchored, so I went around feeling like I'd been shot through with an arrow. Even now, seven or eight months after the surgery, I have a low-grade version of that feeling fairly often, and when the serious aching kicks in, it freshens up nicely.

I spent much of my recovery period worrying about the extraction of the bladder catheter and the chest tube. I probably detest the bladder catheter more than any other aspect of medical care, as it makes me feel like I've been kicked in the nuts the entire time I'm using it. Having that thing yanked out through my urethra (ie, slithering down the length of my cock) is one of the most singularly unpleasant sensations I've ever experienced.

Having the chest tube pulled out was a similar sensation, except extending across my entire left chest. When the doctor removed the tube, I was amazed to discover there had been about twelve or fifteen inches of it inside me. It was like having a small animal crawl swiftly through my chest, then leap out the hole in my skin.

Nothing had hurt nearly so much since then. Chemotherapy is many, many things, but I believe I've only been in pain once or twice, and that connected to the hijinks of a few sessions ago when my infusion port had moved out of place and they had to go fishing with the pointy end. Not to mention the delight of having an accidental intramuscular injection of saline when they missed the port. That creates a brief sensation of burning pain, followed by an ache. We have since developed a new protocol for inserting my needle which avoids such funnery.

The chemo experience itself I've documented pretty extensively, but it's entirely a drug trip, and doesn't invoke somatic pain. Some of the side effects get pretty damned somatic, as discussed, and in fact I developed a new side effect yesterday, when the soles of my feet began to spasm. Mostly, though, the side effects have to do with my systemic health — sleep, digestion, fatigue, etc.

I have arrived at an intimate personal relationship with my scars. Ever since the abdominal surgery, the belly scar has served as a sort of idiot light. When it begins to ache, that's time for me to stop whatever I'm doing and get some sleep. Now, on chemo, one of my fatigue signals is when the chest scars begin to ache. Unfortunately, these past few weeks the fatigue has been so deep that most days (including today) I wake up with the chest scars aching. As I write this, the time is about 7:15 am, I've been up for three hours after over nine hours of solid sleep, and my chest scars ache, along with the shot-with-an-arrow sensation. My abdominal scar tingles, but that's probably the power of suggestion given what I'm writing about. However, my educated guess is that by midday it will be complaining for real.

That's a terribly long disquisition on medical and somatic experiences. If you read it all the way through thank you for hanging in there. Please feel free to ask any questions you want about my cancer experiences, or the pain, or the headspace. I'm going to moderate comments in case someone wants to ask a personal or medical question they don't want broadcast to the blogosphere.

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Reynardo the Red
User: reynardo
Date: 2010-05-30 15:02 (UTC)
Subject: (no subject)
Hey there.

And firstly I find your honesty amazing and refreshing and so good to hear after all the "you will find it like this" that I hear from the doctors. I'm headed for some fairly major internal surgery later this year and I *knew* it was going to hurt, but from what you say about the whole ache in the abdominal area, I now know I'm going to have to be *really* ready for it, and not try to be a hero with the pain. And from what I can tell about painkillers and the way the doctors and nurses react, I've been forewarned that they're used to people going "OMG IT'S AN 11" for a stubbed toe, so I need to be firm BEFOREHAND along the lines of "GIVE ME DRUGS!", and not try to be brave.

So thank you for that.

On a completely different note, the Child is beautiful, and the things she's been asking you sound as if she has a brain, and has been taught how to use this. There needs to be more of that. (I'm on a personal crusade for LESS PRINCESSES). I admit my first thought at the pictures were that her mum must be Native American. That she's Chinese-born makes a lot of sense. That she's been brought up to be herself makes a lot more. I hope you tell the doubters and bigots to take really long running jumps off short piers.

