Woke up.
Happy birthday! It hurts today.
Pain right now is intense.
Starting to hallucinate.
–later–
Lots of pain in the morning, interrupted by spasms of even more pain. I used the Patient-Controlled Analgesia (PCA) device to deliver measured doses of Dilaudid[1] every six minutes, but that didn’t really work because I’d need more than the measured dose to relieve the pain. For me, at least, the point where pain relief starts to kick in lags the time of taking the dose by more than six minutes. I’d find myself overshooting the total dosage needed and move into hallucination territory. I’d then start to actively hallucinate by seeing things: usually people that I didn’t recognize, but also the occasional angel or demon. At other times I would also phase out (like Mitch McConnell). For a few seconds I would not be present before returning to what, I’d assume was reality, but could also be to a different hallucination. Sort of like Chuang Tzu’s butterfly.
I spent the early part of the day in the PAC fighting pain. Later I was moved to a regular ward on the 6th floor of the Ellison building. The doctor and I discussed pain management and they agreed that I could take larger oral doses of oxycodone, up to about 20 milligrams, every few hours. The protocols for dosage and frequency are set by the doctor for how often a nurse can give me painkillers, but these tend to be minimums; intervals will often be longer. Two reasons for the longer intervals: if I was asleep the nurse would not wake me to give me the pill. Second, most painkillers, including oxycodone, dilaudid, and morphine. are Central Nervous System (CNS) depressants which result in a drop in blood pressure. If my systolic blood pressure was under 100 the nurse would not give me the painkiller. The diastolic pressure does not seem to be an issue.
[1] They gave me Dilaudid even though I’d listed an allergy to it on the grounds that last time when fighting cancer it gave me hallucinations. In fairness though, it seems that I’m quite susceptible hallucinations as I found later that I got them with sufficiently high doses of oxycodone.
