My Experience With Opioids

One of the many paradoxes of life in the USA (like the sudden nervousness of the Republican Party about ‘open-carry’ laws that would allow rifles to be brought into the convention being held in Cleveland this week, or the driver with a ‘God Is My Pilot’ bumper-sticker who weaved his way illegally across lane dividers in front of me outside Wilmington a few days ago) is the country’s approach to drugs. While many states are now making the growth and sale of cannabis legal, the increase in the use of opioids is having a devastating effect on the overall health of the country’s citizens. In the USA in 2014, 28,600 persons lost their lives because of opioid overdoses. Where I live, in Brunswick County, I learn that more than half the candidates for positions in golf course maintenance withdraw when they learn that they will have to undergo a drug test.

Operating machinery under the influence of drugs is obviously a real risk. When I was working for IBM in Croydon in the early 1970s, when my colleagues and I went out for a jar or two at lunchtime at the ‘Porter and Sorter’, we probably would have failed any drug test, had it been applied, before operating any of the bank of machines that occupied an acre on the basement floor of Cherry Orchard Road, the beauty of whose environs had inspired Anton Chekhov to write perhaps his most notable play after he came to visit ‘for the waters’ in the late 1880s. (The data centre comprised an impressive range of computing power in those days, although it would have been eclipsed by the iPad that anybody casually uses today.)  Moreover, Thomas Watson Jr. would probably have had a fit if he had known that his male managers, salespersons and systems engineers no longer wore blue suits and white shirts, let alone went out to the pub at lunchtime. But, for recreational purposes, I have never ingested or inhaled anything stronger than a particularly nasty Balkan Sobranie in 1968, apart from the inevitable very occasional overindulgence with the grape or kindred spirits when celebrating such events as the Queen’s Birthday.

Yet I did have one life-changing experience with opioids. It all started in 1972, when I suffered a career-ending tumble on the rugby field that was diagnosed as a prolapsed disk. During the next year, all manner of treatments were tried. The most absurd was the encasement of my trunk in plaster of Paris, in an attempt to stabilise and straighten the spine, a remedy that was extremely uncomfortable and certainly not conducive to romance. I turned the condition into a party trick, encouraging persons not in the know to punch me in the stomach, rather as Sir Mansfield Cumming, the first director of SIS, would shock his audience by stabbing his wooden leg with a pen-knife when provoked to ire. When the plaster was taken off three months later, however, my scoliosis was just as bad as before, and my pain no less intense.

Eventually, in April 1973, I was called to hospital – to New Cross, where a large ward (immortalised by Chekhov in his 1892 short story, Ward No. 6) was occupied by patients suffering from a range of conditions, from herniated disks, like mine, to rheumatoid and other forms of arthritis. (One or two of those poor people were in dreadful pain.) There I was prescribed a regimen of three weeks’ bed-rest, which involved exactly that: minimal activity, lots of reading, talking to other patients and learning a lot, and inevitably chatting up the nurses, which had a very beneficial therapeutic effect  ̶  on me, I hasten to add. (I trust I did not offend any of the sorority through my attentions: I was still single then, and flirting with medical attendants was not then a criminal offence.) At the end of the three weeks, my back pain had diminished, but the rest-cure had not worked completely, so an operation was called for. With 50% of such cases going to an orthopaedic surgeon (and thus staying at New Cross), and 50% being destined for neurological treatment, I found myself in the latter category, and was sent to the Maudsley Hospital at Denmark Hill.

A day or two before I had the laminectomy, I was given a radiculogram (or maybe a myelogram), which involved a coloured dye being injected into the spinal column for better diagnosis through X-Rays, and thus guidance for the surgeon. This did not go well. I was not very excited about the prospect of the procedure when it was described to me, and I somehow managed to faint while on the trestle I had to lie on during the process, and fell to the ground. Whether the test was successful, I do not know, but I felt awful the next day, and was in such a state before the operation, with a headache, and my blood-pressure high, that the thought of an operation was really depressing. A couple of hours before the procedure, however, I was given my pre-medication. I was soon floating above the clouds, the warmth of the sun was gently embathing my whole body, and I was feeling a bonhomie towards all living creatures that would have made the Pope appear a curmudgeon. I could not have been more comfortable as I was wheeled into the operating theatre.

For part of the mixture administered to me was a generous helping of Omnopon. You can learn more about the compound Papavaretum at https://en.wikipedia.org/wiki/Papaveretum: it appears that this opioid derivative is no longer used so frequently, because of side-effects, but it certainly worked for me. (I did not know what it was at the time.) And when I surfaced from the general anaesthetic, the first thing I heard was a soft voice encouraging me to wake up, and, when I opened my eyes, I found that the voice belonged to a most beautiful nurse. Perhaps I had landed in heaven after my trip through the clouds . . . But no, the environment was real, and I was taken to my personal ward in the Intensive Care area.

For a few days, I started to recuperate. But then, I suddenly started to be racked with appalling pains across my body, and a splitting headache. My temperature soared. While I was waiting for the surgical staff to be apprised of my condition (it took several hours to convince anybody I was really suffering), I lay there in agony. It felt as if a hot iron was gradually being moved up my spinal column to my brain. Then everyone suddenly sprang into action – with cold compresses, ice, fans, and massive penicillin injections every four hours. I had contracted MRSA, although I was never told as much at the time.

I could never stand injections, and I dreaded being woken up at four in the morning for the next dose. I would tense up, which made the process even more painful. Yet the beautiful nurse knew how to minimise the insult to the body: she would slap me on the buttock before administering the injection, which made it much less of a shock to the system. I thus hoped that she would be on duty as much as possible. Eventually, my fever came down, and the aches disappeared. But when the doctors tested my sciatic nerve, they found that the problem had not been addressed. I was much worse than I had been before the first operation (which had actually been performed by a trainee registrar). I would have to undergo a repeat – this time by the top surgeon himself.

So I prepared myself for another major operation. The beautiful nurse (who had been very kind to me) had by this time gone off for a long holiday in Greece, so I doubted whether I would see her again. But at least I had another pre-med to enjoy. That would be some compensation. I lay back, accepted the pre-med, and waited for the floating to re-start.

But it never happened! No clouds! No sun! No resolution of all the conflicts of the universe! I had been swindled! I even asked the nurses whether they had the prescription right. Yes, they had. The doctors had realised my parlous state before the first operation, but had judged that I was quite capable of undergoing the second without any artificial sedatives. And so it went. I was wheeled in, and went through the whole process, again, with ten days’ bed-rest before trying to move. (Customs change. When I had my last back operation in Connecticut in 1998, they had me walking around in hours, and out of the hospital in a couple of days.) It was not a simple outcome, as it happened. I contracted repeated infections on my spine, when the sutures refused to dissolve. I underwent further operations, and was eventually released from hospital in September 1973, having been admitted in April, but had further complications  ̶ and operations – that endured until the following year. I never played rugby again (nor did I get to Carnegie Hall), but was able to play squash and cricket for quite a while. And that was my experience with opioids.

And what happened to the beautiful nurse? Reader, I married her. And we look forward to our fortieth wedding anniversary in September of this year. Chekhov wrote about the whole episode  in . . . oh, well, perhaps not.

Scan0026

Croydon, September 24, 1976

This post appears before the end of the month, as I am leaving for the UK on July 21. A report of my trip will appear at the end of August. This month’s briefer than normal set of Commonplace entries appears here. (July 20, 2016)

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