Three weeks ago, I broke my right shoulder after falling in the shower. It was a stupid injury, and one that has severely impacted my ability to do a lot of things I take for granted, and I find myself in much the same position as the plaintiffs I routinely depose about similar injuries. When I hear them tick off all the things the can’t do because of a torn rotator cuff, I am much more compassionate, because I feel their pain – literally. Compassion is a good thing.
It’s also something that the caregivers with whom I have consulted for my injury seem to be utterly lacking. Over the last three weeks, I have learned that there are no circumstances under which I qualify for narcotic pain medication – despite the fact that I have a broken bone in my body – because, apparently, I am at risk for becoming a junkie. Maybe I already am a junkie. I didn’t think so, what with the fact that the only times I’ve ever taken narcotic pain medication has been after dental surgery. I was given a prescription for twenty Percocet after I had Allison, and the doctor who treated my broken toe was prepared to have me take Vicodin for as long as I needed. I never filled either prescription, because I wasn’t in that much pain, and Tylenol was adequate to relieve my discomfort.
The orthopod who confirmed my broken shoulder told me that I should wear a sling for a couple of weeks and then start physical therapy. He noted that the pain would subside, but that if I was still having significant discomfort at the time of my follow-up appointment, he would have to consider whether there was any tendon or ligament damage. As he was sending me on my way, I asked, “what should I do about pain?” – of which I was experiencing quite a lot at that moment.
When he answered, “oh, Advil or Aleve should do the trick,” I was a bit skeptical, but since he was the doctor, and since I was in so much pain I was almost nauseous, I nodded, took the sling the nurse gave me, went home and took some Aleve. Several hours later, I could barely see straight, so I called Michael, who told me to take one of the Vicodin dispensed to Hanna after her appendectomy last spring. “Are you sure?” I asked. After all, who hasn’t heard about the opioid crisis? “Yes!” said Michael. “For Pete’s sake, you have a broken shoulder!”
Guess what? It worked.
Over the next three weeks, my shoulder got marginally better, but the pain was still pretty severe (probably because I insisted on working 10 hours a day typing and writing with my right arm). The only way I got through it was by budgeting Hanna’s 12 Vicodin (which the label says can be taken every 4 hours) at a rate of one every three days, and only at the end of the day, after I’d finished everything that required my focused attention, mostly so I could get some sleep. Without a Vicodin, the pain was so exquisite that sleeping was futile, and there were some evenings I got up and took a swig of Nyquil just to get some sleep.
After two weeks of this, with little improvement, I was ready to report back for my follow up visit. The orthopod canceled due to his overly busy OR schedule, so I was put off for another week. When I called to reschedule, I asked about pain relief. No one called me back.
The pain continued. During this time, I tried to get by on Advil or Aleve on my NVD (non-Vicodin days), and I also tried Naproxen and Meloxicam, both of which had been prescribed for me by my primary care provider when I was having right knee pain. Neither made a dent in the pain.
And so, anticipating that I was almost done with Hanna’s Vicodin (makes me feel like a dirtbag to admit that I took my daughter’s pain meds), I called my primary care provider and explained the situation – I told her what I had taken, what had worked, and what hadn’t worked. I asked for a non-refillable script for 12 Vicodin to get through the next three weeks in the hope that by then, the pain would be more bearable. I told her that I had reported to Michael each time I took a Vicodin so that he could monitor and make sure I didn’t become dependent. I begged her for relief.
She said no.
I should probably mention that my PCP is a former partner of Michael’s – a woman who worked alongside him for 10 years, observed his treatment of hundreds of patients and the very careful approach he, too, took with respect to prescribing narcotic pain medication. Although she has known me both personally and professionally for over 20 years, although I asked for a very limited amount of pain relief, although she knew my husband to be a conscientious physician who was carefully monitoring my care at home – she nonetheless refused to treat me.
So I called the orthopod – again – and did not get a response – again.
A few days later, I had my follow up appointment with the orthopod. To say that he was, and is, a gigantic asshole, would be an insult to assholes everywhere. Without going into details, he was as helpful – and charming – as bag moldy bread – but since he had told me at my first appointment that continued intense pain could be a sign of a larger problem, I made the mistake of telling him how I was feeling and mentioned that I had called twice for pain relief but hadn’t gotten a response. He stated that he wasn’t aware of any request for pain meds and offered to prescribe exactly the same medicines that I had already told him did not work. “Then I guess I’ll have to refer you to pain management,” he said.
“Are you telling me that you perform hip replacements and fix torn ACLS and you can’t prescribe pain medication?” I asked.
“You have a broken shoulder,” he said. “It’s gonna hurt.”
Imagine you hired someone to come over and fix your broken furnace. It’s the dead of winter. It’s 23 degrees in your house. The HVAC guy come over, looks at your furnace and says, “Yeah, your furnace is broken. Put an extra blanket on the bed. It’s gonna be cold, but it’ll warm up by April.”
