Narcotics: made my eyes turn brown

I think I know exactly when my CRPS started. It was right after Christmas, and even though I was spectacularly nauseous, cross-eyed with pain, and/or gorked out of my mind most of the time, I could appreciate the appalling humor of most of these events, even at the time.

Chapter 1: Welcome to my wonderful life
I developed such a number of work-related hand injuries that there's nothing like it in the medical literature. Leave it to me to make history in such a feeble way.

I had a ganglion removed from the inside of my right wrist, just over a year ago. Subsequently, I developed a neuroma which was related to the surgery, carpal tunnel which was related to the ganglion, and radial tendonitis apparently out of pure cussedness. The tendonitis got so bad the radial nerve itself got involved.

Cue to second surgery -- December 23rd, 2002, I got a new wrist for Christmas: my carpal tunnel was released, the neuroma on the back of my hand was removed, and a nick was taken out of my radial muscle to give my radial nerve some much-needed room. The only thing to be worried about, the surgeon said, was if the nerve got trapped in the scar tissue. (You can see it coming, can't you?)

The Vicodin made me nauseous. So he gave me Phenergan for the nausea, which made me even sleepier than the Vicodin. Then he gave me Percocet instead of Vicodin, which made me wackier still AND made me more nauseous than ever. My friend Linda took me to the airport to fly to DC, and had the bright idea of taking Dramamine instead of Phenergan. Then I could take the Percocet, and be relatively copacetic and comfortable. The flight was, in fact, better than the previous two days at home on my couch had been.

Chapter 2: Gumming up the works
Turns out I flew into a horrendous tummy virus the entire DC-area family had, but thanks to my relentless handwashing and disinfecting the doorknobs, I actually avoided it. That may have been my first mistake . . .

My insides came to a grinding halt. Stopped up like epoxy. It was awful. Couldn't get anything in, couldn't get anything out.

I stopped taking the Percocet, which had undoubtedly caused it, and tried to hustle things along. Water, fiber, laxatives, Colace, you name it. After chugging a few oz.s of a particularly effective cathartic (magnesium citrate), I wound up FACING the loo and letting go of everything I'd eaten for the past 18 hrs. Then, in a burst of uncharacteristic sanity, I told Mom to grab a book and take me to the ER. Impaction is no joke. Off we went.

Younger brother Rob, bless his heart, drove over from his in-laws and arrived shortly after I had gotten a gurney and laid my sorry ass down. The three of us kept each other in stitches, and got at least a giggle out of everyone who came into the room. This was a great relief because all I could do in the waiting room was weep with the sheer all-body misery.

Mom was frankly astonished at the way I spoke to the nurses. She was discomposed by what she saw as my dictatorial manner. Coming from her, of course, I thought that was priceless, but, more to the point, I was perfectly in my element -- I loved working in the ER, and here I was in an ER where I knew exactly what needed to happen but somebody else had to do the messy part. Woo hoo!

My first nurse was new to the profession and was perfectly happy for help and advice, especially when it came to starting IV's. I told her I was a hard stick, and why: tough skin, leathery and highly-inervated (=very sensitive) vessels, lots of valves in my veins, and -- since I was both out of shape and dehydrated -- my veins were tiny. After one disastrous attempt, she dashed off and got somebody else. That somebody else listened to my description of my veins, took one look, blanched, and ran off to get a third person without even stabbing me first. (I could tell by that that she was a more experienced nurse: never blow a vein needlessly.) Bless her heart, person No. 3 got it in, first try. (She turned out to be an ER technician who's graduating nursing school this year. That girl's got a bright future.) Anyway, even the ones who got scared off were entertained. Two or more Tiffts in one spot always seems to turn into a movable feast of unabashed commentary and shameless wordplay.

Mom and Huck entertained each other endlessly over my steel-plated veins. Bullet-proof skin. Vacuum-sealed gut. Armor-piercing eyelashes.

Chapter 3: Moving mountains
In the ER, a pleasant, sprightly doctor of sensible years did an unpleasantly thorough exam, with the best manners possible under the circumstances. He said I was not actually impacted, it's just that things weren't moving. So, he ordered some blood work, some medication for pain and nausea (YESSS!), some exciting radiological studies, and, once I could bear to move, the most astonishing plethora of enemas -- in fact, pretty much every type of enema I had ever used on others. We went through the entire list. I counted!

