Oxytocin > Fentanyl

Fun fact, oxytocin is better than fentanyl. That is in my personal experience. I experienced both yesterday.

If you are up to date on my blog, you will know that I had my CT guided FNA of a nodule in my right lung yesterday. The interventional radiologist that performed the procedure was kind, gentle, and lovely. But the procedure still hurt like a mother.

The area was numbed with lidocaine and initially I felt no pain, but once the needle got to the nodule, I experienced one of the worst physical pains of my life. To put this in perspective, I have gone through over 24 hours of induced labor, had a C-section, had a laparoscopic hysterectomy/bilateral oophorectomy/salpingectomy (what a mouthful!), and a bilateral mastectomy. I have been poked and prodded at over the past year, so I am somewhat familiar with physical pain. I am also familiar with emotional pain, which I think is far more potent.

Anyways, for physical pain, this was definitely top five. Interestingly enough, well at least for my medically inclined readers, the pain was in the front of my chest, while the needle was placed in the posterior portion of my ribs. My doctor thinks that the nodule is sitting on an intercostal nerve – I am pretty sure he was right.

“Ow, ow, ow” I said. The pain burned and stung in my anterior chest. My whole body tightened. My port had been accessed for this situation, but the fentanyl wasn’t coming fast enough. Since I was calm before the procedure, they didn’t pre-game me with fentanyl and versed.

After what seemed like eternity, but was probably at most a few minutes I received 25 mcg of fentanyl. Oh, this is why drug addicts do drugs. It feels amazing. I went from one of the most excruciating pains of my life, to feeling calm and pain-free, and just overall lovely. In layman’s term, I was pretty fucking high.

Dr. G got the sample and a pathologist came down and looked at it under a microscope to make sure they got what they needed. They did. Dr. G took another pass with the needle to ensure they got enough tissue to test. This time there was no pain. I floated away in the fentanyl. Well, not really. Obviously.

If you are paying attention, like I was, even though I was floating, you will say oh, they got the tissue they needed? Remember, the tissue is the issue. Does that mean there is cancer in that nodule?

Of course, I felt stupid asking this – I should know this! I am a doctor! Fuck that. I am a patient right now. I asked tentatively, “does this mean that there is cancer in my lungs?” Dr. G reluctantly answered “yes they saw malignant cells, I am sorry.” “It’s okay.. thanks…” I replied. What else could I say? It isn’t his fault I have cancer. It isn’t anyones fault. It just is.

Let’s take a little detour. Did you notice that he didn’t say “yes it is cancer”? I noticed. In all fairness he knew that I am a physician. When he whipped out my CT scan and started pointing out the aorta and which side was left and right I informed him that I am a doctor. Not to be rude, I just didn’t want to waste time being taught something I already know. It was boring. Yeah, I’m not great at looking at CT scans, but I know where the heart, lungs, and aorta are. Thanks LECOM!

Anyways, he said “yes, they saw malignant cells.” They meaning the pathologist. No physician has ever uttered the words you have cancer to me. No medical person has ever told me you have metastatic cancer. I doubt they ever will.

As a physician, I get it. It sucks giving bad news. We want to help and heal people. We don’t want to tell them they are dying. I have been guilty of this as well in my short time of practicing medicine. We hedge, because we want our patients to have hope. And, because we are shit at giving bad news. Not all of us, but on the aggregate we are.

Even when I was first diagnosed (8/10 will be the one year anniversary of my diagnosis), no one told me I had cancer. Do you want to hear how I learned the news? My core biopsy was the day before (8/9/18) and on August, 10th, which was a Friday, I got a call from the oncology office.

“Hi” the receptionist said… “Dr. C has opened an appointment for you for Wednesday.” My heart sank. Well fuck, I guess it’s cancer, I thought. “Dr. C. is an oncologist.” said the receptionist. I already knew this. I had worked with him for a week on my hem/onc rotation during my intern year of residency.

An actual physician hadn’t called me to give me the news of my cancer until that next Monday. By that point I had already signed onto the electronic medical records and looked at my pathology report. When my breast surgeon called me to inform me I said “I know.” She never had to tell me it was cancer, I already knew 72 hours before.

I could be angry, but honestly I just think its funny. I’d rather laugh than cry. Plus it hurts if I cry. Did I mention I had a needle stuck into my chest yesterday? Back to that… the fentanyl was lovely and it was confirmed that the cancer had spread to my lungs.

I highly recommend getting bad news while high on fentanyl – it really eases the blow. My poor husband was not so lucky and looked far more depressed than I felt.

I was more concerned with the fact that the nurse wouldn’t let me sit up – I had to lay flat for 1.5 hours following the procedure. I couldn’t go to the bathroom to pee. They wouldn’t de-access my port. I was stripped of my dignity and autonomy – I was transformed into a patient. They wanted to avoid a pneumothorax, or a collapsed lung. I get it, but it still fucking sucked.

I got a chest x-ray at 10:30 that didn’t show a pneumothorax and I was slowly transformed back into a human being. My port was de-accessed. I was able to get dressed. I could go to the bathroom! I was given home-going instructions. One of the last things I was told was – no heavy lifting.

Wait, what!! No one mentioned this to me until 5 minutes before I left the hospital. But, I have an 11 month old son! I lift him more times every day than I can even count! He is a big boy and happens to be over 20 pounds.

My nurse, who was lovely and kind, informed me that I really shouldn’t lift him for 24 hours following the procedure. I didn’t want to collapse a lung and buy myself 2 nights in the hospital, intubated no less. Well, fuck.

I could go into how wrong this is. To tell a patient this at the last minute. How if I didn’t have a helpful husband and mother in law to pick up the slack I would have had to I guess just pick him up and hope for the best. Yes, I could technically still hold him, but anyone who spends time with little children knows that you are pretty much lifting them in one way or another even if you try not to. My son will climb up on top of me and want me to lift him up. Try spending an hour with a 1 year old without lifting them, it’s really hard.

This is the worst part of all of it. Most people don’t really get it. My husband doesn’t get it. I should be upset that I have metastatic cancer. Don’t worry I am. But the more pressing thing is that I can’t lift my son for 24 hours. Which, to me essentially means I can’t take care of him for 24 hours. Which means I can’t see him for 24 hours. Because if he sees me he is going to be on top of me and then I will have to lift him.

During the evening, my husband read to my son and I sat on the couch with them. My baby boy crawled over to me and I let him snuggle in. I breathed in his scent, which is intoxicating to me. I held him close. I let the oxytocin spread over me. This is better than fentanyl, I thought. Oxytocin is better than fentanyl. I’d take it any day of the week.

That’s it for now dear readers. Until next time, love and light to you all.