Nerve Pain Goes to the Moon

I trusted in the Lord when I said,
“I was greatly afflicted"
And in my alarm I said
"Everyone was a liar”

—Psalm 116:10

If you're ever been to the emergency room, ER, at Any Hospital, USA, before the staff gets to your medical condition, you will be assessed on multiple levels. Outwardly the staff that will assess your physical and mental appearance. Is this member of humanity vying for access to this facility actually in need of medical relief? Slightly different if you come in the ambulance…typically means you're in distress, unless you deny the EMT his moment to treat you. Then they call ahead and give them a heads up, this won't be a trauma patient this will be a standard red herring visit. They want to know if this person has suffered real trauma or they are just going to the ER to use the facility as a clinic. A big secret at hospitals, is that the George Clooney Emergency Room, isn't really where George Clooney works. He works in the trauma center, that's the facility that saves lives. But you don't get to that facility unless you have life-threatening trauma. For everyone else you get to the public ER to be treated for headaches, nosebleeds, and mild cardiac arrest. Aka, gastrointestinal distress manifesting and chest pain. You get to stay in the ER just long enough to fart it all out.

Once you get there, some sort of triage is conducted and you may jump the long line of humanity if you have head and chest pain…you still don't get to the trauma center unless you reveal a gunshot wound or possibly traumatic brain injury. If you arrive in an ambulance and you're in this kind of condition you jump to the head of the line as well. Two things happen in the trauma center, one, they have the medical care to save your life, two they isolate you from any potential threat of being re-traumatized. They make sure the guy who initially shot you will not be following you into the hospital to finish the job.

But today, even though I arrived by ambulance on Sunday, we are just in the clinic ER. The EMT seemed disappointed I turned down both his injection of Toradol, and his desire to insert an IV into my arm while we were driving through traffic…we would be at the hospital in 10 minutes. Was that an absolute necessity? Yes, don't turn down EMT. You must not be in that much pain. Yet they will be running a heart attack checklist (which has saved many lives), they will be asking your level of pain. After they assess that you're not bleeding or having a heart attack they are going to ask you your pain level…and to do so in an orderly fashion you have to pick a number between 1 and 10. It's not a bad system…but it's linear and completely fails if your pain is nonlinear. Nerve pain for instance is nonlinear. It's probably not even possible for humans to grade nerve pain on any scale…somewhere above a 10, and yes there is pain that exceeds 10, you're probably looking at logarithmic pain…and it ramps up quickly…11 for instance would be 100 on a linear scale. A human's not going to pick a 100-point increase in pain in a single linear digit. But here we are.

When you're in this region you're not enduring your pain…you are dropping to the ground, you are passing out, you may be going into shock. Thus is the nature of nerve pain. I can assure you nerve pain is not what caused the opioid addiction in this country. Nerve pain victims require opioids that work in these nonlinear regions. It was the over prescribing of opioids in the linear regions of the pain chart, where they shouldn't have been used at all, that most likely caused the crisis. But we still have a non-linear region.

Now the country has protocol for administering opioids in this linear region and nothing else. And unfortunately, that means anybody with real pain is absolutely fucked. I don't know which political party to blame for this shit show. It doesn't matter if the patient has become the victim. Think about that. With regard to opioids having been removed from treatments, the patient is the victim. Suck on that liberals. Lick my balls conservatives. My apologies I'm in a lot of pain, oh and I lost my ability to walk.

I got to experience that first hand this week and I will tell this story. Recall I arrived at the ER via ambulance but denied treatment for pain on the way. I actually read it that way in the ambulance report. EMT reporting ahead to the hospital that perhaps this patient isn't actually in any real pain. When I go after this hospital for malpractice, I'm going to leave the EMTs off…we still need those guys on the front line and I still need those guys showing up to my house, in serious and professional, asking to start an IV.

When the doctor eventually showed up to treat me there was simply no doubt in my mind there would be no treatment. I was simply there for opioids or whatever myriad of thoughts were going through this particular ER doctors brain housing group. Probably not much, as I would learn. Recall this doctor works at the ER clinic not the real ER, the trauma center…. Their job is to provide Band-Aids at the clinic, collect the deductible, and move them home.

I made the mistake of explaining my pain to be of the 12 level…so not following the rules was probably another red flag for this imbecile with an MD after their name.

vMy next mistake was thinking I had some knowledge of what was going on and felt the need to share it with the person who was charged with actually figuring out what was going on. I told them about my C5/C6 spinal discomfort from about 10 years ago. I told her at this level of pain I'm going to be pushing for an immediate MRI.

She explained to me that this 1000 bed hospital is the third busiest hospital in the country. She explained to me that MRIs are for trauma only… and they would be needed for those patients. Well she's right about trauma patients, I'm glad she's doing her best to support the trauma center. It felt more like a chip on her shoulder since she works at the ER clinic and not a long side George Clooney in the trauma center.

So now that I knew that I wasn't going to be getting treatment, I was free to think through the other possibilities. I was in excruciating pain and I could no longer walk. Of course I had none. I was there for their expertise. Of course she had none either.

