A Few Lessons in Clarity

Unfortunately these, though chronologically recounted, span back to the hospital stay. I hope their potential for amusement will excuse my tardiness in reporting them.

> Will my stitches really explode?

One of the first things I remember amidst the morphine haze was the chief plastics resident--a very stern and cold former Israeli soldier--telling me that I had to be EXTREMELY careful with my stomach stitches as the skin was pulled quite taut and they could explode. Perhaps it was the fact that I failed to realize in our first encounter that he is a *RESIDENT* ("chief" non-withstanding) or perhaps the fact that I was high (though legally) at the time, but I took the man literally. He was particularly concerned about sudden movements or spasms including laughing, coughing, and most importantly vomiting.

Since I wasn't in a mood to laugh, nobody with any kind of cold-like germ was allowed within a mile of me, and I really rather dislike vomiting (plus I was on an all-IV diet), I really thought the explosion could be avoided all-together. Then night fell and the morphene's nausea monster reared its ugly head: I "projectiled" all night holding a pillow tight against my stomach waiting for the moment when everything (literally) would just come undone.

After a miserable night spent in fear, asking the nurse, mom and pretty much anyone around to please check the stitches, and a talk with my actual surgeon the following morning, my very real fears of a total abdominal explosion were set aside. "In the physical universe we inhabit there is no way that coughing, laughing, or even puking would un-do surgical stitches...where did you get that from?" my surgeon asked with a bewildered look on his face as though I had been recently lobotomized. Allie and I were happy to tell him his chief resident had been the culprit. The surgeon chucked it off to a misunderstanding, but I am happy to report his resident was gentle, clear, and not at all hyperbolic with me there-after :)

LESSON: Take everything residents say with a grain of salt; they mean well, but really, they don't have a clue how to talk to patients...yet. Hurray for teaching hospitals!


> How poisonous is Chocolate, really?

Apparently one of the key rules of cancer is no sugar, no coffee, no chocolate and clearly NO FUN! Though the surgery was fairly traumatizing given the complete reconstruction of my torso, I have to say the announcement that I was to turn into a monk was far more shocking.

"Ok, I get the no smoking, and the coffee bit, after all that stuff will give you cancer...oops (smile)! But chocolate? Seriously...CHOCOLATE?"
"Well, it also has caffeine"
"But how much, really"
"Enough to be a problem"
"What if I promise to eat only the really watered down kind? No Godiva for me, just Hersheys?"
Amused laughter
"The Soda, coffee, cigarettes and drastic reduction in sugar I can do...but you have to give me SOMETHING here"
"You have pain killers..." (mischievous smile)
"Point well taken. But still no chocolate. How long?"
"A while"
"Could you be more specific? In cosmic terms 100 yrs is a while, 1 year a mere thought"
"A short while"
"I don't mean to be a pain, but surely you understand I must retain at least one vice--I don't even have a boyfriend--throw me a bone here"
"How long can you go"
"How long do I need to go"
"I'd be happy with 6 months"
"Would you be content with 3?"
"I can live with that"
"Thankfully so can I"
"Deal"

LESSON: A "while" is not a medical term so you shouldn't let your doctors dupe you with it...the art of negotiation (even if for vices) is a key to post-surgical (and life) survival. Oh wait...I still can't drink, smoke, have coffee or sweets...damn!

> *ALWAYS* ask for clarification when doctors talk about pain "management"

I was reminded recently of a saying my high school AP history teacher used to say: "Never assume anything, as it makes an 'ass' out of of 'u' and 'me' (ass-u-me)". That is PRECISELY how I felt when I went to my oncologist last week.

As part of our conversation to get chemo set up, he asked me if I was off the pain medication.
"No", I said, "I am pretty consistently in pain, so am still popping pills daily."
"What?!?!?" -- He looked at me as though I had just run over his puppy several times with a ginormous SUV covered in "I Love Bush" stickers.
"Well" I continued trying to figure out what was so horrifying about the situation "It hasn't been a month since my surgery; I'd assumed that given the extent of the carnage, I'd be in a lot of pain. No?"
"Ok, so let me get this straight. You have been in pain, all the time, since the surgery"
"Correct"
"So what do the pain killers do?"
"They make it so that I don't want to cry 24-7, but merely whimper"
"Let me explain something to you. The whole point of pain 'management' is to NEVER be in pain so long as you are taking pain medication."
"Excuse me?"
"Yes. For your pain to be properly 'managed' your pain must be eliminated, rather than ameliorated by the medication. Your pain is not managed, it's merely tempered."
"Well, how nice."--I said remembering so many long nights wishing I still had the morphine-- "I wish someone would have told me this 4 weeks ago when I left the hospital!!!!"
"They didn't?"
"Not in those terms; they gave me the prescription and said this would help 'manage' the pain. And indeed my pain has been 'manageable', though never quite gone and sometimes quite excrutiating."
He hung his head low and peered at me over his glasses with a look of pity I keep getting from my doctors. "I am sorry to hear that. You should have never been in pain this whole time. Let's make sure this doesn't happen again; would you like stronger drugs since your current pain killers are not doing the job?"
"Absolutely!"

LESSON: Always ask your doctors what they mean by "manage", actually ask them what they mean by anything they say. Perhaps we should advocate for medical schools to teach vernacular in addition to medicaleese. Perhaps hospitals should also make translator services and/or dictionaries available?