Thursday, August 31, 2017

The Hardest Part is Being an Alcoholic

Sunday, 8/20/17, just after noon.

Last week, I spent Sunday, Monday, and Tuesday in a local hospital, where I received excellent care and kindness for the extremely painful condition known as 'small bowel obstruction.'

As it happens, I had been hospitalized with the same condition on Easter Weekend in April of 2001. Despite that prior experience, I didn't recognize what was going on with my body for several painful hours; I thought my hiatal hernia was acting up, and I just  needed some antacids.

The antacids did not help.

 Finally, sometime around 3:30 Sunday morning, I realized that what I was feeling was almost exactly what took me to the Emergency Room 16 years ago.

That visit in 2001 had been an awfully chaotic experience. I had important plans for the Easter Sunday Morning service, to be shared with my beloved brothers and sisters at Allen Temple African Methodist Episcopal church, so I resisted going to the ER until I had no other option, and that meant I arrived there in the late afternoon on Saturday.  
Holy Day weekend or not, Saturday night in a major trauma center is THE gathering place for people who exercise their hard-won liberties by ingesting non-standard pharmaceuticals, and/or copious quantities of fermented and/or distilled beverages, and then find it intolerable that neighbors/friends/relatives hold an opinion on any matter which is contrary to theirs.
So, they fight, with whatever is at hand. They use fists, sticks, fish-sticks; knives, guns; lamps, sofas; cats, weasels, ferrets, squirrels; they have also been known to use the occasional  stuffed penguin which sits in peace on top of the television. All of these memorabilia have been painstakingly gathered over a period of  months by someone with an artist's eye and the ability to attend yard sales.
But on Saturday night,  temporarily any of these treasures may receive a  re-classification as a projectile or a blunt object, and are enthusiastically presented in an active discussion, whereby good friends and close relatives express their concern that a Significant Other is mistaken in their opinion.
And then somebody calls the cops. And then they go to the Emergency Room, because it is a Saturday night.
While the Game on Foot is entertaining enough, sometimes, regretfully, they do not live close enough to the intended recipient of their wisdom to immediately have the desired face-to-face negotiations. In these cases, it is necessary to utilize the family vehicle in order to arrange the meeting.
And, in a certain (large) percentage of those using this approach, something interferes with the proper operation of the family vehicle on our community's roads and highways. Sometimes, it is another family vehicle, but just as often it is a tree, a curb, a light pole, construction equipment, or a Waffle House.
And then somebody calls the cops. And they go to the Emergency Room (along with anyone they may have mashed with their family vehicle), because it is a Saturday night.
That was the environment I walked into in 2001, bent over and experiencing the worst pain I'd ever had.  The staff were dealing with inebriated, frequently hostile, occasionally incoherent clientele, bleeding from assorted locations.  Cops and EMTs chatted with each other, attempting to sort out who did what to whom, for later court proceedings.
And meanwhile, I'm sitting on a stretcher in the hall, doubled up in pain, biting on a towel and screaming quietly so as not to disturb anyone. And at some point,  I discovered that the reason that they couldn't give me anything for pain right away was because they had to make sure I wasn't having a heart attack. That particular trip ended in surgery, and a lengthy recovery period, as I had been a very sick young man.


This time, I didn't want to be sitting around for hours in the ER waiting for a doc, or for X-Ray technicians, so I decided to wait until 7:00 before leaving the house. I figured the shift would have changed by the time we got there, and that would cut down on the waiting. Usually, based on my own ANCIENT (1972) experience working in an operating room, early Sunday mornings aren't really busy. I figured it would cut down on the time it would take for me to be seen; and with my prior history, and my distended abdomen as hard as a rock, I figured it might cut down on the time it took to rule out a cardiac event.

 It also meant 12 year old Kenneth and 11 year old Alicia wouldn't have to get up in the middle of the night, and I could let son Jordan and daughter-in-law Courtney sleep a little longer, too, since they were my plan A for childcare.

That might not have been the best decision. By one of those statistical flukes, they had a LOT of psych admits the night before. No idea why; were people getting anxious about the impending eclipse? At any rate, although the waiting room was empty, ALL of the ER rooms were packed, and I got a stretcher in the hall. If I had come in at, say, 4:00 AM, I might have gotten a room. Don't know if it would have made a difference as to my treatment, however.

At any rate, the location of my stretcher didn't bother me. The SINGLE issue of concern was the pain I was experiencing in my belly.

