This corpus horror

In which I recount the Epic Saga of the last month. Here's the thing, intellectually you always know that you can become really sick, or even disabled, but on some level you never really believe it until it throat punches you.

Diabetes runs all through my family, so I always knew that it was coming for me, slowly but surely, like a fucked-up vampire sloth. A couple of months ago I noticed that I wasn't able to read the item descriptions in my inventory on Mass Effect, and had to have my partner read them for me even though he was just about as far from the screen as I was. So I went to the eye doctor and found that I needed glasses despite the fact that I only had LASIK surgery a few years ago, and quite successfully too. As an afterthought we decided to go ahead and test my blood sugars just to be certain that I wasn't running high, because that's a thing that can sometimes drive reductions in vision.

Turns out my sugars were through the roof, cue metformin. A rare side effect of Metformin turns out to be something called lactic acidosis. I was one of the lucky ones.

Cue Glipizide. This was not bringing my sugars down however, even at top doses, cue insulin. For those of you unfamiliar, this is not the way this usually goes. Typically you have a lot of time before you have to start insulin, and usually diabetes doesn't slam into you like a freeway truck. However even with this cocktail, my sugars were uncontrolled and I wasn't really able to eat much, for some reason I couldn't deduce at the time. I also was having trouble with dizziness, stumbling around like I was drunk despite painful sobriety, and general weakness and fatigue, and not the Monday morning after a late Sunday kind.

As it turns out, my liver was attempting to jump out of my navel. This was uncovered after a blood test revealed that my liver enzymes were just about on level with someone who had Advanced hepatitis. To be clear, I don't have hepatitis. I know because that's the first thing we tested for. By this point I was on Zofran, a medication to keep me from Technicolor yawning all over the house. It wasn't really working, but it was trying hard. We took my blood again and found that my liver was continuing to be pissed off and so we did an ultrasound. This didn't show anything except for, surprise, a liver with anger management issues. This type of thing drives up blood sugars a lot, so mystery solved there at least.

You know, you can go your whole day and not really think about what your liver is up to. That is, of course, until it starts getting an attitude.

My doctor's verdict? I had some mysterious virus that was pissing off my internal organs and was going to run its course and then I would magically start feeling better? I hadn't much hope by then. By this point it had been about 2 weeks since I'd been able to work, thank all the deities for Aflac.

Eventually, the universe took pity on me and my liver just started to chill out as this unnamed mystery virus got bored and wandered off. My doc doesn't believe that we'll ever know what infectious process was slapping my liver around, and frankly I don't care as long as it doesn't take an interest in me ever again.

I've never been truly disabled since I started working as an adult. I mean, aside from the occasional respiratory infection, however those have a really well defined course and you know roughly how long they're going to last. The worst I'd experienced as an adult was bronchitis taking me out for a week or two, or the odd surgery that took me out for a week or two. But here it was three weeks in and I still wasn't sure how much longer this was going to last. The biggest stressor for me was the nebulousness of it all. How much longer was I going to have to miss work? How much longer was I going to have to sit in this recliner? Just how long before I could eat something besides dry toast before I kill someone? I haven't even gone into the details of what liver dysfunction does to your bowel movements, but trust me, it ain't pretty. I'm fairly certain we're going to need a rabbi to bless my bathroom before it can be safely used by humans again. But I digress.

Today marks the fourth week of my being off of work, and it looks like I'll be fit to be re-released into the work force next Monday. This has been without a doubt the most terrifying, most uncomfortable period physically and emotionally of my adult life. I was sick a lot as a kid, but when you're young, you don't really have a sense of mortality, or at least I didn't. All I know is that there's no amount of emotional preparation that I could have done that would have made this any easier to process. When you're that sick, the most simple cognitive processes become intense uphill struggles. The next time one of my clients comes in telling me that they have trouble thinking or concentrating because of pain or nausea or any physical problem really, I'll have a whole new understanding of what they're talking about.

I cried every day of this ordeal. Every. Day. And now, the simplest of physical victories, like leaving the house for something other than another blood test or eating something other than toast and not throwing it up make me feel like Rocky Balboa beating a Russian twice his size.

Yesterday, I went out wearing real clothes, and got 2 oz of sugar free frozen yogurt, and sat like a person eating it with my family at a table and watched random humans go by. After weeks of going to Kaiser an average of 4-5 times a week, it felt like going to Disney World.

