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Acute Abdomen Land Theme Park

Alexander DeLuca
, July 5, 1999. Posted 7/5/1999-07-05; Revised: 2007-05-24.

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[I wrote the following on my return from 10 days in the ICU, the proud owner of a new temporary colostomy. I posted this initially on the ADD_MED listServ where the eminent doctors of that noble round table received it with resounding silence. As the morphine wore off, I thought of the words that are the title of this brief essay. And I started to laugh... ]

Yes, Acute Abdomen Land is a wild ride indeed! Actually, folk here would probably get something out of the experience; along the lines of 'a person who has himself for a physician is a fool.'

I had been constipated for a week or so, and understand I've little experience with constipation. Some abdominal discomfort caused me to stay home a week ago Friday, but I was able to lift and carry 50 lbs sacks of mulch uphill in the heat that weekend without acute pain, and ascribed the mild mental dullness and fatigue to psychological reasons and stress. I went to work Monday but left at 3pm with a feeling of bloating with occasional stabs of pain I ascribed to 'gas.' I became progressively more irritable and restless Friday evening, but I was also fighting on phone with Hospital attorney and talking with the resident who was being wrongly screwed by same, and anyway, irritability and anger come quite easily to me under the best of circumstances.

At eight PM I made the fateful decision to 'treat' my condition and went to local Rite Aid for MOM and drank half a bottle of same on walk home. I became progressively uncomfortable and restless, but the real fun began about midnight when I entered an almost hallucinatory state in which I spent the rest of night till dawn unable to lie down, in pain that caused involuntary cries, staggering about the apartment bent over muttering stuff like "please, no more pain," and "I'm okay" over and over and over again.

 Here come the kicker (actually kickers):
I am the son of a surgeon and pediatrician. I'm board certified in Family Practice (not Psychiatry). *Not for one minute* did I think like a doctor and ask myself, “Hmmm, what can cause constipation, increasing abdominal discomfort and restlessness rising to a psychotic crescendo” which is a fairly short differential in an otherwise healthy 43 year old. Nor did it occur to me to palpate my abdomen beyond hugging myself as if to keep from exploding. 

And my surgeon, the best surgeon in the Bronx IMO, was 15 minutes away and I get along with him fine; he’s my father. 

Finally at 8 AM the pain became constant and seeing-red intense and called said Surgeon who wearily told me to “get your ass in a cab and meet me in the ER” of a hospital in the Bronx. I was moaning all the way on the cab ride (potholes! OUCH) and was barely able to crawl into the ER where my father and my friend Steven Berger from medical school, who is an excellent surgeon in his own right, and my fathers protégé and partner (aka "the good son"), examined me. I received 1 mg of morphine (I said, "Steve, your kidding, right?" He wasn’t.) Then to the CT scanner (stretched out on coldest, hardest slab imaginable - OUCH!) babbling quietly to myself while getting confirmation of a ruptured diverticulum of the sigmoid colon. Then up to the Operating Room where I was given Versed (midazolam) and morphine (Bless you kind doctors!!) and laparotomy revealed pus filled abdominal cavity with peritonitis - classic ruptured diverticulum with peritonitis - which yielded me the loss of a foot or so of sigmoid colon, and a temporary colostomy.

I've learned a lot about pain; exquisite pure pin-the-gauge max pain. There is a limit; 10 is 10, max is max, and that is the point you are quite willing to die to make the pain stop (which is not thoroughly logical but makes a *whole* lot of sense at the time.) But it doesn't kill you; you don't die; you can tolerate it (at least for 12 hours or so). (This is perhaps akin to labor pain?.) 

Of course, “Pain” is not the only ride in Acute Abdomen Land. There is the “Opiate Analgesia Roller Coaster” in which one attempts to explain, through post-anesthesia haze and post-op pain, that the correct dose of morphine is the dose of morphine that works, not some damn, dogmatic this-is-what-we-give rule (which finally ended with me demanding the anesthesiologist - the only other person in the Bronx who understood opiates it seemed) and even then, now on 7 1/2 mg of morphine every 2 hours (up from 5 mg every 4 hours) the pain was dulled just enough that I was awake the entire night in order to be able to truly grok “Post Op Pain Land” with a clear head while not slugging nurses. So I now have a lot to say about pain relief in America, which is a national shame IMO, and about the 'opiates are dangerous, evil drugs' mentality which is all too common even in our enlightened field. I ended up requiring 12.5 mg of morphine every 2 hours for the rest of the week.

And who could forget the realization which comes, once you get home and the opiates wear off, in a sort of 'The Scream' intensity, that you've gotten on the “Oh My God There's a New Hole in My Body Ride” in which one is wracked with sobbing without clear content but which hurt my poor wounded body almost as much as the uncontrollable laughter set off when I first thought the words 'Acute Abdomen Land Theme Park.'

Now, I admit I'm nuttier than most, but I am not the only one. While in the hospital I heard about the urologist who treated himself for non-specific urethritis for months while missing the bladder cancer which killed him, and the very similar-to-me cardiologist who treated himself for heartburn with Maalox for a week whilst missing the evolving Myocardial Infarction (aka 'heart attack,' or 'coronary') that was the true source of his pain.

And who amongst us with the power of the script has not written antibiotic, pain, or psych meds for self or family-without-examination? 

Beware good doctors, beware.




Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D.

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Originally posted:  1999-07-05

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