I’m so wired I don’t need coffee

Surgeons rarely kill people. They might screw them up, but they don’t normally leave them dead as a doornail on the operating table. Anesthesiologists are more likely to do that. How weird is it then that people choose their surgeons but take whichever anesthesiologist walks through the door? I made a big deal today of requesting the same anesthesiologist I had in March. I liked how he dealt with my sleep apnea, and he and Mark (my surgeon) obviously liked one another.

This brings me to another thing to ponder when you’re having surgery. You want to do what little you can to insure that your surgical team works well together because a successful surgery is never a one man affair. This is why I didn’t ask Mark to operate at my usual hospital—the big one where Peggy works—even though Peggy wanted me to. Better for me to be in a strange environment than for him to be in a strange environment.

I went both to the hospital and to Mark’s office for my pre-op today. The lady at the hospital smiled when she said I wouldn’t “have to be stuck” for blood tests. I said I wanted to be stuck, so she stuck me. The negative results were welcome after all these months of heavy medications.

The lady at Mark’s office said he would be in shortly to talk to me about my upcoming shoulder replacement. “I’m not having a shoulder replacement,” I said. “I’m having arthroscopic surgery on my left rotator cuff, which is to include an acromioplasty, a bursectomy, a supraspinatus repair, a glenohumeral joint debridement, articular cartilage restoration, and a few other odds and ends, but no shoulder replacement.” “Since the surgery on your right shoulder went so badly, he wants to go ahead and replace your left one at the outset,” she said. Peggy and I looked at one another. When Mark came in, he said there had been a mix-up.

If I didn’t trust him, I would have needed an explanation, but a good patient needs a good doctor more than a good doctor needs a good patient so I don’t rock the boat unless it matters. Besides, we had a lot to talk about. Like the following, which I wrote for him and will condense for you. It might not look like much, but it contains considerable learning, some of which might be of benefit to you someday.


“Prescription-related challenges and requests”

“Sleeping in a chair while in pain was a major problem last time (I was in that chair for four months), and I fear it will be this time too.

“I’ve learned that a good sleeping pill is often preferable to a narcotic because it: (1) enables me to get to sleep sitting in a chair, (2) enables me to stay asleep through a surprising amount of pain, (3) lasts twice as long, and (4) doesn’t make me itch. I would therefore like to rely on sleeping pills more and narcotics less. The Restoril you prescribed works well, but one can develop a tolerance in ten days, so I did some research and came up with Dalmane as a reasonable companion.

“Ron at Peace Health Pharmacy agreed that Dalmane is my “best bet” as a companion to the Restoril, and added that it has the advantage of being stronger and longer acting. I also have some Ambien on hand, but he confirmed my observation that it isn’t all that strong and wears off quickly. My insurance requires prior authorization for Ambien CR, but I have a coupon for a four-night sample if you see fit to authorize it. I also have a coupon for a week’s worth of Lunesta—which is also a wuss drug compared to Restoril and Dalmane.

“The reason I am so enamored of sleeping pills is that I’ve never had a really great experience with a narcotic whereas (aside from a little day-after grogginess) I’ve never had a bad experience with a sleeping pill. Of course, I’ll never complain that you’re ordering too many blood tests to verify that I’m not inadvertently poisoning myself.

“So, here is what I would request.

“A painkiller. Maybe more Demerol, since it’s the only narcotic that doesn’t make me itch.

“Dalmane (flurazepam hydrochloride). 30 mg is the usual dose. If you specify tablets rather than capsules, I can start with half a dose (I always prefer tablets for this reason). As with everything else, I can get three months’ worth for the price of two, so if you prescribe 90, I won’t need a second prescription.

“I’m set for Restoril and I don't need a prescription to buy all the stool softener that a person could ever want to own.”


