The doctor takes the wrong end of the scalpel


In the head there’s this thing called a brain.

Where we feel our pride and our pain

But when the cutting is done

Are narcotics just fun?

Or the source of some ill-gotten gain?

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

Recovering from surgery cuts into the desire to write, but I’m doing better now.

Even doctors must have doctors; the internal dialogue that leads us to minimize contact with our own profession has gradually led us to healthier life styles.  Few doctors smoke in the 21st century; most of us exercise regularly.  While no doctor should prescribe for him or herself, neither should any patient completely abrogate self-advocacy nor decision-making. 

I won’t dwell on the circumstances that led me to a repeat surgery; denial worked for a long time but eventually failed.  Thus on Valentine’s Day I sat in our local specialized surgical center, hungry and thirsty waiting for anesthesia.

The procedure started on time, but went long, only because of the nature of the problem.

A lightweight when it comes to most medications, I dozed off and on for the rest of the day.  When it came time to leave, I adamantly refused a prescription for a popular narcotic.  The exchange with the nurse went several rounds and finished with her tearing the slip to bits and putting it in a small plastic envelope designated for that purpose.

All narcotics slow the gut and suppress the cough reflex.  I feared constipation (after a major abdominal procedure) and pneumonia more than I feared pain.   Nor would my marginal kidney function permit me the usual pain relief of the NSAIDs (a drug class that includes Ibuprofen, Alleve, Toradol, diclofenac, and 28 others).

Which left humble acetaminophen, also known as Tylenol.

If we assign post-operative pain a range of 1 to 10, we know that the much-abused oral opiates like Percodan and Norco can bring the pain down by 2.7 points in the same study where an inactive pill will bring it down by 2 points and Tylenol by 2.1 points.

(Interestingly, propoxyphene, the active ingredient in Darvon, now removed from the market, would decrease it by 1.7, which means that despite bringing euphoria, a drug could aggravate acute pain; a phenomenon we see with marijuana and chronic pain.)

I have spent most of the last 5 days asleep, but today I’m coming around.  My appetite and my sense of humor have palpably improved through the day.  I still fear coughing but I do it anyway. 

I didn’t actually need the narcotics.

When I talk to my non-drug abusing patients after a surgery, most of them didn’t, either.

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