Comfort Care in the Age of Opioid Abuse (Or “What Happened in the ER the Day I Broke My Face”)


Sometimes, enduring a bad time is about pain reduction, not elimination.

So, Visitors, I have these two little dogs that we rescued about a year after Chris died. My children were bereft at the loss of their father to cancer, and at the beginning of Year Two, I decided that they needed something else to love. Enter Mia and Gigi, a bonded pair we rescued from the local shelter. For dog lovers, Mia is an Italian Greyhound, and Gigi is a dachsund/IG mix. She’s an odd-looking little thing, sort of like a dachshund on stilts.

28827662_1102195246588464_7382364662412004232_o      I have this routine where I clip their little retractable leads to the support columns on the outside deck for short periods of time before I start my day. Being nervous little things, they often get entangled around the posts and each others’ leads.  That morning I squatted to untangle the mess, and had a lead in each hand. Unbeknownst to me, I had left about a four-foot portion of the tiny, threadlike, nearly invisible lead strung up between two of the support posts, about three inches off the deck.

This makes for a very effective tripwire. Boom! Down I went like a felled tree, catching myself with my face. I lay there stunned, face down,  as a pool of blood collected beneath my head on the deck.

As awareness returned, I realized I was very badly injured as I hadn’t braced myself with my hands. I staggered upright, hazily trying to locate my phone, blood gushing everywhere. I found my phone, and called the nearest daughter for help. She dropped everything, and headed over. I then called the paramedics and bled a trail out to the front of the driveway where I waited for them to arrive.

Now, here’s where it gets interesting, Visitors. For those of you who don’t have a lot of experience with trauma or illness, I want to tell you there is a great deal of MENTAL activity that is influenced by the PHYSICAL past and present, and vice versa. What happened next is also pretty bloody and descriptive, so be warned.

Before I called for help, I blearily tried to assess the extent of the damage in the bathroom mirror. To my dismay, I could see the outline of my teeth through the split in my lip. Instantly, I was catapulted back to the day in October where I helped a young boy through an automobile trauma that involved a massive hand-sized piece of flesh that had been stripped from his exposed skull. (See “On the Short, Sweet Life of Liesl Wiebe” in the search bar above”. ) The tear in my lip was that deep, and the triggering flashback was completely paralyzing for several minutes. Classic PTSD response.

After that waned, the wash of pain that flooded over me was simply dizzying. I grabbed a hand towel to press to my face as I went outside to wait for the paramedics, weeping uncontrollably. I tried to control my breathing, knowing that if I tensed up and made the pain worse, I would likely lose consciousness and fall again.

One first responder  arrived in his own car, and through tears I got out what happened.

“I am so sorry this happened to you!” he said, as he proceeded with the exam.

“Me too!” I wailed.

The next set of paramedics arrived in an ambulance truck. I repeated the story through the bloody towel.

“Good grief,” said a burly one, who seemed in charge. “Well, your nose is likely broken, which is painful as hell, and that lip needs quite a few stitches.  I’m so sorry!”

“Thank you.” I said. I could feel a bit of mental clarity returning.

“What’s your pain number now, dear?” said another as he pressed my neck and spine.

“An eight.” I said, muffled through the  blood-soaked towel. “Unaided childbirth was a nine.”

“Ohhhhh, shit! ” he muttered.

I laughed just a little, wincing through streaming blood. I could feel my body unclench a  bit with that tiny bit of empathy, and a voice in my head assured me that this will end, I will feel better in the not-too-distant future. I was certain I was headed for a cascade of ‘the good drugs’ if I could just hold it together a little longer. Opioid Heaven, here I come.

The men gave my daughter detailed instructions for the ER, and informed her that since I didn’t lose consciousness, an ambulance ride wasn’t merited. I was happy enough to ride in with her, and was loaded into a wheelchair when we got to the ER.

When I got assigned to a room, a friendly nurse bustled in and performed his assessment.

“Well, that looks like shit and must hurt like the devil. I’m so sorry! Let me tell you about my aunt who got tangled up in HER dog’s lead and broke her hip!”

He compassionately related a similar story of injury, concluding with his aunt’s bouncing return to good health. I could feel myself relaxing a tiny bit more. This will end.

“So you think I’ll live? They can stitch me up soon, right?”

“We see stuff like this all the time, hon. These doctors are good.” I could breathe a little easier.

So I waited, and shortly a red-haired, competent PA came in and did his assessment.

“OK, here’s the plan. We get you stitched up and we will take several scans to look at your head and neck to make sure that’s OK”.

OK. So, what followed was pretty gruesome. He injected several doses of lidocaine into the wound, and I crushed my compassionate daughter’s fingers into a powder during that.  She chattered away and held my hand until the medicine took effect.  Then, he gave me two internal stitches for the inside of the lip, and six to stitch up the outside.

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After that horrible procedure, I started to feel a little more like a human being again, instead of a walking mass of pain.

I then saw two sets of imaging technicians, one for CAT scans and one for X-Ray. Each had a compassionate story to tell that involved freakish accidents with pets. I smiled at each one, grateful for the diversion. I felt a little more at ease with each one.

Finally, six hours after the stitches were in place, I realized that the lidocaine was wearing off, and a big bass drum was beginning to play in my head.

“Nurse, may I please have some pain relief?  This is getting bad.”

“Of course.” He promptly scanned my bracelet and dispensed 500 mgs of naproxen, and over the counter anti inflammatory drug, and a single Norco, one of the slightly weaker opioids.

Oh my, I thought. This will be an experiment in trust. I didn’t think that was anywhere close to enough to mitigate the chaos starting in my head.

I downed the drugs, and in less than an hour the pain began to ebb. The capable nurse came in again, and gave me the wonderful news that incredibly, my nose wasn’t broken!

Visitors, what can I say. I like to cook, I like to eat. The prospect of not tasting my food for months until my broken nose was healed was depressing. This whole freakish episode threatened to plummet me into incredible depression. The news that my nose wasn’t broken was welcome indeed. Then my boyfriend arrived – code name, Stockholm- hugged me and held my hand some more. I relaxed a little more.

Eight hours after those whole interlude began, the PA came back to my room. My nose wasn’t broken, my neck and spine looked normal, and I had one upper lip again instead of two.

Oddly, I discovered that all of the compassion and kindness had helped. The single Norco and naproxen had reduced the pain from a shriek to a dull roar, and with so many people around determined to help me, I discovered that I could handle this mess with a minimal amount of chemical intervention. It’s almost as if people are good medicine.

Go figure.

American Visitors, I’m sure all of you know someone, or of someone, who has been touched by this opioid epidemic.

MY particular set of problems that day produced an amazing amount of excruciating pain. The gentle touch, the encouraging word, the capable presence of professionals and friends, all of these things helped to de-escalate the pain to a point where a minimal amount of pain-relieving medicine was necessary. Isn’t that interesting?

I can handle this, as a group of pop philosophers once said,”with a little help from my friends”, and much less help from the opioid bottle than I thought.

The takeaway from this terrible day? Get messy. Call your friends. Offer to help. Go to the hospital. Hold a hand. Use swear words, feel for your friends, be sorry for them, you just might influence a positive  outcome much more than you think.

Much love,

Victoria

 

 

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