Mark gave me what I wanted but not as much as I wanted. Sometimes, he will give me a lot of something, and other times he won’t. I can see no rhyme or reason in this, so I suspect it’s simply a matter of mood or attentiveness, but I never ask about it. These drugs are addictive, and that alone makes it impolitic to ask for bigger bottles. Just asking for a particular mood-altering drug can put a doctor on guard, yet I do it all the time because I’ve learned that I have to be my own authority to an extent. No doctor can know what works for me, and no doctor will spend one one-thousandth as much time as I will focused on what I need. In my experience, most doctors aren’t even that good at pain control. They basically have one or two favorite drugs that they give to everyone who walks through the door. Some doctors even view a patient's request for pain control as a sign of weakness or addiction. They are unworthy of their profession. People in pain need to feel empowered.

I spend so much time thinking about and reading about drugs that I even give them personalities. Vicodin? A skinny little nymph for those days when you need just a whiff of a narcotic. Norco? Vicodin’s big sister (her parents didn’t want a baby back then, and that’s why they gave her that crappy name.) Percocet? Full-figured and cuddly. Demerol? The thinking man’s drug because it makes a man sit and think—even when he would prefer to get up and do something. Ambien? When it’s 3:00 a.m., and I’m not in a lot of pain but I can’t get back to sleep either, Ambien comes like a sleepy-time angel with long white wings and a long white gown. Restoril? A fatherly hand that covers my eyes and drowns my pain in the waters of oblivion.

As I approach this latest surgery, my main comfort is that the things I’ve learned should give me a better shot at sleep and pain control even if this recovery is as bad as the one I started in March—for which I still sleep with ice packs. And, who knows—maybe it won’t be as bad. After a little vodka, I can even think of it as a grand adventure—sort of like a trip to an exotic land, only with a lot of pain and disability thrown-in at no extra charge.

But even if it is as bad, things could still be A LOT worse. Parkinson’s, Alzheimer's, kidney failure, liver cancer, complex regional pain syndrome, amyotrophic lateral sclerosis… Yes, things could be worse. I have no real complaint, but sometimes I get carried away by fear as if fear were itself a drug. I picture it as a big horse with frantic eyes and frothing lips. It keeps running faster and faster, and I struggle mightily just to stay in the saddle because to fall would be unthinkable.

Where am I?

I have given but little time to blogs lately--my own or others--because I am preparing for shoulder surgery in December on the shoulder opposite the one that had been done in the photo. After surgery, I will be limited to using one arm for three months, so I am working to get as many chores out of the way as possible. If something important occurs in your life that you want me to know about, please post it in the form of a response to my last entry.

Why not die?

Three days ago, I got an email from a follower (I’ll call her Jackie) who asked if I could think of a reason she shouldn’t kill herself. I wasn’t surprised that Jackie was considering suicide, but I was surprised that she would solicit my opinion about such an important matter. You see, no one other than Peggy ever solicits my opinion about anything. My opinion is so NOT solicited (or accepted when offered) that I think of myself as like a reverse salesman—if you want to talk someone out of something, just send me to talk them into it. I can’t really say why this is so because my opinions are often excellent. After all, I’m smart, diversely educated, slow to act, a deep thinker, an extensive fact gatherer, and old enough to have experienced a lot of life and seen the results of a lot of decisions.

I was about to rake the leaves when Jackie’s mail arrived, and I wasn’t in the mood for such discourse, but I knew that I couldn’t delay my response lest the day end with my yard clean but my friend dead. Such an outcome might have soured me on yard work permanently. Besides, I was honored that she wrote to ME because—as I said—no one ever solicits my opinion.

I had little thought for what I might say when I sat down to write, but little trepidation either because I am more effective on paper than in person, plus I have given suicide A LOT of thought over many years as a solution to my own problems. Yet, I recognized that I probably had little if anything to say to Jackie that she didn’t already know. One of the downsides of aging is the realization that, aside from information pertaining to specific disciplines, you’re not likely to learn much from other people. This is probably why suicidal psychiatrists don’t tend to seek help. I mean, what could anyone possibly say to a suicidal psychiatrist?

