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Thursday, January 26, 2017

Caught in the Machine

Look up Oxycodone on the web and you will be flooded with blather about addiction and 'accidental' overdoses. But you can also find this coupon that can help you become an addict. Is this a great country or what?
The patient had surgery on his ankle Tuesday. The surgeon and his crew of five:

  • his assistant, 
  • the anestheseologist, 
  • the sterile nurse (who hands him his tools), 
  • the X-ray technician, and
  • the charge nurse (who is charge of the Operating Room),
did the work. I may not have all the titles exactly right, but that's how I recall the story.

The patient is experiencing some discomfort for which the physician has prescribed Oxycodone, one to two (five milligram) tablets every four to six hours. We check our supply this morning and we have 28 pills which, given the current rate of consumption, is enough for two days. Hmm, better see about getting a refill.

A call to the doctor's office puts things in motion. In short order I hear that a new prescription is ready for pickup at their office. Just in case you are not aware, Oxycodone is a 'controlled substance', which means that the doctor cannot simply call in a refill order, a piece of paper with the correct magical markings must be picked up from the doctor's and carried to the pharmacy. Accursed bureaucratic bullshit, but that is the world we live in.

So I drive to downtown Portland to pick up the magical piece of paper. I'm a little slow off the mark, so it's 2 PM before I am on the road. Traffic, as expected, comes to a halt half way down the hill between downtown and the Sylvan summit. It is creepy-crawly in the 5 to 10 MPH range for the last mile. Traffic has been getting worse on the freeways all over Portland for years, but nobody seems to have any kind of solution. For right now though, we'll just give the 'government by the people' a big fat black mark.

Once clear of the mass of tax reductionistas heading for Washington, it is clear sailing, if 20 MPH through downtown streets crawling with pedestrians can be considered clear sailing. And when I get to the doctor's office there is an open, unmetered parking spot right in front of the building. The time limit is only 15 minutes, but that should be more than enough.

Upstairs the receptionist has the promised script ready. I take a look and realize it is for 40 tablets, which will last us three days, so I am going to have to repeat this trip again on Friday. Can I get larger script? Or a second one? The inquiry goes up the chain of command. I pace back and forth between the window and the desk. Is the meter maid coming to ticket my car? Do we have an answer to my inquiry? I am afraid I may not have an answer to my question for hours, by which time I will have accumulated thousands of dollars in parking citations. Why didn't I just take my piece of paper and go? But an answer appears after only ten minutes. The answer is no, no and no, which is kind of what I expected, so I take off.

When I get home we realize that if all goes well we should have enough Oxycodone to get through the weekend. This evening, though, the pain ramps up and there is some doubt as to whether even doubling up on the Oxycodone is going to be enough. Going to the Emergency Room for morphine might be our next move. We shall see how things go today. The pain may retreat, which would be good. However, I should be prepared to go back downtown on Friday to get another script, just in case.

Meanwhile, I schedule a follow up appointment for our patient. I have my choice of the downtown office, or the office at Providence Hospital on the Eastside. The Hospital is maybe four miles farther on, but they have parking. It's not the best parking garage in the world, I may have to cruise through four or five or six levels, but it is easy to find, it's free and they have always had space. Parking downtown is horrid. It usually involves driving around and around and around until you find a lot or a spot on the street. If you are lucky it will only cost $3 and you will have to walk a couple of blocks. If you aren't, it might cost you $10 and you'll have to walk a mile.

So screw downtown, we're going to the Eastside.

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