LEGACIES AND LOLLIPOPS - Part Seventeen
By MAGDALA
PART 17 FIRST DRAFT
The tragedy of life is what dies inside a man while he lives. - Albert Schweitzer
The level of noise in the auditorium from the chatting students was surprisingly loud as a Tink and I re entered and stepped onto the stage. They fell silent after Tink rubbed the white board clean and picked up a marker.
"Now I am going to write three lines down and I want your honest and immediate reaction." She spoke as she wrote.
"Pain patients use narcotics often.
"Narcotics can be addictive.
"Therefore pain patients are often addicts."
"Hands up. All those who agree with that statement?" A number of hands went up. "Leave them up ... How many is that, Stacy?"
"Fifteen." I answered. The bully from the first half who had so much trouble with the white board had his hand up and had obviously networked and gathered numbers during the break. They started to put down their arms.
"Leave your hands up I will want to deal with your questions later." Said Tink. "Have you got that letter, Stacy?"
I handed her Cameron's blog.
"Everyday he attends work, it is an act of personal courage. This is a man with few reserves of energy or fortitude He measures himself and manages his output of energy and intake of medication with care. But an unforeseen physical or emotional event can put him at risk then it is clear just how fragile he has become.
This is as a result of his original injury and the continuing undertreatment of the severe pain he has now suffered for many years. He compensates by keeping others at a distance that they don't, won't, or can't see it.
Some aspects of his personality indicate the chronic pain may have remodeled his nervous system. He may also be suffering from pseudo-addiction due to inadequately treated pain. He deserves more understanding but behaves in a way that leads some of his colleagues to believe he is addicted when all he requires is better pain control."
The writer of this feels honored to work with this man. I am honored to call him my friend."
She walked to the edge of the stage and signaled to the people through the door, which had been left ajar.
"Ladies and Gentlemen I want you to welcome Dr Gregory House."
Julian wheeled Greg in and they stopped at the foot of the stage. Greg was already wearing an open lapel mike. "You see. No wheelchair access to the stage. They don't want gimps talking." Tink and I walked forward got down and swung our legs round so we were sitting on the edge of the stage either side of Greg. Greg kissed Tink on the cheek "Tinkerbell that soppy introduction. You are a most embarrassing woman."
Greg looked at the audience. "I would like you to meet Mr. Julian Campbell he is Professor Chan's husband and a leading British microsurgeon. In England they work and study for years so they can be called Doctor then they do twice as much work to take up a specialty so they can be called 'Mister'... I've never worked that one out."
"Have fun I'll go and sit up the back with Dr Wilson and Dr Cuddy. Tink, are you aware there are a heap of people with their hands in the air?"
"They thought PNT was right." Tink explained pointing to the message she had written on the board. Julian looked at the students.
"Not very smart ... my wife looks cute as a button but if she sees a lack of compassion she's sweet as a razorblade."
He headed to the back of the hall clambering through the crowded aisle.
"Have you covered the "paleospinothalamic" pathway of chronic pain? The hypothalmus and limbic structures?" Greg asked Tink.
"First off" she answered.
"And you still thought PNT was correct." he looked at those students with distaste. "Leave your hands up until they start to shake."
"Listen to me and listen good. I have chronic pain, pain-killers don't make me high, they make me able to function. They stop me from screaming, throwing up or passing out, which is embarrassing to everyone and would frighten the patients..
"People pain take painkillers when they have pain. They are dependent on them to control the pain they are not addicted.. If the pain stops so do the pills. That simple. People with chronic pain may be dependent on their medication but in less than one percent of cases show any signs of addiction.
"Pain is exhausting and misunderstood. Those who live with it are often exhausted and invariably misunderstood. Under-treated chronic pain destroys relationships. Very often the person suffering chronic pain loses their marriage, their job, their home and their livelihood. First they lose their lives and then often they will take their own life."
"I am fortunate I can still do my job. I still have a friend. But as someone with chronic pain I am not alone. Between 70 and 83 million Americans suffers chronic pain but there are only approximately six thousand medical practitioners with the guts and the humanity to treat them."
