I had surgery last week, and I'm feeling pretty good and had a couple of things I wanted to share with you about how all of that has gone.
The first is about anesthesia. I had had a lot of anxiety about the potential cognitive and mood effects of the anesthesia But I came out of it pretty much completely lucid right away. So I woke up to one resident telling another that Roe v. Wade had been overturned—we were in surgery while it happened.
So I was also alert enough to notice that the last thing they did before they took me to the recovery room was take an x-ray. And I realized later that they do that to make sure that they did not leave any instruments or surgical materials inside of your body. I thought that was both horrible and sort of funny—you know they started doing it because it solved a problem, and the problem was leaving surgical materials inside patients’ bodies. Surgery is so violent and weird!! Anyway, I figure that a lot of people are too out of it to remember it later, so I am here to tell you about it!
The other thing I wanted to talk about was how pain management has worked. As I'm sure you know, physicians now prescribe opioids (“the good drugs”) very rarely. I was worried that acetaminophen and ibuprofen wouldn’t be enough to take care of the pain.
But there were two things that were important here— one thing that I didn't know and then another thing that is not discussed much. The first is that surgeons now use nerve blocks administered at the beginning of surgery to manage patient pain. So an anesthesiologist—there were two attending anesthesiologists—did an ultrasound-guided pectoral nerve block. He told me that it can last anywhere from eight to thirty hours depending on your body (they never really know how a given person will respond). But mine definitely lasted 30 hours.
The other thing that helped my pain management was cycling Tylenol and Advil. There are clinical studies that show that doing that is as effective as opioid medication for controlling pain from most patients. (There are some procedures where I think that's not true and some patients do not respond as well to nerve blocks.) So they gave me a Norco in the recovery room and that was the last opioid painkiller I had. The way you cycle the drugs is by alternating them every three hours so they're always overlapping, and there's no room for breakthrough pain. That's all to say that a lot has been done in the critical care space to manage surgical pain with minimal opioid use, and you might be surprised by how well it works.
The flip side, of course, is that patients for whom these protocols don’t work often have huge problems getting adequate pain management—folks with bone-crushing pain from chemotherapy, say, might not get the drugs they need or face the accusation that they’re drug-seeking, which of course disproportionately affects patients who already have chronic pain and is also an obvious result of medical racism. It’s especially problematic for Black women and femmes, whose physicians often underestimate and dismiss their pain in the first place because they have racist and false ideas about biological difference that date back to, frankly, slavery. And it’s not just older physicians—that includes medical students. It’s so common. (Alex Moffett-Bateau, who has lupus, had a frankly harrowing experience in the NYU Langone E.R. a few weeks ago.) And that becomes a further problem because significant pain makes healing much harder and is much more taxing on the body—inadequate pain management has longterm effects on healing outcomes and life outcomes.
So this bodily good fortune has kept me mostly pain-free, but if it hadn’t worked it’s hard to say what would have happened—but whiteness would have been a kind of protective factor. But I think it’s helpful to know that it’s possible, at least, to have well-managed pain without opioids, which is also better for recovery and health.
Anyway, I am enjoying faffing about in matching pajama sets and eating a lot of an orange digestive biscuits and feeling pretty good. I watched Minx on HBO Max and liked it a lot! I just wanted to say hi and I made it and thank you so much for your support. Let’s talk soon!