I can't help thinking I've probably paid off some serious karma.

Once my stomach stopped arguing with me and my arm stopped screaming, I could prepare for the CT scan. I swallowed the contrast dye like a trooper, thinking that this was another thing I'd had to bully people into, so I was going to knock it back and say, "That's not so bad." I even had intravenous dye, just to make sure we got pictures of everything. It was really interesting to be the subject of all these tests I had administered to others. The IV dye was actually kind of fun -- I was all tingly-warm, and just high enough to enjoy it. Then, back to the ER and more enemas. I wondered when I'd start developing hemorrohoids.

I have never shoved so much stuff up a single butt in my entire life, yet nothing, nothing, nothing happened. It was awful.

With all that garbage going in at both ends, and nothing coming out, I was beginning to feel a bit ragged.

As I lay there, sweaty and despairing, the doctor swung his fist determinedly and said, "Don't give up. I'm not giving up. We can move mountains -- we can move your bowels!" I hadn't thought of it that way.

"Next," the doctor continued, then took a breath to brace himself to deliver the news. "Next," he started again, "we're going to try a soap-suds enema."

A soap-suds enema works like this: You pour a couple quarts of warm water into a bag, add a little packet of castile soap, mix it up, and instill it (nice word, eh?) into the colon in a process that means every leg of your colon gets at least half a quart of warm, sudsy water in it. Have you ever knocked back 2 pitchers of beer in a span of 5 minutes, and then not been able to get to the toilet for half an hour? It feels a bit like that, I suppose, only without the fun of winning a bet for succeeding.

The idea behind the soap-suds enema is that the soap acts on the intestinal lining to make it want to contract, and the sheer volume of water reminds the muscles of the intestine that they have a job to do. It's an excellent remedy, very mild, and is generally well-tolerated. However, it is definitely not the first thing you'd think of when your patient is already packed out to the point where it's standing-room only in there.

I looked at him dumbly a moment. Finally, I got my voice box back in gear: "You're kidding."

He shook his head. "I think volume is the trick."

I didn't know what to say to that. If he thought that 5 days' food and water (and tea and Colace and fiber and drain cleaner -- just kidding -- and I don't know what) and then the past 4 hours' concerted efforts didn't add up to enough volume for any 3 colons, there was simply no reasoning with him.

I fell back in the sweaty sheets and said weakly, "Okay. Bring it on."

The nurse did all the things I remembered doing so often, instructing me in the process I once knew so well but had conveniently completely forgotten the moment I realized I was getting it. I did like every patient I've ever had who had this procedure, and wailed and bitched and moaned that I couldn't possibly hold it, she was going to have to stop, wait wait wait it's coming out. And she, like the ER nurse that I was, was kind but absolutely relentless, and told me first that there was hardly anything in there (liar!), then that I was doing fine, then that we were nearly done, and finally not to fuss because I could hold it a lot better than I thought I could.

Bitch.

She was done, and all that remained was for me to hang onto that ghastly load for 5-10 minutes by the clock, and hope I could make it to the portable potty that stood by the bed.

I lay there, breathing carefully in order not to disturb things, trying not to think about exploding. Five minutes slowly passed. Five and a half.

And then ... it worked. Boy, did it ever work! It worked really amazingly well.

I can't say that I didn't know intestines could hold all that, because I know they can -- I've seen quite a lot of intestinal contents in my professional life, and I'd seen more at once than this.

I've smelled a lot, too, and it was on that scale that this stuff was really impressive. The stink would have knocked over a horse. It certainly cleared every sinus in a 30-meter radius, and may have triggered a couple of asthma attacks. I could hear Mom exclaiming from the hallway, "Honey, is that YOU??"

Even as a nurse, you don't often get to take a whiff of bowel matter that has had the best part of a week to fester and mature before reaching the open air. It's just not a common occurrence. It really reminded me that the colon is simply alive with bacteria whose sole job is to rot your body's effluent.

What rot! What effluent! It was stunning.

One of my nurses came in as I was recovering from my frankly astonishing performance. I felt fantastic, although I could barely hold myself upright. I said, beaming, "Aaaah, the sweet smell of success!"

She sniffed (foolishly), gagged, then riposted, "Well, I wouldn't go that far!

