CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Rita Agarwal, MD, FAAP, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD

 

Anesthesia Nation – Part II

by
  • Chow, Harrison, MD
| Apr 15, 2019

Harrison_Chow “Dad, you need to get up.” Who was that? The blinds were drawn it was dark in my home office. During my wife’s battle with cancer, we had moved our bedroom downstairs into my office. We had lived there for nearly 3 years, an agonizing time of struggle and pain, for both her, myself and my family. But she had passed away nearly a month ago, having succumbed to the final mutated species of lung adenocarcinoma that would finally destroy her body and organs.

“It’s Adam your son, remember me?”, said a voice from the dark, as I lay in the bed in my office, medical books amidst the scattered oxygen cannulas and pain pills, remnants of my deceased wife’s struggles. Everything felt numb, I had been working on my wife’s memorial statement which was one of the emotionally traumatic events of my life. I had Ambien to help me sleep, Xanax to help me deal with being awake, and an unfinished bottle of Pinot Noir to help me write my beloved late wife’s memorial statement. I was fully anesthetized, all parts of my current life under anesthesia. But why?

My son’s big round brown eyes peered down at his father, fully numb lying anesthetized in a bed in his home office. I hadn’t worked in the OR since my wife’s passing in July. It was August now, the kids would be starting school soon and the memorial statement was still wasn’t finished. What time was it?

“Dad, I want to go get some lunch could we go to Corner Bakery and get some clam chowder?”. I took an assessment of the now awake patient, myself. I was unable to drive. “Adam, can you go microwave something, give me a few hours to let all this stuff wear off, we can go Corner Bakery for dinner.” Adam nodded his head and wordlessly took away the bottle of Pinot off the desk. Time for his dad to get sober if he was going to get his favorite clam chowder.

As I lay in bed for the next hours getting sober, I thought about the last several years of my dysfunctional family life. I had an operational plan for everything, kids, school, psychotherapists, even including my own personal health. My parents were in the house watching the family, but I’m missing something in my plan. What was it?

 I remembered my wife’s last dying days, the agony of bone pain from the metastasized cancer and the gasp for breath from lungs riddled with tumor and a pleural cavity full of exudate fluid. Her last moments were equally spent agonizing from body-wide pain and choking on her own suffocation. Not a comfortable way to die. Cancer patients die a horrible death.

We had struggled to get fentanyl patches and Oxycontin or “Oxy” in her last days. Both the palliative care pain management, oncology service and pharmacists were beginning to run into limitations on her narcotic use. She was dying and sometimes for days she could not get her pain medication. A nationwide and statewide set of narcotic scrutiny and regulations (CURES database?) had coincided with her actual medical necessity for narcotics. My dying wife was literally fighting for the same drugs as a nation of narcotic junkies.

I looked around my office, bottles of Vicodin and Oxycontin, labeled with my late wife’s name, lay around the medical debris on my office shelves. I looked in particular at the Oxycontin bottle, the newly christened “suburban heroin”. This is what the housewife junkies wanted, what my wife needed, maybe I should try one? Wasn’t I in pain too?

As I lay in bed, sobering up, I started to think about clinical Oxycodone. The pharmacology of long acting narcotic release for our surgical patients, my late wife and the junkies. The distant lure of “Oxy” to me as I lay there. “Try me” I could hear the bottle whisper to me “just one time”. So much pain all around. Take a pill, have a drink, have another pill it will make the pain go away.  Were we a nation of junkies? Perhaps a better question are we a nation in pain. Surgical level of pain.

I thought about my practice of anesthesia, as a regional/block anesthesiologist I have so many ways to blunt or eliminate the neurological sensation of pain. I can anesthetize a patient’s brain so there is no cognition of surgical trauma being done to them. I can anesthetize a patient’s muscles so they cannot recoil from the cutting of a knife. I can block using local anesthetics any peripheral, epidural or central nervous system nerve bundle of patients so they cannot feel the postoperative pain of the surgical trauma we have inflicted on them. And lastly I can send them home with “Oxy” to deal with pain. Surgery and it’s pain is anesthesia. But who else needs anesthesia?

Perhaps we are not only a just a nation of junkies in an epidemic. Perhaps we are a ONE nation under anesthesia? We are Anesthesia Nation.

I sobered up enough, sans any red wine, Ambien or Xanax or “Oxy”.  On the two-mile drive in my Acura SUV to the Corner Bakery, we passed a number of the inebriated homeless people shuffling through Silicon Valley. As observed the shuffling gait of one man, I thought “that could be me if I stay under anesthesia”. I could choose a life under anesthesia or a life without anesthesia. What’s it going to be?

Adam, my 13-year old middle son, and I sat quietly in a booth table. The death of my wife, Amy, Adam’s mom was still raw and fresh. But school was going to start soon. Adam confessed to me his fear of my drinking, my leave-of-absence, my afternoon naps in a drugged, anesthetized stupor. I explained to him that grief is pain. But the pain was tolerable now, it was time to turn off the anesthesia. He seemed satisfied with that answer and returned to eating his clam chowder.

When I returned home, I called one of my drinking buddies of all people. For now the second time I had called a friend in to do an a home alcohol purge. “Take it all tonight “please I implored. We can always have a drink TOGETHER, but no more drinking alone. My friend promised he’d swing by around 7pm with a big box to take the alcohol. “I’ll store it for a different time,” he agreed.

I hung up with my friend and went to garage and grabbed a large Amazon brown box. I systematically went through my home office and swept all the pills, syringes, needles anything that was for my late wife’s care and then drove them over to the pharmacist near the hospital for disposal. As I handed over the full box to my late wife’s pharmacist, virtually a boxed mini-pharmacy of hospice level care, I thought not only about the end of her life in pain, but also the end of my life in pain.

I thought of the inebriated homeless man I had seen earlier, the surgical patients in the hospital recovery room, the drunken man at the end of every bar in America, the pot-stoned teenagers, the screaming parturient begging for a labor epidural, the housewife fumbling through her purse for Vicodin, the heroin abusers and prostitutes in San Francisco, the methamphetamine addicts, the crack dealers, the small towns in West Virginia wasted on “Oxy” and my Xanax and Ambien bottles that were also in the box. Anesthesia Nation.

 I thought about all the overdosed artists, Ernest Hemingway, Marilyn Monroe, Prince, Heath Ledger in Batman, and of course Michael Jackson. I thought of the anesthesiologists who died with fentanyl, with sufentanil and with propofol. I thought of the DEA, JCAHO, the Coast Guard and the Trump wall. All efforts to stop, in large part, anesthesia. Because we have formed a nation under anesthesia – all trying anesthetize themselves from pain. This is a serious policy question I felt. What causes the pain? How do we stop the pain? Why are we so anesthetized?

I thought about these people as I faced the pharmacist. I had become one of them, if just for this moment in time. My pharmacist had tears in his eyes, he had come to know my late wife Amy well, he felt the pain too. I gave him the large pill box I had carried in for total disposal.

It was over, my struggle with home anesthesia was over. I was elated, I felt I had won a big victory. How big I may never know. I choose a life without anesthesia. I am leaving Anesthesia Nation. My passport to freedom is punched. I am convinced I am one of the lucky ones.

Harrison Chow, MD, is a practicing anesthesiologist at Vituity Anesthesia Medical Group and is formerly was the Specialty delegate to the CMA and Chair of the CMA Hospital-Based Practice Forum and Chair of CSA’s Legislative Affairs. Amy, his wife of 27 years, passed away from complications related to lung cancer this past summer. This part two of a 3-part series of articles special to the CSA. To read part one, click here.

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