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Pain management is the doctor’s job, not the desk monkey’s

By From page A13 | January 13, 2013

Let’s talk about pain.

There are three subcategories: Those who cause it, those who endure it, and those who can’t take it. Although I’ve fallen into all three at some point or another (and everyone who knows me is pointing wildly at the first one), it’s number three that I’m concerned about today.

On the pain tolerance scale, from zero to 10, I’m a zero’s zero. The absolute alpha of the pain spectrum. Somebody has to be the beginning of every spectrum, and when it comes to pain, that somebody would be me.

I’m lucky to have led a relatively pain-free life — just the usual bumps and bruises of childhood. I used to get migraines, which were like an ax in the skull, but compared to childbirth? Childbirth trumps migraines.

I took those Lamaze classes, and learned to breathe through the “discomfort” of contractions. Discomfort? Would they call shoving a grapefruit through your nostril “discomfort”? Oh, what a sad, cruel joke all that heeh-heeh-heeh nonsense is. You don’t need to pant heeh-heeh-heeh when in labor. You need to know how to grab the gurney and say — growl actually — “So help me God, I will drop this kid on the floor if I don’t feel a needle in my butt right now!” It’s amazing how fast the nurse appears with the Demerol when you create a public disturbance.

Yes, I was a lot wiser the second time around.

My other significant brush with pain was when my appendix was leaking and ready to burst. Through the mist of agony, I experienced that eerie premonition that I needed to get to the hospital right now or I would die. Turns out, I was right. I was on the operating table in no time.

And then there’s vein ablation, a process to treat varicose veins, which are on the surface, and peripheral vein disease (PVD), which is deeper inside the leg. In both cases, the vein valves collapse and just flutter uselessly in the bloodstream, leaving the heart to do all the work of returning the blood. Lucky me, I have both conditions, but the PVD was the most concerning. It made my ankles and feet swell because the vascular system backs up all the way down to the capillaries, and I felt like I was wearing lead stockings all the time. Left untreated, PVD will ulcerate right through the skin and destroy the flesh on the surface.

Yeah, it’s bloody gross. Why do you think I endured this procedure six times already?

Well, last week, I endured my seventh. There I was, face down on the procedure table, the vascular surgeon on his third attempt to close a particularly large and unruly vein — a perforator, they call it — that runs horizontally at the top of the inside of my calf, and had opened to about the size and length of a hot dog. The ablation process begins with a series of rattlesnake bite injections that ostensibly numb the area (ha ha). Then they make an incision, thread a wire through the vein and zap it with lasers at intervals, fusing the vein walls and essentially creating a blood clot sausage that eventually hardens and is absorbed by the body.

Squirming yet? Suck it up, buttercup. It’s way less painful to read than endure it.

And here’s the kicker: no anesthesia. No pain killers. Just two lousy little Valium that are about as effective as Tic-Tacs when you are seized with anxiety-fueled adrenaline because you know what’s about to go down.

All you get to help you cope with the pain is a pair of grips on the table to grab onto, and I’m amazed that I didn’t twist them right off.

I begged for mild IV sedation this time, as it had helped in the past, but the medical assistant refused. The reason: The insurance company won’t pay for it. The insurance company decided it’s unnecessary.

Really.

I say we slap a few insurance CEOs face down and tell them to hold on tight while we jam some acid-filled needles into their veins and then fry them from the inside. How unnecessary is that sedation now, Mr. CEO? Wipe your nose before you answer. I can’t understand you while you’re sniveling.

The most exasperating detail of this story is that my vascular surgeon agrees that I’m at the extreme weenie end of the pain scale. He knows that what feels like a pin prick to another patient feels like being stabbed with an ice pick to me. Maybe I simply have more nerve endings per square inch than other people. Or maybe my nerve endings are a thousand times more sensitive than other people’s, picking up on pain frequencies that other people don’t, just like dogs hear things that people can’t. Maybe it’s some variation on fibromyalgia, where my pain receptors are incorrectly interpreting pain signals.

Whatever it is, my experience with pain is wildly amplified. And it’s real. I’m not wired like other people. I know it. My doctor knows it. But he can’t do anything to alleviate it, because the insurance company holds veto power over his medical decisions, and employs legions of flunky clerks to screen the “Mother May I” preauthorization papers doctors must submit before doing anything. Talk about the tail wagging the dog. When did a medical degree become a prerequisite for rubber-stamp clerical jobs? Do you even need a high school diploma for that? Why are white-collar desk monkeys calling the shots on medical decisions?

This is insanity. It must change. The only role an insurance company should play in medical decisions is to shut up and pay the bill. My insurance company has no right to decide how much pain I can withstand. I’m the only one who knows that, and my doctor is the only one with the expertise and medical judgment to decide how to deal with it — not some desk monkey with a rubber stamp and a GED.

— Email Debra DeAngelo at [email protected]; read more of her work at www.wintersexpress.com and www.edebra.com

Debra DeAngelo

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