The point of all this, if indeed I have one other than to record this experience as a means of upload to external memory, is as a reminder. Both to appreciate any moment of good health that you have, and to be as kind and patient as possible to those who have less of it than you do. Because that, I assure you, will be you someday, and you will not be ready, and you'll need all the kindness and patience you can get.

Meanwhile, that thing that you were really wanting to do but were putting off until you had a little bit more money? Go do it. Because you might not have the spoons to do it tomorrow.

Dat fourth reich tho

Chuck Wendig recently, and super no-scopedly, called this the epoch of syphilitic dipshittery. (I had to spell check syphilitic omg am I a nurse?)  And it got me Thinking About Stuff. Specifically, it made me think about why I keep having sweat-and-pee soaked dreams about all the body politic.  I'd been questioning my reactions to the persistent, hyperspeed onslaught of news, each byte more freaky than its predecessors.   Was I being melodramatic? Was I just losing my teflon-coated Daedric armor of positivity?  The news kept calling me a snowflake, were they right??? Holy shit, it's June, snowflakes don't historically last long in these kind of heatwaves... I better figure this socio-political angsty shiz out, and that right quick.

I'm quite stereotypically Ashkenazi. Like so many of my peers at my heeb school growing up, lots of my family branches had been burned during WWII.  (Yes, literally.)  My great Aunt told me stories about growing up in the Warsaw ghetto while her sister, my grandmother, got gently drunk on white Franzia and turned off her hearing aid so that she couldn't hear my mom squawk at her to put the box down.  I hadn't dredged those stories to mind in a long time, but recently, they started fluttering limply back from the 'ol hippocampus like Exxon Valdez birds. 

So many of my aunt's stories sound vein-chillingly familiar to some of the news stories of the last 6 months.  Stories of the gestapo being helped by local militant groups, or just conservative randos who were nearby, to herd and incarcerate the Jews of the area when they were moved to the ghetto, or, more specifically, when they resisted being moved. Jews being shot by law enforcement just for talking back or walking down the street.  My aunt hated telling me these stories, though my dad and I always pressed her to.  She was beaten pretty badly once as she was on her way to school when she was 8 by some older teens while being called (screamed) the equivalent of kike, just before her family moved.  That particular story she never told me, my grandmother recounted it because, as she put it, "it's too hard for her to talk about, but it's important you never forget it, where we were, and what we did, and why we're here instead.  Now eat some ruggelach, you're too skinny."  

Baked crumbly Jewish delicacies aside, she was right, it was.  I think, looking back on it now, she meant that this moment right here is why it was important to remember.  It was important to remember what impact the news can have on a populace, and how that populace can feel empowered to be monumental prolapsed anuses to any group they don't like if those in power encourage it.  It was important to remember how to identify the warning signs of an impending autocracy. It was important to remember how it looked and felt as empathies, and rights, were degraded by centimeters and eventually parsecs.  They tried to trust the law, the government, their non-Jewish neighbors, wanting to keep to the high road and assuming it would all work out because, c'mon, these were their neighbors.  But, eventually it all exploded in a long, heavy shit shower, and the country eventually disappeared entirely up it's own asshole and then imploded.  And that's how I ended up here.  Blogging at your face. About how this all feels way too familiar.  My aunt and her family didn't march or protest, they feared, and they ran.  To be vodka transparent, I ain't mad at them for self preservation.  BUT.  I can't help but wonder what my aunt's stories would have sounded like if she, and all of the other amcha and righteous (or just middle of the road) gentiles at the time, would have loudly taken to the streets.  

My point, if indeed I even have one in all of this fappery, is this: TAKE TO THE GAWDSDAMNED STREETS.  I'm tired of despairing, I'm tired of feeling like there's a heavy inevitability to all this syphilitic dipshittery.  Cussing a lot helps, so cuss up a fucking storm.  Yeah, I'm still sad, it's unavoidable.  But I'm rapidly finding that the best tonic for sad is RIGHTEOUSLY FUCKING PISSED OFF.  It's important you never forget it, it helps when you're where we are, doing what we're doing, here instead of someplace better. Now go eat some muthafucking resistance ruggelach. 

This pain

WHY YOUR PAIN IS NOT BEING TREATED

Hi. I'm your friendly neighborhood NP, here to talk to you about how THE WORLD IS GOING TO END  ARG ARG ARG RUN RUN RUN THE OPIOIDS ARE COMING FOR US ALL.