As it turns out Fairfax Abysmal has another option if the clinic supervisors have a little doubt in their mind that the patient they are sending home maybe shouldn't go straight home. Probably good not to send someone who can't walk home. There exists in the professional service building the Adult Observation Unit. A master stroke of money saving genius probably dreamed up by United Health Care. The last thing you want to do is send a real heart attack victim home…so if they didn't sufficiently fart out their heart attack, maybe we put them overnight in a holding cell, my bad an observation unit. In the morning if they're still alive it's safe to send them home.

We will monitor them throughout the night by worst and lowest paid the technicians in the building. They will wear rubber gloves and check their blood pressure, oxygen sats, and temperature every 4 hours. If aspirin is to be prescribed, we will have the worst nurses in the building provide them the pills. And we will staff this facility with an attending physician, that we could never put anywhere else in the building for fear of maximum malpractice lawsuits. The Hippocratic Oath does not apply in this purgatory because there are no decisions to be made that could possibly make matters worse. “Hold my beer”, she said. But that story comes later.

As I landed in purgatory on day one of my Six-Day Odyssey, a decision was made. But not by the ER clinic quack, but by the attending physician that night, who correctly thought, a patient who couldn't walk might not ought to be in the observation lounge, as we probably cannot send a patient who cannot walk home. He had the authority so he actually did schedule an MRI. Let's think that through…I'm being put in an observation cell and being scheduled for an MRI. That literally is the business of an emergency room. I'm curious if the ER doc when apoplectic when she heard. She probably did not get the pass back…she had moved on to the patient who needed Mylanta.

MRIs are definitely in short supply and should be reserved for trauma patients. No argument there. Level 12 pain with no ability to walk apparently didn't rise to that level in the ER…it did rise to that level in the observation room because one doctor was paying attention…so off I went to receive the MRI at about midnight on the first day.

In the morning the radiologist had read and reported on the results of the MRI…it was a solid report and indicated the patient had herniated discs impinging on the nerve root at the L34 and L45 disc locations. There's also significant degeneration in spine caused by arthritis. I should have had more milk grown up. It does a body good. It was clear in my holding cell that I probably wasn't lying about my pain. And my inability to walk was not psychosomatic. I thought about sticking knife in my leg to find out.

Well, our conscientious doctor took a quick and mild interest in my case…clearly, we can't send him home there's evidence that he might actually be in pain…plus the fact that he can't walk…there must be something else going on. Whether he instinctively knew what to do or asked somebody, I was scheduled for an epidural of cortisone straight into the button at L45. This sentence they carried out at noon on the second day. At this point, I should have been admitted to the hospital. That however never occurred. I was left in an ER limbo based on attitude, and not a good one. No real doctors would be assessing my case, trying to figure out what was really wrong…instead I was now under the care of a pain physician. Dope him up and send him home. Except, nothing worked. Valium, Robaxin, Morphine, Toradol, Gabapentin, Tylenol, Ibuprofen and eventually Dilaudid, and then later Dexamethasone. Nothing touched the pain, I remained unable to walk, unable to stand, unable to flee a zombie or even get out of bed…I have a worthless left leg that can’t even hang limp. Worse, I have to lay on a tightrope. Movement in any dimension, outside of about 2 inches, sends me into the stratosphere of nonlinear pain.

I don't want to say I'm the poster child for pain, or the infantryman who, having had their leg blown off by an improvised bomb or hand grenade, has to lay in the mud and meditate on the CIA derived numbers, 55515, until Morphine arrives, and hopefully within the Golden Hour…but I shouldn't have to do that meditation. I'm looking for the assistance of modern medicine. I'm at the hospital in one of the most learned and affluent counties in the United States. What if someone falls off their roof, cleaning their gutters, in Erie Pennsylvania, for instance. How long would they have to wait for pain relief? Longer than the Golden Hour is my bet. These things are unconscionable, yet here we are, once again. And we wonder why certain people in our country are fed up with medicine, among other things.

The country seems to be having a conniption, and snowflake meltdown over opioid use…apparently something both sides of the political aisle have agreed too. Yet non-linear pain remains. That's another subject. For me, the scant amount of opioids I did receive, and the large amount of Gabapentin, I have been receiving, up to 1000 mg per serving, 10x what my GSD was taking for back pain, hasn’t done much. Even the veterinarians don't know dick about pain control.

So here I remained, in some sort of experimental limbo, at the whims of doctors who didn't want to treat me, and nurses and techs, who didn't want to be there. The nurses were confused…why are you here? After 48 hours you should have been discharged or admitted to the hospital. Neither was occurring. Each morning, I would talk to the doctor, and each day I would receive a confusing array of medicines from nurses who couldn't even read my medical chart. In some cases, meds were missed and, in some cases, I was able to take medicines at my request, yet I was not informed of that option. Oral Dilaudid was an option I didn't know I had. I've been on IV Dilaudid and it didn't do anything…I was given 5 mg of oral oxycodone before my MRI. Had you seen me in a pale cold sweat enduring the pain to get in position for the MRI, you would know the oxy did nothing. And when maneuvering to lay my stomach, on the tall skinny table for the cortisone injection the next day, the technicians were particularly horrified.

Now still in pain, and still unable to walk, we had a radiology report and a treatment. Something that could be observed…and what better place to observe said treatment but the adult observation unit. I was already there, ready to begin day 3.