"Chapter 4: "Oh, by the way ..."
Turns out that, among the other blood tests, the doctor ordered a pregnancy test. Naturally, I tried to suppress a giggle. Mom asked, in amazement, "Why didn't he just ask you?"

I replied, "Well, he has good manners. It's not something you want to ask a young lady when you've just had your hand up her butt."

She choked on her water. Rob had to pat her on the back.

I got admitted to the hospital, which meant they had to make sure they had dotted all their i's and crossed all their t's. Somebody at the nurse's desk smacked their forehead and realized that they hadn't checked ALL possible sources of internal distress. The nurse and doctor trooped in with rather grim expressions, and said we had to do a pelvic exam.

ER docs hate doing pelvic exams. They really think it offends their sensibilities as much as the patients' own. (Most of these doctors are men, so we really don't need to comment further on just how silly that is.) They didn't spend ten years in school in order to stick their hands up stranger's skirts. It's gross. Give 'em a messy trauma any day.

Blood, guts, bits of bone sticking out, messy burns, plastic tubing everywhere, monitors beeping in every key -- they love that. P

ubic hair? EEEEEW!!!

Consequently, they tend to be pretty clumsy with the GYN stuff. It hurt like hell. And they expected me to be sympathetic!

Chapter 5: Life on the inside
There was a delay in getting me admitted. The only spare bed in the hospital that night was on the cardiac step-down unit (my second-favorite type of nursing work), and they finally put me there for the hell of it. It was like old home week for me, except their beds and machines were much nicer than the ones I ever got to use. They gave me IV pain medication, but of course they used another narcotic, Dilaudid. (Honestly, my admitting doctor was a bit of a turkey.) I could only have it every 4 hours, but unfortunately it only lasted about an hour and a half, and I spent all that time sleeping because the pain kept me awake the rest of the time. It was another flashback for me to see the expression on the nurse's face when I called for pain medication with tears streaming helplessly down my face, and she had to say she couldn't give me any for another 2 hours. I'm sorry to say, though, that I had no sympathy to spare for her. It was all I could do not to plead or snarl. I suspect she cheated as much as she could without fudging the law, in order to get me my next dose sooner. But she didn't call the doctor for a different order.

Every time I opened my eyes, I saw Mom sitting and reading in the chair nearby, or I saw her coat draped over the back of it and knew she'd return soon. She's no mush, which is just fine, but knowing she was there made my dazed and painful world immeasurably better.

I spent 3 1/2 days in the hospital, getting rehydrated (16, count 'em, 16 hours of a high IV rate before I even whizzed!) and trying to figure out wassup. To start with, I had x-rays of my abdomen, which required having a clean colon. I was utterly aghast when the nice young nurse brought me a bottle of magnesium citrate. I said, "You realize, the only time in my life I had that, I threw up all over the place."

She shrugged. "That's what they want you to take. Your insides have to be clean." This, after 3 days of nothing to eat, and the most spectacular bowel cleansing I've ever seen not 2 days before. There wasn't anything left to clean!

I opened my mouth to argue, but then realized that things could be worse. There's always the electrolyte-based cathartics, like Colyte and Go-Lytely, which taste like a mixture of sweat and window cleaner and come in, I'm not kidding, gallon jugs. I pinched my nose and chugged the dose. Two hours later, my intestinal tract was cleaner than it's been since I first saw the light of day.

Chapter 6: X-ray vision
I was still bloated, but my insides felt as light as air. Sitting in the radiology hallway, with a serious case of bed head and draped in ghostly hospital wear, I felt like a giant marshmallow with a bad hairdresser.

I was fifth in line, but the radiologist, a hunky Italianate with a sense of humor, stepped into the hallway to amuse me periodically. At one point, he asked if I was "Mrs. Tifft." I blinked and said, "Something like that." One of the things I really like about Black English is the title "Miz," which is perfectly respectful yet maritally vague. He wasn't Black and didn't quite know how to recover from the faux pas, so I said what was on my mind, in order to salvage the conversation. He wrinkled his eyebrows and replied, "Your arm hurts? I thought you were here for abdominal X-rays."

"I am. It's been a helluva week."

"What happened?" he asked.

