Dr. Mortimer Fein strikes again…
Thank you for his “Fein” post Morty!
For quite some time my pain clinic colleagues and I have joked that a vacation has a half- life of 5 work hours. Thus, no matter how relaxing or indulgent your holiday may have been, you were back to your stressed out, overworked baseline by mid-day Wednesday. And I got to thinking about the present vacation from opioids that the CDC and others have so graciously granted providers these last 10 months. With all the controversy and pressure, you needed it. You got it. Everyone has hopefully been able to relax and enjoy a tall beverage with an umbrella in it (maybe a duloxetine daiquiri or a gabapentin gimlet) while lying under a blanket of lidocaine patches and daydreaming about a world without opioids.
Welcome back. And by some coincidence it just happens to be Wednesday. I woke up to a desperate email from a family I never met whose 
physician is retiring; this after they moved across the country to be nearer to the one person willing to continue a therapy that had been arrived after multiple trials over the course of many years. I also called a clinic on behalf of another former patient who can’t get anyone to continue his post cancer regimen for his intractable pain and other complications. Then a news report came on discussing upcoming changes in local regulations with regard to opioid prescribing and all the while our local news played footage of heroin paraphernalia as a back drop to the story. What happened? The video of the factory conveyor belt moving a river of capsules wasn’t available? Oh that’s not it, you don’t know the difference between heroin abuse and pain treatment, that’s right. I forgot while I was floating in the pool on a cushion made of unneeded fentanyl gel patches.
We all need a vacation from the stresses and strains of clinical work. And you were missed. Let’s remember though that people with pain didn’t have a vacation from their suffering. Indeed, I have patients who have told me of the subjective experience they have had that they have indeed had the experience of lessened pain from time to time for a period of minutes to hours to days, but didn’t realize it until their pain returned. So they missed their vacation; so pervasive and co-opting of one’s attention is the burden of suffering that you sometimes don’t recognize that it is temporarily gone.
Maybe it isn’t Wednesday yet for you. I have every bit of confidence though that it will be Wednesday in America sometime soon and that the pendulum will swing back some; swinging against the tidal wave of negative media and public opinion, simply because there is no viable alternative on the near horizon for millions of people. Maybe refreshed, you will return to work with newfound empathy. Maybe you will be able to appreciate anew how difficult this has all been for patients – not just the pain but the humiliation and ostracism.
Maybe before 5 half-lives pass and you are no longer refreshed, you will re-examine this through rested eyes and with a rested heart and help someone have half a life.
Overall Information Prevalent this output government healthcare plans
I have been a doc for 40 year. I have been ravaged by mixed connective tissue disease (MCTD). Once thought to be no more than a bad case of fibromyalgia, we and I are finding out how wrong that first assessment 20 years ago was. I have been ravaged by myriad of missed diagnoses including a missed esophageal perforation, a array of cardiac arrhythmias with CHF, myocarditis, and hypotension requiring multiple ablations (ventricular, nodal, atrial). I have the first reported case of normal pressure hydrocephalus in MCTD, and an axonal neuropathy with evolving global paralysis and such unresponsive neurogenic pain! I have lots of old degenerative injures from water and snow skiing as a youth. Oh, and scleroderma bowel dysmotility with chronic intestinal pseudo obstruction and small intestinal bacterial overgrowth caused by mu receptor agonists – autoimmune and opiate induced. There goes any pain relief – I had to stop all opiates or live with an NG tube. SOOOO, we obviously need something new for pain relief. We who cannot take opiates are not all junkies. For my rotator cuff arthropathy, my hip arthroplasty for avascular necrosis, my cervical and spinal stenosis I use TRAMADOL, my placebo. My pain doc will not give me benzos because I might get addicted to them! Thank God I can still sleep – a low level of anesthesia that allows me to ski and fly and walk again – like an Avatar in Pandora. People say get a hobby, meditate, how about some CBT – that insurance does not cover. Get stoned – MJ cures everything. I think not. All I want to do is get my resting pain below a “nurse level 5” and go back to work treating chronic pain. There is nothing as bad as unrelenting severe pain that does not shorten your life. You live with it, your partner in pain who leaves you homeless, jobless, and with no social support – who wants to hang around someone in severe debilitating pain?