Sorry, I've raved a bit myself. Thank you again for sharing your rough and personal journey with me!
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Jay Lake: child-laughing
User: jaylake
Date: 2010-05-30 15:29 (UTC)
Subject: (no subject)
Keyword:child-laughing
Good luck on your surgery. I strongly recommend not being a pain hero, because when you're in the pain tunnel, pretty much nothing else can happen, including healing. Another strong recommendation (which I perhaps should have included in the post) is to have a trusted friend or family member present 24x7 as a patient advocate while you're in the hospital. My pain crash was essentially a prescribing error compounded by the night doctor's fear of contradicting an existing order — without my family's sense of urgency (and, frankly, anger) to drive the nurse, who was herself very focused on making it right, she might not have had the nerve to go over the night doctor's head. Stuff happens, and only your trusted/loved ones have your interests completely at heart. Trust me, you won't be in a position to say much.

And thanks for the kind thoughts about the_child.
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cathshaffer
User: cathshaffer
Date: 2010-05-30 18:12 (UTC)
Subject: (no subject)
Yes, this is something I have heard from experts, too. The most dangerous part of a recovery from surgery is the first night after. Someone who has had surgery really needs an attendant with them in the room constantly, but hospitals can't provide this. There are also predictably going to be human errors in any system that includes humans. The fact that in your case the human error was a night resident who was an absolute moron is infuriating, but that is a very good argument for having a family member present. I can't comprehend why the resident did not think it was his job to write prescriptions for pain management. This is a completely normal part of his job and yes all surgery patients need pain management immediately after surgery, unless your regular doctor remained on call for that purpose, in which case, what was the delay in making that call? Argh!
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Jay Lake
User: jaylake
Date: 2010-05-30 18:14 (UTC)
Subject: (no subject)
Yep. Argh doesn't even begin to cover it. I spent several hours enjoying unmediated surgical pain, an experience I don't ever care to repeat.
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cathshaffer
User: cathshaffer
Date: 2010-05-30 18:22 (UTC)
Subject: (no subject)
I've had a couple of experiences like this. The first was when I gave birth to my son. For reasons I did not understand at the time, my pain was over-limit from the very beginning. I had planned an unmedicated birth, but that went out the window fairly soon after I *finally* got some medical attention. (This after two days, no sleep, unmedicated contractions every five minutes.) Once I was in the hospital, though, a sleepy baby and a very, very busy day in the maternity ward delayed my epidural. It only ever took on one side, and then they typically let it wear off a bit toward the end, when you need to be able to push the baby out. Had my pain tolerance redlined for many, many hours at a time.

The second such experience was when I had jaw surgery. Again, I had greater pain than the average patient, and my surgeon prescribed me tylenol III--tylenol with codeine. I found out years later that some people do not receive any pain relief from tylenol III. Well, that was my situation. For three weeks I managed post-surgical pain from an operation in which my jaw was sawed into five pieces and reconnected with a drug which was functionally an over-the-counter dose of acetominophen. Again, lots of pain absolutely redlined, there. It was really awful.

I have found out since then that my nerve conductance is on the high side of normal. I am just very sensitive. I don't have a "low pain tolerance." In fact, because of the way I am wired, I have probably dealt with more subjective pain than most people experience in a lifetime. I find that people are usually pretty compassionate about surgical pain, but become very judgmental regarding the pain of childbirth. These people are shitheads.
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Jay Lake
User: jaylake
Date: 2010-05-30 20:08 (UTC)
Subject: (no subject)
I have an immense amount of respect for the effort and pain of natural childbirth. I also have learned to be careful what I say about that. To wit, when I was about 22 I was admitted to the ER with an undiagnosed abdominal swelling that was of the "if I had a gun I'd shoot myself" pain level. Best description I could come up with was if you'd heated a 20# stage weight to red-white, then sewn it into me. They finally gave me Demerol because my screaming was bothering the trauma victims. (That was after letting me scream for about 30 minutes to check if I was serious or just drug-seeking. I fucking hate drug-seekers because of that.) When I came off the Demerol, the pain and swelling had vanished. Never did figure it out.

My doctor later observed that the three most painful things besides trauma are childbirth, kidney stones and uncontrolled abdominal swelling. (I have no idea if this is general wisdom or his opinion.) I've quoted that a few times to a very irritated reception from women who were quite offended that I'd implied I'd approached the pain of childbirth.

So, yes, self-evidently I have no idea, but I know from pain redlining. And childbirth can last days, which time-dilation-from-pain I can scarcely imagine.