I told him, "I had surgery in three places on my arm on Monday. The first pain medication didn't work and it made me nauseous. The second pain medication stopped me up. I spent ten hours in ER getting cleaned out, and it's taken two days to get me rehydrated. I also had an abnormal pelvic exam. So we're trying to figure out what the hell's going on."

He blinked, looking stunned. "Well, you sound like just the kind of girl anyone would want to marry."

"Yeah," I said, "I'm a ball of fire."

Chapter 7: Radical tonsillectomy
On Monday, I got to see two competent doctors: the partner of the idiot who admitted me, and the gastro-intestinal (GI) specialist he referred me to.

The GI guy was clearly one of Nature's perfect gentlemen. He made a special effort to see me that day, and came in at 4:50 looking like someone at the end of a very long day with no rest in sight. I thanked him for the effort, and he waved off my thanks politely, saying that tomorrow was going to be a nightmare and he wanted to speed things up for me. It was December 30th.

I told him my adventures of the past week, describing my surgery, my pain, and my adventures with my gut. I added, "My pelvic exam was problematic, too. But it was done by an ER doc -- bless his heart, I think he was reaching for my tonsils."

The doctor's facial control was truly admirable. His face flickered as he stored that comment for a private fit of complete hysterics later.

He held absolutely still for a fraction of a second, not daring to breathe.

Then, after a short, controlled breath, he snapped right back into the interview with a straight face. I was impressed.

Chapter 8: Potty training
The GI doctor ordered an ultrasound. The nurse came in with a quart of fluids for me to drink, and I, remembering all the times I had had to send patients back because they hadn't drunk enough, asked for seconds. Well, I still have a nurse's bladder, which means I can increase a full dress size before I become all that uncomfortable. They forget that nurses are weird that way, and think that it's not worth examining you until you're really uncomfortable. And then there was a delay.

By the time I got to ultrasound, I was in agony, and the ultrasound technician took one look at my abdomen and expressed serious concern that I might pop. She scolded me, in her best maternal manner, and said that I should trust her to know exactly how big she needed my bladder. She sent me to the bathroom with a cup, telling me exactly how many times to fill it, and exactly to where.Some idiot had pissed all over the floor. Not just the cute little territorial dribbles most men leave. This guy must've been blind or something. It was appalling.

Incidentally, I've got a little rant to insert here. EVERY guy dribbles. I love my men friends, I really do, but I have to mop after every visit. And, just to cap it off, they don't drip dead center -- they ALWAYS put it just where you want to put your feet. Now, I hate vacuuming, so I never wear shoes in the house. I hope I don't have to spell this out for you. I mean, really, would it kill them to use a little toilet paper? When the door's shut, who the hell is going to see? I've told them: despite what they've heard, there is NOTHING in t.p. that will make It shrink. And don't let's start with the toilet seat thing. The entire lid is always closed except when the toilet's actively in use, so EVERYONE in my house has to pay attention to the seat -- so all of y'all can stop your whinin'!

Boy, I feel better after getting all that off my chest. Back to the hospital.

I was too wonky to really deal with the flood. I unfolded paper towels and piled them high, until no more leaks got through. And then, of course, I had to wipe off and cover the seat, and figure out how to wee into a cup while keeping my eye on the measuring marks and simultaneously keeping the paper cover on the toilet seat in place, while craning over a hugely-inflated abdomen and trying to keep my IV not only inserted in my arm, but out of the toilet. It was the most athletic activity I had had all week.

It turned out that the ultrasound technician had been waiting for me the whole time, and she was rather afraid I had gotten flushed. It turned out there was a larger toilet down the hall, but she hadn't wanted to make me walk all that way. Had I thought to complain, it would have saved a lot of time. And trouble. And paper.

Chapter 9: The sweetest sound I never heard
The tech enjoyed having an interested and educated audience. She gave me a complete guided tour of my abdomen, as seen on ultrasound.