At least, that's apparently what this, er, let's call it "measured and thoughtful" letter from our US Surgeon General, Vivek H Murthy, is trying to tell us.  By us, I mean every practitioner with a prescription pad or, more to the point, a DEA number.  Yesterday I walked into my office and saw this little number waiting for me on my desk, enjoy. My opinions follow.  No, there will be no jumpcut. Read it.

"August 2016
Dear Colleague, I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure. It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. Tis coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain. Te results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly two million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C. I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. Tis is one of those times. Tat is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge at www.TurnTeTideRx.org. Together, we will build a national movement of clinicians to do three things. First, we will educate ourselves to treat pain safely and effectively. A good place to start is the enclosed pocket card with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing. Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.
Thank you for your leadership."


Well then.  And thank you, Vivek, Vivvy, may I call you Viv? Viv. Thank you, for alerting me to this "urgent health crisis that threatened our nation."  Naturally, as a conscientious practitioner, I wish to be up on the latest data and, hey, if prescription opiates like Norco and Vicodin are killing people in droves, quadruple the deaths since 1999 sounds super scary after all, I better take your advice and make sure I'm as educated as I can be, right? Of course right.  So, off I surf to CDC.gov, to fill up on data, omnomnom delicious data.  I mean, the last thing we'd expect is to find is that this kind of vague, inflammatory language isn't... *reads opioid overdose stats page* isn't based on actual facts that... *reads some more* facts that.... *re-reads*....
....
*re-reads again*
....
Gawddamnit, Viv.
Turns out, according to the CDC, "Changing the way deaths are analyzed seems to result in a decrease in deaths involving prescription opioids."  Huh. What does "changing the way deaths are analyzed" mean, I ponder. Turns out, this means that while deaths from opioid overdoses have indeed increased over the last several years, this means deaths related to ANY opioid, including such best selling titles as frakking heroin (which is NOT a prescribed opiate, just to be painfully clear) and bootleg Fentanyl cooked in a bathtub and cut with who knows what.   Apparently, overdoses from NON prescription sources, specifically heroin alone, accounts for most of this uptick.  Also, given that Oxycontin wasn't even INVENTED until 1996, it makes sense that the deaths from this medication have, you know, increased, since before it existed.

Viv, from the bottom of my prescription pad and from the bottom of my heart which belongs to two amazing partners who struggle with chronic pain every damn day, please go fuck yourself vigorously with a cheese grater. And do it, obvis, without pain meds.  Because years from now, I want us to look back and know that, in the face of reactionary ableist tripe, it was our profession that stepped up and looked critically at said tripe and led the way to ripping it to shreds.

This paradigm

Hey there.  I'm Jake.  I have a lot of discomfort related to neuralgia in my left femoral area, due to nerve root impingement.  In English, I gots pains, yo. Pins and needles that shoot pretty constantly from my left hip down to the knee.  High doses of turmeric help. I'm a PMHNP so I can't take anything that might intoxicate me or hinder my judgement while I'm prescribing, though to be fair, pain can hinder your judgement pretty profoundly too, so, yeah.  (and no, don't @me about that unless you have some fucking experiencing being in consistent, cringing discomfort for months on end while having to make important day to day decisions which significantly impact other people's wellbeing all the while just wanting to punch a baby square in the cutes)  I only have one functional kidney, so I can't take NSAIDS on the reg, gotta baby that thang.  Which brings me to the point of all dis glorious tmi:  HOW DO I TREAT DIS SHIZ BEFORE I KILL SOMMUN????  Glad you asked.  Since I live in Portland, I know what you're gonna ask, and no, I don't smoke weed.  I vape cannabis.  SEE WUT I DID THAR? Here's the thing, I get my curls in a twist when I see the dominant thoughts about cannabis being amplified by, well, most platforms.  Even the platforms that are pro-cannabis are hit and miss when it comes down to it, because eventually at least 50% of the sites I go to for information degrade into the all-to-familiar tropes most associated with cannabis.  Yeah yeah, that joke about Chong was hilarious, sure sure lacing that article about anti-inflammatory effects of cannabidiol with stoner-talk euphemisms is super cute, and original af too, never seen it done before, now please just render unto me my relevant medical information. *disappears in a puff of vapor*