The last time someone told me that she (it was a she that time too) had been thinking about suicide, she put it this way. “I was sitting in the kitchen with the rifle barrel against my chest, wondering if I would really pull the trigger, and then Dale walked in. When I saw the look in his eyes, it scared me, and I realized that I really needed to turn my life around.”

I thought this meant that she HAD turned her life around (after all, she seemed happy). A few days later, she was dead of a self-inflicted gunshot wound to the chest (that’s me, then Dale, and then her at the top of the page). If you really want people to think about you A LOT after you are dead, just tell them you’re thinking about killing yourself, and then kill yourself. If you want them to remember you their whole lives long as if you had JUST died, that will do it. Believe me, they will NEVER get over your death. My friend, Kathleen, has been dead thirty years, and I still haven’t run out of tears.

Anyway, I sat down to have a go at a response to Jackie based upon my knowledge that people who suffer from cancer, alcoholism, chronic pain, or almost anything else tend to get along better with the support of their peers than with the support of trained counselors. This is because they feel better understood and know that what they are hearing is real rather than theoretical. So, I told myself, I will be real. It’s really all that I had to offer. As I reread what I wrote, it seems woefully inadequate. Maybe you can think of something more.

Dear Jackie,

I’m glad to see from your letter that I’m not the final strand in your last string, but I’m still worried that you’ve sat by your computer all day becoming increasingly despondent as you reflected that maybe I haven’t written because I don’t care about you or because I resent your coming to me. Neither is the case. I simply haven’t been indoors.

As for reasons to not commit suicide, it is a subject that I think about a lot since I am often tempted. In my case, it would be an extraordinary situation in which I would do such a thing to Peggy without her consent, and she wouldn't give her consent unless I was in extreme and hopeless pain or suffering from a terminal illness. You too have relatives who need you to stay alive, so you too must behave responsibly. You must make suicide—when and if you do it—an honorable retirement from life, devoid of shame or failure. It can be, after all, an exemplary act; not an ignominious retreat but a sensible and well-timed withdrawal.

Suicide to me is like a get-out-of-jail-free-card that I take comfort in holding in case all else fails. Even without Peggy to consider, I doubt that I would do it anytime soon because I still have reason to hope that my health will improve, and at least a few things left to enjoy; but even if I were to lose both Peggy and these, there might still be some good that I could accomplish. If nothing else, I could comfort dogs at the pound. Yet, the temptation to kill myself is often with me when I’m in pain, or fretting over the fact that I have lived long but accomplished little, or feeling overwhelmed by the possibility that my health will get worse. I’m not a prisoner without means but a free man with guns and drugs, and I am grateful for them. I’ve rehearsed every detail of how I would make my exit, so it is simply a case of going to the station, so to speak, from which I would book my passage into the Dark Land to which all go but none return.

Anyway, these thoughts are what come without much reflection, but with the conviction that days of reflection would not yield anything more profound. I hope that you can find meaning (or at least pleasure) in your life apart from your family, but if not, you do have people whose own lot would be made miserable without you, and that alone makes your escape untenable.

“When you gaze long into an abyss, the abyss gazes into you.” Nietzsche

Just remember that suicidal thoughts can take on a life of their own. The more you dwell on it, the less frightening it appears, and the more likely you are to deceive yourself into thinking that the very loved ones who are holding you to life would be better off without you. I would therefore ask that you limit your excursions to only the outskirts of that cold land. Think of suicide as simply one of many options, albeit the last.

Finally, there is the wee small chance that there might actually be another life awaiting you beyond the grave, a life that will be made better or worse according to how you live this life. Imagine thinking that you are permanently escaping your pain only to awaken someplace where you are in worse pain and without even the appearance of escape. Such a prospect need not preclude suicide, but it should make us more careful to use it as a dignified retreat rather than a humiliating rout.

With love and respect,
Snow