You say, “but we’re freezing! We need some heat!” and the guy says, “Well, I could fix your furnace, but then you might become dependent upon heat during cold weather, and we can’t have that.”
After I left the orthopod, and as I was driving home, I found myself in tears of pain and frustration, wondering, what do you have to do to get appropriate relief when you are in serious pain without being presumed a drug-seeking junkie?
Believe me when I say, I understand that there is an epidemic of opioid addiction in this country. Several months back, I read an exceptional article in The New Yorker about a town in West Virginia where pretty much everyone is addicted to opioid medications. Those who can’t get prescriptions from their doctors are now scoring pills – or pure heroin – from dealers. It’s become a huge problem, it’s a scourge, and people who took opioids for legitimate pain are now addicted, and dying, because it is so very easy to become dependent on this class of drugs. Some blame Big Pharma, some blame the FDA, some blame the doctors who prescribed opioids like candy before anyone understood how terribly addictive they are.
I’m not so interested in playing the blame game, and I agree that something has to be done to address what has become an almost unmanageable problem. I do take issue, however, with the notion that from here on out, no one should ever get another prescription for narcotic pain medication, end of story, case closed.
Sometimes, people have injuries, and sometimes they are in pain. Conservative pain management makes sense, certainly, but I believe that the medical profession, which was at least somewhat complicit with getting so many people addicted to opioids, has now made a wild over-correction, similar to banks who, in the early 2000’s, where handing out subprime mortgages to people who clearly could not afford them.
After the economy collapsed due to the greed of companies like Countrywide, it suddenly became far more difficult to get a loan of any kind – even if you had high credit scores, steady income, and a low debt-to-income ratio. In an effort to make sure that people did not take out loans they couldn’t pay back, the mortgage industry started demanding that any potential borrower – regardless of their credit history – provide twenty years of paystubs, a letter of explanation for an unpaid parking ticket from 1982, and a semen sample before even opening a file.
That’s what’s going on these days in the medical industry where the issue of pain is concerned. Providers are immediately suspicious of anyone who asks for a narcotic, the assumption being that they are drug-seeking. Now, I’ve been married to a family practice doctor for 29 years, and in that time, I’ve heard a lot of stories about drug-seeking behavior: The patient who is going to multiple doctors to get prescriptions and who fills them at different pharmacies. The patient who is going away on vacation and needs a new script because they are going to run out of their pain meds while they’re away (even though, according to their chart, they still should have plenty to get them through). The patient who’s purse/car/bike/briefcase was stolen, with the prescription for pain meds inside – remarkably, the same patient has sometimes been robbed six or seven times!
So, I get it. I understand why certain types of physicians (orthopedics, pain management, for example) insist that patients receiving narcotic medications sign a contract acknowledging the prescription policies and the limits on what will and will not be prescribed. I appreciate that doctors have to be very careful and discerning lest they get a patient hooked on opioids.
I. Get. It.
But, hey, medical profession…WE’RE NOT ALL JUNKIES. Some of us are nice old ladies who wouldn’t know how to score drugs if our lives depended on it (is that something you Google? Yelp? I have no idea). And honestly, who has the time to got to six different doctors and eight different pharmacies? I am not trying to minimize the very serious issue of addiction, but here’s the thing: ASKING FOR PAIN MEDICATION AFTER SUSTAINING A SIGNIFICANT INJURY DOESN’T MAKE YOU AN ADDICT. If medical science didn’t recognize that humans can experience unbearable pain from time to time, I guess it wouldn’t have seen the need for developing pain medications. It makes me wonder if, should I have to undergo surgery, I’m going to be told to take two Tylenol while someone cuts into my body – you know – so I don’t become addicted to anesthesia?
It’s frustrating that I have not been able to get any relief for my pain, but I’ll get over it. Eventually, the pain will go away, and then I’ll just have arthritis that will flare up when the weather is bad, much like Uncle Henry’s bunions. I’m tough. I will endure.
Far more upsetting to me is to have a health care provider who knows me well question my veracity when I relate the my level of pain; I find it downright offensive that by making a request for pain medication that has proven effective, I am presumed to be drug-seeking.
It occurred to me ask how that same physician might respond if it were she, or her spouse or child, who had the broken shoulder. Would that same physician tell her loved one to just tough it out? Would she discourage them from seeking, or taking narcotic pain medication? Somehow, I sort of doubt it.
In the future, I will know better, and I won’t bother to ask for help, even if I’m in pain, because I would rather live through the “discomfort” (such an inadequate work) than be made to feel ashamed for asking for relief from legitimate pain. I mean, it’s not like the pain is going to kill you, except that it might: Statistics suggest that 10% of all suicides may be linked to chronic pain.
Pshaw. Just put on an extra blanket and take a Tylenol, and don’t call me in the morning.