My belly is in pain because some part of my gut has closed, so that nothing can get by. 'Nothing' is literal: no food, no liquid, no air. So, beside everything I had to eat and drink, all the drainage and regular processes are continuing to dump into my gut, and there is nowhere for it to go, so my gut blows up like a balloon. At the time I wrote this, five days later, I was still swollen, and a LITTLE sore; but on Sunday morning, my belly was rock hard, and it looked like the belly of a woman 9 months pregnant. And the pain was such that I could not speak a coherent sentence.

I am no stranger to pain; it's a constant companion. And let me milk that analogy for all it's worth: I am no stranger to cats, either. SugarBelly, my fat black Manx cat, is also a constant companion. So, let's use SugarBelly to represent the pain I usually feel.   Here she is, playing with 18 month old grandson Trey:
See, this isn't so bad. Nice kitty.

But what kind of kitty cat will represent the pain I experienced with the small bowel obstruction?

A Kzin.
With a laser.
"I'm in your guts, monkey boy."

Except not nearly as funny.

I think it was around 10:00 AM before I was finally able to see a doc. Fortunately, I had my medical records with me (another story), and they had access to the prior surgical records, so that helped. They immediately slapped an 'NPO' status on me (meaning I could have nothing by mouth), and put in an IV line, so I could get fluids (I was dehydrated) and eventually, the nurse arrived with the blessed relief in the form of a shot of Dilaudid.

I could feel the goofy bit in my head almost immediately, and I was worried that might be the only effect. The deal with a lot of pain meds is that they really don't take away the pain; they just make you goofy so you don't care about it. However, I was going to have to be a LOT goofier before that would work. Fortunately, though, in a couple of minutes I could feel my belly pain change, first from something near unbearable, to "I swallowed a cactus" , then to a pain like cramps, and finally it eased off into the background and I was back in the world of humans again.

Then, they gave me a nasogastric tube, and started to drain my belly, and eventually, that's what took away most of my distress, and kept it away.

And then, life-threatening crisis resolved,  the docs, nurses, other medics, and Mrs. Jordan, the Haitian angel who arranged her housekeeping duties so she could stop by and pray for us, left us to minister to those in more immediate need of their services. This leaves me with some privacy with my gift-from-God, happily-ever-after, trophy wife Vanessa, the elegant, foxy, praying black grandmother of Woodstock, GA. No, we did not use this as an excuse to make out (hardly at all); I still have a tube up my nose. But we do need to figure out how to work out the details, like taking care of the kids, getting them off to school on Monday, does Vanessa stay with me that night or go home; all that stuff.

And then finally Sunday is over, Monday (also Eclipse Day) is here, and I am left inside my head to figure out what I'm going to do about pain management. 'Inside my head' is not the best and safest location to make decisions about mood-influencing medications.

You see, years ago I forfeited the privilege that normal people have, of access to God's gift  of comfort and relaxation that comes through appropriate use of alcohol. There is plenty of evidence that people with my genetic make-up have problems, but it was my own actions of consistently abusing the privilege, ruthlessly and without relenting, over a period of decades that lead to abstinence as the only solution.  Thanks to some pretty amazing circumstances (another another story), I took my last drink on January 1, 1988. After that date, I gradually and painfully and joyfully developed a way of life that would provide me workable alternatives to the relief and sense of ease and comfort that alcohol regularly brings to the fortunate majority who were less profligate in their actions in their early days.

But, because of my history, I am faced with a dilemma.

You see, the hospital policy will NOT permit me to use my own, less powerful medication. It's Against The Rules! And I AM going to need to have something to manage pain. I have both the residual gut pain I feel from having my intestine blown up like a balloon, as well as my customary ankylosing spondylitis pains, aggravated by having to sleep someplace beside my bed (although the hospital bed wasn't bad at all).

BUT: the only pain med the doc has written for me is Dilaudid, which is a synthetic form of morphine, a heavy duty narcotic. And I can have it as often as every three hours, IF I tell the nurse my pain is 8 or 9 on a 10 point scale.

With the very first doses of pain meds, in the crisis moments in the Emergency Room, and on Monday morning in my hospital room, I didn't have any control over what I was given. I hurt, this is what they had on order, they gave it to me, no discussion. After that first Monday dose, though, I have to come up with a plan, because I'm the only one who understands all the factors in play.

Now, my cunning, baffling, and powerful alcoholic mind tells me: 'Don't be ridiculous! These are guilt-free drugs! You didn't choose this, this chose YOU! Take the drugs, enjoy the high, and you'll never have to deal with this again.'

