4 - Pain Management Part I

I awoke in the recovery room after my anesthesia wore off. I was immediately overcome with a sharp and unrelenting pain in my knee that only got worse as the seconds passed. Nothing had prepared me for this level of pain. I underwent back surgery twenty years ago and time certainly dulls the memory of pain but I didn’t recall ever demanding more pain meds and screaming viciuously at the nurses after my back surgery. I suppose age has given me the ability to clearly, if not inappropriately, express my needs.

I dominated my nurse’s time and she eventually had to call for help since I wouldn’t allow her to leave me in order to attend to the other cooperative, clean speaking, comfortable, quiet and apparently painless people lying in beds on either side of my mine. As I writhed in pain and blurted out all kinds of obscenities, my nurse kept trying to get me to breathe and relax. I tried my damndest to comply but controlled breathing and relaxation would not come to me for more than a few seconds before I started crying out again.

My nurse asked me what level of pain I was experiencing. I was dumbfounded. I thought I had been screaming my exact level of pain from the moment I regained consciousness. Did she not hear me? Perhaps she was a volunteer from one of the local group homes. But I wanted medication and only she could provide it so I stopped and pondered and decided that if I were on the battlefield and all my limbs had just been blown off, I would have to be at a pain level of 10. I, on the other hand had all of my limbs and I was still able to use language (be it filthy or not) to communicate and was not in shock so, to be fair, I gave myself an 8. “Well that’s not so bad”, said the nurse. “You are acting like it hurts a whole lot worse than a pain level of 8.” “OK,” I countered, “I’m at a  9.” “But you just said you were an 8,” she replied, "which one is it?" I thought maybe, just maybe, I was in kindergarten hell. “My pain meds are not working!” I screamed.

They had me on a PCA morphine pump which lit up to indicate I could press the button like a good little rat to get another burst of morphine. Nice idea, but to work effectively on my pain, it would have had to light up every 20 milliseconds or so. Finally another nurse came over and held my hand and stroked it gently as if I were a little kid and I responded like a little kid. I wanted her to hold and stroke my hand for the rest of my stay. I was able to calm down enough to tell them, without interjecting a single swear word, that I needed some pain meds that worked – NOW. The nurse called a doctor over who said, “It looks like his nerve block wore off a lot sooner than we expected. Let’s put him on Dilaudid.” Finally, a voice of reason came down from the heavens. Yeah, what a great idea! Maybe I could use some Dilaudid. Twenty minutes later I started breathing more regularly and I was able keep more of my thoughts to myself. My nurse noted my newfound disposition and said, "See, all you had to do was relax and control your breathing." I tried to respond but all I could manage was a little smile as I slipped into a restful sleep.