Losing battles

 Sorry long post again but a glimpse to my job 

Pain should be the most feared symptom man faces .

It changes his or her  perception ,confidence ,

,attitude ,and perseverance  in life .

My professional work has been in relieving this pain not the acute short term one but the long term chronic pain ,debilitating and depressing .

By judicious use of medications to a large extent we can control this and make patient pain free .

Unfortunately this specialisation is denied its importance to an extent diluted by being clubbed with palliation ,either with or without palliation is what is achieved by pain relief .

Iam giving three examples of patients I treated recently .

 NK a 9 year old boy with an advanced soft tissue sarcoma and an angry swelling in his groin in excruciating pain ,bed riddance and swelling of his legs and groin but bearing it with the  fortitude of a saint .

He was on high dose of an opiod patch which controlled his pain to a large extenct till he left us all ,probably to be free of his pain forever .😔

Iam sure it looks very tragic to be in such a speciality

 My take is otherwise ,

I may not be in doing miracles but by relieving him his pain by my formulations ,adjusting its dosages ,adding and removing drugs so that he was to an extent pain free but also alert and wakeful Iam doing a lonely battle in makong him happier .

I did achieve that in NK s case as endorsed by his father

 ( my heart goes out to the parents of these children )

 its a fight against pain I do along with the parents or caregivers of patient .

NK is no more .

The second is a 65 year old temple priest with a sad wife the only care giver again with an angry purple swelling on his neck ,

Looking at it one can understand the pain he went through ,coupled with  his bipolar disease he was moody angry and irritable 

His wife warned me on him when she came to  my consultation room that he was a terror full of anger and frustration and would even beat her occasionaly .

He was resting in observation room ,

I went there to see him ,

Yes he was one angry man who was impatient to me and just kept repeating stop my suffering will you !

I dont need your words 

try to stop my pain 

Even with all my training and knowledge I was put off and I felt sad for his wife who bore this all the time !

I just told her to give the pain medications I started in time and also review his Bipolar disease medications with his psychiatrist .

After one week the wife came again and requested me to see him in observation room ,

she was smiling,

" Dr ippol kandal aalle manasillaavilla 

paavam aanu vedana kondaayirunnu "

ie you wont believe it he is so quiet but happy poor thing it was his pain that made him the monster you saw last week .

I was surprised at J getting up greeting me with a smile telling me he was pain free and happy,though his purple tumour had not changed .

To me that moment was like getting an award it even removed the clouds of NK loss to a small extent .

All it needed was his pain to be wiped off to make him a lamb from a vicious angry tiger .

Of course many do get their pain back and its a never ending changing doses ,medicines ,at times requesting a shot of radiation or a nerve deadening intervention management .

We use all our nuclear weaponry to fight our formidable enemy PAIN .

The third patient I saw was today 

B was a middle aged advanced breast ca with severe pain due to disease spread to her right upper arm nerves .

Neuropathic pain is unlike any other .

 we use terms like lancinating ( cutting with a sharp knife ) scalding or burning ,pinpricking or like pricking with a thousand needles ,

Even a touch or a wisp of a breeze  can cause excruciating uncomfortable pain .

She was accompanied by a cheerful most mature child for her age ,her ten year old daughter who kept and gave her medications .

How many brave people we see in times of hardness !

Poor B told me 

" Dr please relieve me of this torture ,my literally weak arm is listless ,my daughter takes care of me so well " 

I gave her the new set of pain medications explaining to both mother and daughter ,asked them to call me if needed as she was staying in Trivandrum.

She called me just half an hour back though I tell my patients not to disturb me after office hours unless its  an emergency .

Four decades of medical practice gives me the wisdom of strict timings though available to them most never misuse .

She had called as her pain had restarted after initial relief and apologised for the call .

I told her it would take a few days of adjusting doses etc but not to be depressed as I adjusted her dose .

Hopefully I can reduce her pain .

We in Palliative care and chronic pain management are not those swashbuckling dashing doctors ,

We treat desperate souls ,most who have lost hopes for cure ( exceptions there too ,some get cured and we even stop all pain medications ) 

We talk to families saddened by the plight of their beloveds going through suffering ,

Our goals are limited without glamour but genuine in its efforts .

Every minute of thier being free of pain or discomfort is a reward for us and gives us the strength to face the loss of the likes of innocent NK s .