But another voice tells me: 'You better DON'T! Sure, this set of circumstances isn't likely to repeat itself, but are you really wanting to get high so much that you are going to put your integrity on the line?'

I wasn't sure how it was going to turn out, frankly.

And I decided to manage the issue by seeing just how long I could go without asking for pain relief. Things weren't HORRID; if I had access to my own, less potent pain meds, I would have taken something, but I sure didn't need the Dilaudid to manage what I was experiencing. So I held out, just  until 2; then once I had made it until 2, I decided to see if I could go until 3; then 4, and then 6, and then 8.

And then it was time for my sleep meds. At that point,  I did two things: first, I accepted the pain shot. I had been brave long enough, and it was time for me to catch some relief. Second, I asked the nurse to see if he could get the doc to authorize a less powerful pain med.

And the nurse asked the doc, and the doc authorized something milder; and that's what I took on my last day in the hospital. It's how I got out of the hospital without cherishing the sensations of being utterly dorked on narcotics, and perhaps relapsing later into abusing prescribed pain meds.

I know that my cunning, baffling, and powerful alcoholic mind used to argue me into all sorts of situations in which it was ESSENTIAL that I take a drink. I don't get hooked by that kind of thinking anymore, and I haven't picked up a drink since the last one on January 1, 1988. It's a relatively straightforward transaction: if I don't take the first drink, I can't get drunk.

But, I'm an alcoholic with a chronic pain condition, on daily pain meds since 2005, and the option of life without pain relief isn't open to me. It's been a difficult path to navigate; unlike alcohol, I can't abstain from narcotics.

I know; I've tried. For almost a year, from 2012 - 2013, I was was determined to live without narcotics, and relied instead on meloxicam, a powerful non-steroidal anti-inflammatory drug. It worked great for months! But then, I started to experience severe gastric distress, and when the bleeding started, that was the end of my treatment with NSAIDS. Now, I can't even take an aspirin, or ibuprofen, much less the more powerful formulations.

So: how do I maintain my sobriety, and at the same time have access to narcotics?

The solution requires rigorous honesty, with myself and with others, and also strict determination to ONLY take the narcotics for pain, not for emotional relief. I have been completely open about my history with the docs at the pain clinic. I'm subject to frequent and random drug screens. On the single occasion when one of the docs at the clinic demanded it, I went for an addiction screening with a Certified Addiction Counselor (which I paid for, by the way), and was given a clean bill of health. Perhaps most importantly, we have found a weekly patch medication called Butrans, which doesn't goof my head the way that the other narcotics do, and still effectively manages my pain.

I'm at peace with that. If I could live without the meds, I would. Since I can't, I use them as directed. And I spend as much time in self-examination as I need to in order to maintain my peace of mind.

Peace be on your household.


  1. I understand the struggle. I've had vicodin 5's prescribed, as well as other strong pain relievers (I like the Oxy best - it doesn't mess up my gut). But My family has issues with addictive behaviors, so I have to be very cautious. Heck, I have pain meds prescribed from years ago, still in the medicine cabinet. If I take something, I'm in bad shape. So, like you, I learn to live with it.

  2. I know what you mean about living with pain. It makes it hard to think, and almost impossible to make good decisions.

    I'm fortunate that Celebrex, which is not a CFS med particularly, seems to handle keeping mine down to a dull roar.

    And I never leave home without it - and the other meds I take every day, because the generics only work from some companies and the hospital can't guarantee which generic company they use on a given day.

    We have the argument every time, but I just tell them I already took it! Then they get 'permission' from the doctor for me to take my own. Whatever.

  3. I don't need regular pain meds, but I have needed them situationally in the past, with surgery/kidney stones/broken tooth, and I have discovered that I absolutely LOVES me some pain meds. This scares the crap out of me, which means I don't touch them until I've been screaming for a while.

  4. As a fellow recovering addict, who just happens to come from the pretty end of the same gene pool as you, I always find it interesting when we have parallel experiences. When I was in the hospital having my first son, in my head I had already decided that I was going to take every single dose of pain pills they'd give me. My DOC is fentanyl, but opiates and opioids in general are my favorite, so as soon as I was offered pain meds, I jumped on it. I have never been so looped in my life. I was spinning, sick, couldn't concentrate, cotton in the ears, zero euphoria. Right then and there, I decided I was done. Even if I was offered pain meds in the hospital, I wouldn't just take it because I wanted it. Life is better without abusing substances, it just is.
    Also, 91 days sober today. And September 6th marks 4 years clean.