I have a paradoxical reaction to opioids. From wikipedia: A paradoxical reaction or paradoxical effect is an effect of a chemical substance, mostly a medical drug, opposite to the effect which would normally be expected. An example of a paradoxical reaction is pain caused by a pain relief medication.
Opioids don’t cause me pain as described in the example. They wake me up like speed. I sweat and shake a lot. I become very anxious. This also happens with all benzodiazepines like Valium
I don’t have much experience with opioids or benzodiazepines, because I’ve never enjoyed them. I even avoid them. Doctors always seem to be trying to give me one or the other. There’s no use trying to tell a doctor or a nurse that you have a paradoxical reaction to these drugs. They aren’t listening. Or maybe that’s another part of that thing I do where I don’t show any emotion. People are just going to miss it.
“I have anxiety.”
“Okay let me give you a prescription for Xanax.”
“I have a paradoxical reaction to benzodiazepines.”
“Okay cool. Hey it was good to see you. Let’s try to get that weight off and the cholesterol down. Here’s the script for the Xanax.”
This has happened many times. Also, why do doctors want to give me Xanax for almost everything?
“I can’t sleep.”
“I dislocated my foot.”
“I have a pinched nerve in my shoulder. My arm feels like someone set it on fire. All day.”
I’ve never taken them. I think that I have not spoken up about it because I wasn’t sure. I know that I shake and sweat and that it wakes me up. But I just wasn’t sure that it was being caused by the drug. I suspected anxiety. Anything that changes my mood except coffee and wine cause anxiety. At least in my adult years. So I may not be saying it correctly. Maybe I phrase it more like a question.
“I have a paradoxical reaction to opioids and benzodiazepines?”
That questioning inflection at the end. Nobody wants an indecisive patient.
When we lived in Oklahoma, a few incidents made my problem a little more clear. In the first incident, I dislocated my foot while playing ultimate frisbee. The EMT’s came.
“Do you want anything for the pain?”
I was in a lot of pain. I couldn’t make up my mind.
My co-worker, Jarred, was taking pictures of my foot (it was nasty) as they worked on me. He looked at me and said, “Yes you want something for the pain.”
“Yes I want something for the pain.”
Seconds later I was sweating and shaking and my mouth was dry. The pain was still there.
“Do you need anything else?”
“Something to drink? I need some water.”
“Nope. You’re going into surgery. That looks nasty.”
I didn’t end up needing surgery.
In the second incident, I was having a Lasik procedure. At the information session, a nurse went through all of the steps.
“First we’re going to give you a Valium. Then we’ll put some drops in your eyes to paralyze your eyes. Then right before the procedure, we’ll give you some morphine.”
“I have a paradoxical reaction to benzodiazepines and opioids? I shake and sweat a lot on both? Is that okay?”
“Okay cool. So have someone drive you here at 6am…”
Each time someone in the practice described the steps in the Lasik procedure, I said, “I have a paradoxical reaction to benzodiazepines and opioids?”
So the day of the procedure, they gave me a Valium. I waited a while. Then they gave me some drops to paralyze my eyes. Then they moved me to the procedure room. They gave me a shot of morphine. I got on the table, laid my head back, and started shaking.
“You’re shaking! Um…”
“I told everyone in this room that I had a paradoxical reaction to benzodiazepines and opioids and that they made me shake and sweat. Now you’re surprised?”
Opioids also apparently make me a little aggressive. They put a weighted blanket on me and held me down while they used some lasers to cut my eyes.
After six hours of surgery, I woke up in post-op. I’m not saying that I was entirely coherent, but this is what I remember: There was a very short man emptying the sharps container. That was the very first thing I saw. A nurse to the right of me was trying get a cart around my IV poles and kept bumping the bed and apologizing. Another nurse sat in a chair at the foot of the bed. I lifted my head a little bit.
The nurse in the chair said, “Do you want something for the pain?”
I felt around for a bag or tube coming out of my stomach.
“No colostomy bag?”
“What? I don’t know.”
“I don’t feet any tubes or bags coming out of my stomach.”
I felt relief. Then guilt. Why did that mean so much to me?
“Do you want something for the pain?”
She kind of slurred when she spoke. I don’t think she was intoxicated. It was a colloquial slur. Like an accent or a speech impediment.
I said, “What do you have?”
“Morphine or Dilaudid.”
I had discussed this paradoxical reaction with my friend Elysa at some point. She told me about how they had given her Dilaudid when she was hospitalized for bowel surgery. She loved it, and she had problems with Morphine.
“Hmm… Dilaudid? I’m not sure…” I sucked air in sharply and sat straight up. “What did you do?!?!”
The nurse’s eyes were wide open. She was frozen with the IV line in her hand.
“I didn’t tell you to give it to me!”