What I really don't understand is the variable compassion you mention. I've certainly seen, and experienced it. In fact, I sometimes encounter a minor version of it with cancer. I'm still plump and have my color, so I don't *look* sick unless you watch me walk around. One of my last outings before I gave up leaving the house for non-medical reasons was my daughter's school play. When it came time to hustle a bunch of chairs, I got some dirty looks for not leaping up to help. It's the whole "invisible disability" thing.

Edited at 2010-05-30 08:08 pm (UTC)
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cathshaffer
User: cathshaffer
Date: 2010-05-30 20:16 (UTC)
Subject: (no subject)
People are jerks. It's a dimension of human nature. The way I interpret my labor experience, actually, is that labor often has an element of hazing ritual to it. We are supposed to keep expectant moms in the dark about what they might experience. Then, during early labor, we laugh at their pain and tell them they'll know what real pain feels like "soon." Then, when the "real" pain hits, we coach them to make weird puffing sounds. The goal of this is to prevent screaming so that the staff people who are staring at various instruments and monitors (instead of you) do not get annoyed and distracted from their work. A mother reporting for her second or later child is typically not expected to wait as long for sympathy and pain medication.

Of course there is no reason that childbirth should trump all other experiences painwise. From what I've heard, it's quite the opposite. Most women have pretty manageable pain in labor, though there is huge variation within normal. Kidney stones, on the other hand, are always described as total agony, and I don't think it's because men are wimps. I have known women who have done both. The abdominal bloating you had I have never heard of, and sounds weird and scary!
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shelly_rae: Jay & Me Chemo 10
User: shelly_rae
Date: 2010-05-31 05:45 (UTC)
Subject: (no subject)
Keyword:Jay & Me Chemo 10
You worried and fretted about pain to The Night Watch and seemed surprised when you felt ok. You probably don't remember that though. I gave you meds during the night--you never really woke up for them the first couple of nights--just talked randomly and sleepily before dozing off again. At least until the Ninja incident.
Anon
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(no subject) - (Anonymous)
Jay Lake
User: jaylake
Date: 2010-05-30 17:49 (UTC)
Subject: (no subject)
My calibration for "10" is the unmediated surgical wound, so, yeah. That's great advice.
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Reynardo the Red
User: reynardo
Date: 2010-05-31 04:34 (UTC)
Subject: (no subject)
That has got to be one of the most sensible things I've seen! Thank you for that. The calibration will be good - due to some weird wiring in my own brain, pain will sit in the background and I'll be aware of it but not really feeling it, until it gets to a certain level and suddenly it's "F*#& THIS HURTS" - and people think you're just looking for attention because "you weren't this bad before". I know a friend's son with a much worse case of the same wiring who came home from school limping. They took him to the doctor who sent him for fast X-rays to discover he had a fractured femur - the kid was "oh, it hurts, I suppose..."

I also must learn to trust them when they *do* give the drugs. I had a nose operation that hurt to high hell after. The nurse gave me a shot of pethedine. It still really hurt. So she gave me another, and it was still hurting, but I felt my breathing slow down so much that I was scared to ask for a third (which was on offer).

You know what's ok (that I'm learning from this?) It's ok to be scared.
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e_bourne
User: e_bourne
Date: 2010-05-30 16:53 (UTC)
Subject: (no subject)
There were a lot of ugly things about Mark's surgery (how did all that coiled wire fit in his heart anyway?) but the one that will always stay with him is removing the stomach tube.

It's like the Spanish inquisition, nothing can prepare you for it, so they don't.

Which is a way of saying, yes. I understand, even though I haven't personally gone through your own experience, I am the standing by one, and I understand.
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ygolonac
User: ygolonac
Date: 2010-05-30 19:42 (UTC)
Subject: (no subject)
Glad that didn't happen during my colon resection!

I was doing fine and thinking 'Man, this epidural isn't really doing much' and then after a few days they turned it off and I got to push the button when I needed some pain relief. That button was not enough!

