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Wednesday, April 20, 2011

Pressing the Red Button

Years ago, in hospitals, people were given the unique opportunity to
control their own pain. When they felt pain they pressed a button and
more pain relief would flow through their veins, from an intravenous
line (IV). This technique is not in fashion any more, from what I have
seen, and of course it would not be used at a rehab center, where you
don't want patients hooked up to IVs if you can help it. Patches are
another way to manage pain relief, with small doses of the pain killer
being released into the bloodstream throughout the life of the patch.
This technique has some drawbacks as well: by the time the pain killer
starts to have a negative side effect on the system, it will still
continue to course through your blood for a while. With pills you can
control the pain more specifically. If there are reactions, stop the
pills. So this is how it is here, at the rehab center. Every other pill
is brought to me in a little cup at regular intervals, but pain relief
is at my discretion. I have to call for it. To do that I press a red
button on a cable near my bed.

I suppose this method reduces the chance of abuse. Every time I want
pain relief I have to call someone and ask for it. I find I am reluctant
to do so. I think the staff is going to pin me as someone who simply
enjoys those pills. They say not, and repeatedly tell me the old refrain
that if there isn't enough pain relief in my system I won't be able to
do the therapy I need to do and therefore will not recover as quickly.
They say it's fine to call for it; if I need it, I need it. Yet still
it's hard.

When I finally decide I need to call I am sometimes in a lot of pain,
even when I call at the earliest possible time. Last night I could not
get relief much of the time. I woke up sobbing, whimpering to myself,
trying to keep down the pain. The dose can be repeated only every four
to six hours, so I could not call between midnight and four, because I'd
had my last dose at midnight. So even if I am johnny-on-the-spot and
call right away when the four hours are up it may not be soon enough,

It's an imperfect system. I expect a good system would include visits
from some sort of pain management person, a doctor of course,who
evaluates a patient's experiences and changes the drug if necessary.
There is a general-purpose doctor on staff here (he is not usually
actually on the grounds, though) to address the odd issues, like my
rash. The pain relief, though, is prescribed by the surgeon, and he is
the one who can change the dose or the medication. I am reluctant to ask
for help from him because he does not visit the care center and any
information would get to him third-hand.

Right now I am in pain and therefore this issue feels more important.
Chances are good that I will find some relief later, with another dose
or two, and I'll get through the day all right.

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