He looks at the students with their hands up. "Put your hands down you idiots you are not alone either. The only thing that might stop you from souring to mediocrity will be a lawsuit based on elder abuse or medical negligence. Because you don't give a damn you won't have black helicopters circling your practice and your patients won't be woken at 4.00am by a SWAT Team."
Greg turned to me and I could see how much this was taking out of him. "Stacy tell them what happened in 1984."
"In 1984 Congress handed the DENS Office of Diversion Control discretionary power to revoke a doctor's registration to prescribe medicine. From that moment in order to write prescriptions, doctors had to be registered with the DEA." I said. "This legislation enabled the government revoke the registration if a doctor commits "such acts as would render his registration inconsistent with the public interest." This phrase, buried in the fine print of the Dangerous Drug Diversion Control Act, significantly expanded the ODC's latitude."
"This country established a bureaucracy to catch doctors making errors." said Tink. "As a result, fear is endemic among physicians."
One of the students's raised her hand. "Yes" said Greg.
"How did this start?"
"Someone in Washington said 'Just say NO to Drugs' and that resulted in opiophobia." Said Greg turning to Tink who took over from him.
"Opiophobia is a generalised but erroneous fear of narcotics and addiction on the part of physicians and patients. You will find Opiophobia in your study kit provided. You will find several excellent article and the Martino paper. I'll read you an extract from that paper."
Tink opened her file and started to read.
"Opiophobia has been heightened in recent years by the rhetoric accompanying the government's War on Drugs. One of the central tactics in the War on Drugs has been to focus broadly on the horrors of addiction in media campaigns and anti-drug and prevention programs, without drawing distinctions between drug dependency and abuse or types of addictive drugs. It is thus not surprising that many patients fear that taking any drug in large doses for relatively long periods of time will cause addiction." Additionally, doctors who do treat pain aggressively often face the threat of investigation by medical boards or the DEA, a circumstance that can ruin the careers of doctors, even when cleared. Hence, internal values and external consequences contribute to the Just Say No ethic in pain treatment."
I then took over outlining the New Jersey legislation and quoting from it.
"When protracted prescribing of narcotic drugs is utilized for the alleviation of intractable pain, practitioners shall remain alert to the availability of new or alternative types of treatment. The practitioner should attempt periodically to either cease the medication or taper down the dosage, or try other medication or treatment modalities in a regular and vigilant effort to reduce the addiction propensity for the patient.
Regulations have the force of law, and compliance with specified conditions becomes the responsibility of the practicing physician. Indeed, failure to comply with such conditions might constitute a violation."
A number of hands went up and they were all looking at Greg. "Have you ever had to stop taking medication?"
"Yes and the pain was damned near unbearable. What I did not know was that red flags were popping up. I had no idea what my doctors were going through. But it would have been easier if they had leveled with me. Maybe then we could have done something to make that week easier. But I felt I had just been hung out to dry."
Again a heap of hands went up. "Isn't there something doctors can do about this?"
"You won't find any politician left or right who want to be seen as soft on drugs. Stacy will give you a full briefing on the law. As far as your patients are concerned. Listen listen listen. And never ever lie to them." Said Greg.
Tink had finally caught Julian's eye and he and Wilson threaded their way down the aisle. Greg was tiring badly he took my hand and held it to his lips briefly then turned to the audience.
"I don't want to talk about this subject again so when we next meet we won't refer to it. Understood. You have another half hour to go. Listen to everything these women have to say and you might learn something of value. I know I have."
This time Wilson took the chair as Greg was wheeled out the students applauded him and one by one started to stand.
When they had gone Tink again looked at the students.
"I really didn't expect to find people suffering chronic pain, under-treated, humiliated, dismissed, and brutalised by a system that chooses not to differentiate between those suffering acute and chronic pain and hardcore addicts or recreational drug users." Said Tink. "I didn't expect to find a system which cannot differentiate between a highly skilled medical practitioner and a drug pusher."
The students seemed upset and confused. So many of them had wanted to be doctors so they could help people. They needed something they could hold onto, some sort of direction.
"I think it is important for all of you to realise that pain is a human rights issue. Failing to alleviate a person's pain is tantamount to engaging in torture." I said. "Legislation determined by the same criteria that is applied to the illegal drugs is forcing medical practitioners to protect their licenses at the cost of breaching the human rights of their patients."