vendredi 12 août 2011

pain, a discrete branch of medicine

A few days before Frida Kahlo died on July 13, 1954, she wrote in her diary: "I hope the exit is joyful — and I hope never to return — Frida".

This time i'm not rushing to get there
we've given it three hours and i'm plenty early
it's a hot 85º outside so i hole up with a
book i've been trying to read for
a month in spite of motion sickness
a french book nonetheless just to
make it harder on myself
roll eyes, cue exhaustion, 
drop the book on the floor
jerk awake, hear my name called

Standing in line at the
prescription counter (main pharmacy)
i take a number - #0013
it gives me time to decide
if i'm actually going to buy this poison
the new doc has just prescribed
or if i'm going to stand by my guns
and tell her to go fuck herself

A year ago out of the blue my pain swelled
so hot and white that all i thought about
was getting out out out of here
the bottle of pain pills was full at the time
it would have been so easy, so
righteous, so in or out of your face
depending on our relationship
all without a shred of salvaging guilt
instead i got an increased dose
then decided to titrate off all narcotics
i got to half my usual dose and stopped
before the pain punched a wallop

Six months later in her office, I tell the doc
that i need extra 10s to break the pain cycle
breakthrough meds like i used to get
before i titrated down to almost nothing
"our little experiment didn't work 'cause
i hit a pain wall and it was a knockout
my shoulders are up to my earlobes
and i'm carrying a second body around
there's a burning fire i can't put out
in my arms, in my breasts, in my lymph
i've been surviving like this for 12+ years
and i think i know what i need to control it"

"well, it's still more of the drug, dear,"
smiling with a sardonic glint
as if she's already read my script
and disapproved of my editing
"besides," she suddenly announces
"this pain med is going off our formulary"
and she offers me another neuroleptic
the one another doc had recently said to avoid
at all costs: "the side effects are awful"
but that doc had another one to try
because each new doc has a favorite kind
"prescribers" i think and i sigh, resigned

At home on the web I read pages of comments
by patients transitioning from one pain
med to the other, to the one my new doc
suddenly remembered to discuss with me
after 40 minutes of useless arguing
"oxymorphone is 2x stronger than the one
you're on", when all I really want is not
to be knocked out, to be able to sit up
and take nourishment without an overwhelming
desire to throw up and maybe write some poems
is it permissable to still want to write poems
with a 24/7 pain condition?

When the pharmacy tech arrives
i still haven't decided
so i plop down 60 bucks
and take all of it
topa topa topa max
maximum security prison
i'd rather be fat and free than
under the twinkling eye
of lousy prescribers
topa max, i think when i get home
no thanks!
been there, done that!

And then my eyes fall
upon unforgettable words
"when they changed the formulation
of oxycontin a year ago..."
pumped it full of polymers and fill
to keep addicts from crushing it 
and sticking it in a needle
and how all the pain patients got sick
how it lost 20-30% of its efficacy
with burning guts, face rashes, oozing
orange gel from rectums... oh my god!
yes yes and yes, plus tachycardia!
and when the pain ganged up on me
and i suffered alone for three solid months
enough to contemplate suicide
and leave my family to grieve what
they should have done to save me
(but never could)
no one had told me about the bait
and switch of one pill named OC
for another, same color, named OP
not purdue pharmaceuticals 
or my stupid doctors

"so if it's not on our formulary," said the doc
"you're going to be the one paying for it
out of pocket, so i think we had better
consider trying oxymorphone
go home and look, you're a good researcher"
and i feel a pain slither through my gut
the first alarm that my constipation is
coming to its bitter end along with
my appointment, my heart racing to 120
as I rise from the cushy chair with loads
of new options dangling from my hand
and a sick feeling like i'm sooo done
and i hit the bathroom, still unaware that
a now uncrushable polymer-laden pill
that used to work well for me before
has made me so much sicker
and that is why i have had to come
100-plus miles to meet my
great - new - prescriber

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