Also, be careful eating almonds... http://ygolonac.livejournal.com/175924.html
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martianmooncrab
User: martianmooncrab
Date: 2010-05-30 19:42 (UTC)
Subject: (no subject)
Its defining the pain levels, I had trouble for years because my version of a 10 is curled up on the floor in the fetal position losing all verbal skills and other bodily functions. So, if I told the docs I was at a 4 or a 5, they dismissed it.

My surgeries have been informative, I still dont feel half the noises I hear in my abdomen, but the worst pain I have had was the pneumonia, where it felt like I had a gaping wound through in the middle of my chest.
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User: xjenavivex
Date: 2010-05-30 20:16 (UTC)
Subject: (no subject)
Moreso through my husband and my son, I can understand. I am not the sufferer (except for the defunct gall bladder of doom) but watching those I care about have their numbers reset, sucks. Understanding how the scale changes is very important. Thank you for this post.
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User: brownkitty
Date: 2010-05-31 03:33 (UTC)
Subject: (no subject)
http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html

Just in case this amuses.

Thank you for telling about your experiences. I'm sorry you have them to share, I appreciate both that you are around to share them and that you are willing to do so. I'm finding it interesting and informative.

The more I read your entries, the more I find that I am learning a lot from you. Thank you for that.
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vicki_rae: 15 Year Survivor Ovarian Cancer
User: vicki_rae
Date: 2010-05-31 05:45 (UTC)
Subject: (no subject)
Keyword:15 Year Survivor Ovarian Cancer
Thank you for being so willing to share the things one can only find out from someone who has been there.

What surprised me the most was how long it took me to truly heal inside. My incision goes from my pubic bone to my diaphragm. Six months later, an airline seat belt buckle pushing on the incision was a nasty surprise.

Huh, I like that idea to give a baseline to go along with a rating on the pain scale. My baseline 10 was set by large ruptured ovarian cysts thanks to Polycystic Ovaries.



Edited at 2010-05-31 05:46 am (UTC)
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Anna Feruglio Dal Dan
User: annafdd
Date: 2010-05-31 14:01 (UTC)
Subject: (no subject)
This makes me want to survey the whole medical population and physically take out all the ones that do not agree wholly and enthusiastically that pain management is of great importance, certainly greater than drug misuse.

My grandfather was allowed to die in pain (of lung cancer) because the doctors held back on the morphine telling my mom, and I quote, "Well, we don't want to make him a junkie, do we?". This was one month before his (completely inevitable, as they well knew) death.

I thought the medical profession had moved on since then. In Italy, during one brief interval of political sanity, we had an illustrious oncologist as Minister for Health. As a result heavy opiates for pain management are a lot easier to use now.

I hope that night doctor got a stern talking to.

The zero-to-ten scale is, alas, the best way medicine has found to measure pain. (It's called VAS, Visual Analog Scale). Unfortunately pain is a subjective reaction and the only measure is asking the patient. At least this what an anesthesiology professor told me about ten years ago.
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Jay Lake
User: jaylake
Date: 2010-05-31 14:12 (UTC)
Subject: (no subject)
I don't object to the pain scale in the slightest. It just seems so utterly subjective as to be nearly pointless. But then I'm not trained in interpreting patient response. All I know is me.

I am sorry to hear about what they did to your grandfather. That same attitude — an overblown horror of addiction, even in the terminally ill — is still widely spread in the United States, though it is definitely being pushed out.
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Anna Feruglio Dal Dan
User: annafdd
Date: 2010-05-31 14:43 (UTC)
Subject: (no subject)
The only use of the VAS scale is in determining if the pain, in the same patient, goes up or down. It is useless for seeing in how much actual pain the patient is, but if they are admitted with 8 and then it goes down to 2, then something is working. (Or, in the papers I was translating, the difference is a measure of how effective the painkilling treatment was.)

This doesn't stop people using it as an absolute measure of course, human nature being what it is. :-(

I am not sure there can be an absolute, objective measure of pain, anyway. Not only there are individual differences and thresholds, they are recalibrated through life. It's a perception, like perceiving the color blue. You can measure the wavelength of light, but cannot measure how it is perceived.
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