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