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.

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[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.

I woke up in recovery in the Post-Acute Care (PAC) facility at MGH here. Disoriented of course. My throat was dry and my arms hurt. Not a lot of pain in the leg because of the nerve block. SLC stopped by and told me that the lesion was benign and therefore they just scraped the lesion and put a metal cap over the  area, screwed into the bone. Maureen and Miranda came in and stayed with me for about an hour. She said I looked pale. Nurses were great, stopping in every few minutes to check up on me. Relieved of course that it was benign and that they didn’t need to cut any bone out. SLC says it would be very unusual if the lesion on the right leg was any different to what was on the left leg. It’s still going to be a major surgery.

Moved from the PAC into a regular ward. I have a bed in a double next to the windows where I can look out on a mass of grey pipework and air conditioning units. The occasional sparrow flies up to the window. I can see a small tree fluttering in the wind, growing on what I think must be a balcony above. The nurses in the ward are, for the most part responsive, although there was an initial problem with my call button. The room is a bit stuffy.

The first day I had a roommate who was only here for a few hours. He left without completing the discharge. Followed the next day by another patient. I don’t know what he was in for as he was quiet and wanted the door closed, which made it even more stuffy in the room. The temperature in Boston has been in the 80s. After he was discharged, and later in the evening of the second day here, I got a third roommate—young guy—sounds like  they’re going for some major spinal surgery.

Watched two games of the World Cup so far. The first one, USA versus Paraguay, I watched on my phone. The US exceeded my expectations with a 4-1 win. I then started a Fubo subscription to watch Scotland versus Haiti on my laptop. Scotland were lucky to win, I think. Haiti came so close to scoring in the second half.

They’re still working on identifying this specific malignant cancer. There are two possibilities:  Chondrosarcoma, for which no chemo will be needed. The second Chondroblastic Osteosarcoma for which chemo will probably be needed.

I wrote an update “One step at a time”  about my first surgery to send out to friends and family.