Just then two guys came in to wheel me up to my room. I was burning up and sweating and shaking. I was wide awake.
I don’t remember who was with my mother when I arrived back in my room. I think it was Troy. My escorts pushed the gurney next to my bed and held all of the tubes and wires up in the air. I crawled over. My mother was sitting in the chair.
“They gave me Dilaudid. The bastards gave me fucking Dilaudid.”
I was so offended. I recounted the whole thing. I don’t remember anything in those first few hours after surgery besides waiting on the Dilaudid to run its course. Opioids are so unpleasant for me. Troy has this funny story where he describes the first few minutes after an opioid is administered. “Pain. Pain. Pain. Warm titties.”
I am seriously envious that I don’t get the ‘warm titties’. So many people describe opioids as this wonderful experience.
“I have to have my appendix out this week.”
“Oh man that sucks. At least you’ll get to do a bunch of great drugs.”
Nope. No ‘warm titties’ for you son. Have some pain.
At this point, I had still not slept outside of anaesthesia since my arrival at the hospital. I may have dozed a few times, but not for long. I was crazy tired. I stopped mentioning that I hadn’t slept to anyone, doctors and nurses, because inevitably someone would say, “We could get you some Xanax.”
Holy shit with the Xanax. They talked me into a Flexeril that first day. I slept for forty five minutes I think. I woke up plastered and still in pain. They tried to talk me into Tramadol. I have some in my cabinet right now. I’ve never taken it. I just needed to sleep.
I heard Fight Club quotes, “Chew some Valerian root and get some more exercise… You wanna see pain? Swing by First Methodist Tuesday nights. Go see the guys with Testicular cancer. That’s pain.”
The wise words of a coder I had worked with in Oklahoma, “You don’t get to Valhalla dying in a hospital bed.”
I wanted to get up and walk. Oh what the hell is that?
“Is that a catheter?”
My mother,”Probably. Why? What do you want to do?”
“I want to get up.”
A nurse walked in right at that moment.
“Can I get rid of this catheter?”
“Are you sure?”
“Yes I want to get up.”
“That’s funny. I was just coming to tell you that they are going to want you to get up.”
“That’s good because I want to get up.”
The catheter is such a weird experience. I hope I am never awake when they put one in. It feels bad enough coming out. It’s a strange humiliation. The feeling of it coming out. With my mother in the room.
I stood up. It wasn’t that bad. I wasn’t ready to fight my way to Valhalla, but I was upright. I went to the bathroom. I stood around for a while. Maybe a few seconds. Then I went back to bed.
Many times throughout the next six days, I wondered if there were a way to prepare someone for what I went through. The day of the surgery was nothing. I still wasn’t sleeping. I was up and walking around. My abdomen ached. I was aware that something was different. But it wasn’t that bad. Not yet. The doctors and nurses said things and asked questions that only took on relevance later.
The nurses didn’t need to battle to get me out of bed. Now the battle was about getting me to sleep. No one wanted to sleep more than I did, but lying in bed after surgery just sucks. I didn’t have anything else that I wanted to do. I had no energy. I just wanted the oblivion of sleep.
There was the usual array of visitors that stopped by regularly. I appreciate everyone for coming to see me. Everyone that called even if I didn’t answer. Texts. Facebook messages. I had, and continue to have, so much support.
Justine stopped by with the kids. They didn’t stay long. I don’t blame her. I was not well. All of my attention was inward. I can’t imagine how I must have looked. Still it was good for them to see me on the other side. I asked questions about the first day of school. I don’t remember the answers.
My mother spent the night that day of the surgery. I tried to sleep. I would open my eyes and see her. She looked so uncomfortable in the recliner next to the bed. I was so grateful that she was there. Up until that moment, I hadn’t considered her experience. I thought of myself and my own kids. My mind kept returning to how were they handling things. How could I negotiate this crisis to make it easier for them?
My mother had a son in the middle of a medical crisis. I can’t even imagine what that must be like. My daughter’s three ear tube procedures were hard, but I never feared for her life. There was a time when Lucy had a stomach bug that wouldn’t quit that I took her to the emergency room. They checked her in very quickly because she couldn’t stand on the scale to be weighed. She was dehydrated. I held her hand as they put the IV in her arm and pumped her full of fluids. I watched her lips inflate as the fluids filled her body.
The natural order of things is that the parents die before the children. I know that it happens often outside of that order, but it is still how we hope and dream. Our kids will outlive us. We have done our job. But there she was at seventy seven sleeping in a recliner with her forty nine year old son in a hospital bed.
I didn’t sleep that night. It was Monday night. Outside of anaesthesia, I hadn’t slept since the previous Wednesday night. The night before I woke up bleeding out of my ass. Five nights of no sleep. My discomfort was growing.