I love radiology anyway, but seeing my own inner workings (working innards?) was fascinating, completely fascinating. Once I figured out how the transducer worked, I could tell what she was aiming at, and could interpret the shadows on the screen. It was the most amazing, warm and fuzzy feeling to see my own organs bubbling and sloshing away, going about their work as we peeked in at them. All the anatomy books, all the photographs, all the trauma surgery had not prepared me for how beautiful the organs are when they're just pottering happily away. I've seen a beating heart in an open chest before, and I thought that was the most beautiful thing ever. I've felt the warm rush of gratitude to my own busy heart as I feel it going thub-bub, thub-bub (I have a tiny murmur), day after day, never asking for sick leave or overtime. I've listened to my lungs -- a lot; I'm asthmatic -- and am probably more familiar with those sounds than a normal person ought to be, but on the days when the air moves in me as sweetly as the breeze through new leaves, it's a joy to hear.

But this was the first time I got to see my own parts in action. Each one is extraordinarily appealing, in its own distinctive way. My liver is a modernist work of art. Jackson Pollock on his best day, working with Miró, after a really good martini lunch with Stella, might come close. It's an arrangement of seriously artistic disorder, with a sense of gorgeously strange method to its apparent madness.

My kidneys are so adorable you just want to cuddle them. Honestly, they are darling! If they were people, I'd want to ask them out, because anything that looks so sweet has got to be worth hanging out with. I never thought of kidneys as being cute before. Who knew? It was marvelous.

The weird thing in my pelvic exam turned out to be picture-perfect ovulation (and a classic example of how poorly-understood what constitutes "normal" is in women, thanks to the centuries-old bias in medicine.) The ovarian follicle swells up as it ripens, forming a cyst; this pops to release the egg. A follicle was in full bloom, opening like a chrysanthemum, the egg possibly visible as it started off, tumbling approximately downhill toward the fallopian tube.

Chapter 10: "Free at last! Free at last! Thank God almighty, I'm free at last!"
The GI doctor with the beautiful manners discharged me just in time for a New Year's I was in no condition to enjoy, with strict instructions to follow up with my gynecologist and a GI doctor at home. Once things were moving, there wasn't anything visibly wrong with me, but everyone was a little worried.

So, I have the rather unpleasant prospect of comprehensive GI and GYN workups ahead of me. (I hear the horrified screams: "That wasn't thorough??)

On the up-side, my arm pain is finally managed, without drugs. I'm using this wonderful thing called a TENS unit. It sends a mild electrical current through the relevant part of your body, interrupting pain signals sent by your skin and subcutaneous tissues. Love it.

There are a couple of downsides: the cords are affectionate, and want to hug everything in reach; and if one pad gets slightly pulled off, the same current gets concentrated over a smaller area, and that HURTS. So I can't use it every time I need it, but it is there for when I can.

I have one on loan right now, but when I get one of my own, I think I'll name it Panacea. Or possibly Heroine, since it does save me, and it takes the pain away. Nice little double entendre.

While I was still in DC, though, I couldn't get a TENS unit. I made the doctor's day when I said emphatically, "I don't want narcotics. Give me Toradol." (Toradol is like Motrin on steroids. The one downside is that the healthiest person has no business taking it for more than 10 days, because it will punch a hole in your stomach.) He blinked and said, "I don't hear that very often."

I'm susceptible to stomach ulcers. I still got Toradol for 10 days. I was so relieved not to be suffering that that alone reduced the general level of stomach acid, so the drug did no apparent harm.

I had a couple of days of lying around the house and recovering, drinking up the ginger ale mom hadn't finished when she was sick. It was absolutely delightful to be warm indoors, have the run of the best private book collection I know of, and have Mom being as sweet and attentive as she could be.

On the downside, I wound up overhearing far too many of her conversations with our nearest and dearest about my recent situation. I had to spend my limited social time trying to explain events tastefully (because of course they all asked me to tell them about it anyway), after knowing for a fact that my mom had been very free in using words like "bowels", "enemas", "pelvic exam", and other ghastly, pitilessly explicit terms to everyone she spoke to. You'd think someone with a vocabulary like hers could come up with something better!

But then I knew I would not be misunderstood, using terms like "insides", "cleaned me out", "female exam", and the like, because those I spoke to had gotten the inside dope -- sorry, the poop -- that is, the facts of the matter, from her in such unmistakable language beforehand. Besides, it made me look all kinds of classy by comparison.

Chapter 11: Need a hand?
Yes, the nerve did get trapped in two of these scars. However, after weeks of hard work, I've made a lot of progress in busting it loose. With any luck, all should be well in a few months.

That was exactly 3 years ago -- to the very day. The rest, as they say, is history.