I'm sorry that this is all about me lately, but ...

... my stupid and evil pancreas (and the pain thereof) has kind of been the focus of my life over the past couple of weeks. So, I posted about ER visits #1 and #2, and left you hanging about ER visit #3, which my GI doctor's office told me to make, right? Okay. Scott came to my apartment and picked me up, and off to the ER we went. (Incidentally, while we were there we ran into someone that goes to his church, so we were talking to her while her dad was back with the 0%-compassion ER doctors. Her dad's caregiver was there too, and when she came in she told us that people were coming out of the ER with prescriptions for Lortab and such, and selling them right outside in the parking lot. Nice. So the 0%-compassion ER doctors, who walk around with soap boxes for shoes and who think they are waging personal wars on drugs, are - uh, not. Instead they're making chronic pain patients cry.)

Anyway, we had to wait for hours and hours, and Scott read an article called "Dendrimer-Functional Self-Assembled Monolayer as a Surface Plasmon Resonance Sensor Surface" to keep him occupied (he's a peach - I kept trying to make him go home, but he stayed until I left, at 3AM. He's also such a science dork. I love him.) When I went through triage, the nurse looked at my chart from earlier and said, "Oh, so you don't have pancreatitis, huh?" I said, "I wish." He said, "Well, your enzymes aren't elevated, so they have here that you don't have pancreatitis." I said, "I have CHRONIC pancreatitis. The enyzmes don't go up anymore because my pancreas is a shriveled, calcified, fibrotic nugget." Don't have pancreatitis. I wish. And then when I saw Dr. 0% Compassion, he determined that I take narcotics. Well, duh - I have a chronic pain condition that I'm trying to manage. Then he says that he called my GI doctor twice and that the GI doctor told him that he was concerned about addiction and tolerance. (Again, duh on the tolerance - I've had to take pain medicine on and off for years - I'm sure I have mu opioid receptors galore. It also happens with steroids, and TOLERANCE and physical dependence have nothing to do with ADDICTION.) Incidentally, I think I love Dr. Jennifer Schneider, MD, PhD, and I almost want to travel to Arizona to see her. She says something great in this interview about addiction, that tells me that I'm NOT an addict:

Opioids also can, and usually do, cause physical dependence. The body makes changes to adapt to the opioids and if you stop suddenly, you get this unpleasant withdrawal syndrome.

... that's what physical dependence is — it has nothing to do with addiction. Addiction is not necessarily a physical thing. Addiction is a psychological phenomenon consisting of three elements. One is loss of control, which means you intend to use only so much but when you have access you keep taking the substance. The second is continuation despite significant adverse consequences, which means even if the substance – let’s say alcohol -- is causing liver damage, you’re arrested for a DUI, or are fired from your job, you still take it. In fact, one of the major differences between chronic pain patients and addicts is that the opioids expand the life of the pain patient. They make things better — they improve the patient’s functioning and pain whereas with the addict, their life constricts and they become more and more focused on the drug that they are misusing. So you have the opposite effect, and that’s what I’m talking about when I say addicts continue to use it despite adverse consequences. Pain patients on prescribed opioids don’t have adverse consequences — they may have side effects from opioids but they don’t have these types of adverse consequences (eg, loss of a job, organ damage). The third element of addiction is the preoccupation or obsession with obtaining, using, and recovering from the effects of the drug.

The thing about expanding your life is so true - when my pain is controlled, I feel like eating, exercising, spending time with Scott/family/friends, enthusiastically getting through my rotation assignment for the day, and studying at night. Oh, and I can sleep without having to wake up in the middle of the night in pain. When my pain is undertreated (like I was on the q8hrs prescription from the pain clinic) I can barely get off the couch, I have to lie in the fetal position to try to squish my intestines together, I find it hard to concentrate on anything because the pain is so bad, and I'm in a bad mood. It's not withdrawal, it's pancreatitis pain.

Back to the ER. Dr. 0% Compassion, after telling me that my doctor thought I was an addict, said, "You addicts lose the high from your Lortab or whatever, and come in here for your IV Dilaudid fix." Yes, he called me an addict. I said, "I haven't been to the ER as a patient in SIX YEARS." That didn't interest him - he went on to tell me that I was not going to make it through the rest of medical school, and by this time, I'm so humiliated and beaten down and sad (not to mention in pain) that I'm just sobbing. And then he said that he was going to order an abdomen/pelvis CT and if he didn't see acute pancreatitis, he wasn't admitting me. (If I hadn't been crying so hard, I would have told him that he wouldn't see ACUTE pancreatitis - I'm way past acute.) "I'm telling you this as a friend," he said, and left - I didn't see him again. They gave me a shot of IV fentanyl, told me that I didn't have acute pancreatitis after my CT results came back (surprise!) and discharged me, so I left feeling worse than when I came in.

Yesterday, I went to see my GI doctor (who told me that he told them that my pain was not being managed well and that I needed to see a pain specialist.) He also told me that I wouldn't finish medical school if I was taking the medication that I've been taken throughout medical school (and throughout my life, for that matter) and that if I did, that I'd be fired from residency. Great. So part of my breakdown last night was the idea that the past two years of my life have possibly been for NOTHING. That I've cried and basically given up my life, and sacrified so much, and spent so much money and borrowed so much, for NOTHING. That better not be the case.

Y'all pray for me, please.