A Bone to Pick

“Whaaaaa aw ma-a-a-n owwww! *@*#$%^#$%#(*(@$#^&$%!@*!()$#*^@!(#$$ [censored]” I screamed every expletive I knew and a whole bunch I made up. The world had gone completely white and was overlaid by even more brilliant explosions of light. My vision tunneled down to a pinpoint and then went dark. The pain was so exquisite I passed out from the sensory overload. 

My vision began to clear and I saw my wife bending over me and looking concerned and frightened. “What happened?” she asked.

A good question. I tried to think of an answer but I couldn’t seem to get my brain in gear. My senses were locked onto the excruciating pain and I was helpless to defer it. Every breath caused a dagger of pain that made my breath catch. I sounded like I had machine gun hiccups. “S-s-s-s-iddup. S-s-sudn p-p-pay.” I knew what I wanted to say now, the holdup was my inability to speak it.

“Take your time, honey. Tell me what happened.”

“Was laying. Here. Sat up.”

“You were laying here and sat up? Is that it?”

I nodded. “F-felt like a t-tick. Click. D-d-dunno. Then h-h-h-urt. Ohh ma-an! F-feel like b-b-broke-ken r-r-rib.” I was shaking and pumping sweat. My wife ducked into the bathroom and came back with a wet washcloth and laid it across my forehead. The coolness made me wince, the wince sent electric jolts of agony. I started swearing again but the words were so broken as to be unintelligible.

“You’re so white –you’re almost gray. Blue. Jesus. You think your rib is broken? We need to get you to a hospital.”

“Feels like i-it. I d-don’t know. Gedd-dd m-muh p-pain m-meds and wah-wah-water.” She moved off to do as I asked then sat with me as we waited for the morphine I took to kick in. After a half hour I took more, not getting a lot of benefit from the earlier dose. I had her help me to sit up, pushing the buttons on the bed controls to boost me into an upright position. That helped more than the drugs did, somehow relieving the pressure that felt like someone was using a cargo hook to rip my ribs out of my chest. Finally I could take breaths, little ones, without feeling like the hook was being twisted. By the time the pain had been dulled enough that it was only super uncomfortable, I’d tripled my standard morphine dose and added some dilaudid and aspirin as well.

Sunday I gave thought to going to the VA hospital. But on weekends they have minimal staffing. I do mean minimal. A doctor, a nurse and technician, a radiology shooter and a lab tech to do blood tests. It would tken them 8 or 9 hours to deal with an issue like mine only to tell me I had to come back Monday when the hospital was fully staffed. I elected to stay home and wait for Monday so I liberally dosed myself with narcotics and tried to read and catnap the day away. It accomplished the same end as if I’d gone to the medical center –but avoided the pain of travel and in-hospital shuffling about.

On Monday the hospital was jammed. It was always jammed these days what with the many satellite clinic closures bringing people in from western Montana, north Idaho and eastern Oregon in addition to the eastern half of Washington. But Mondays are the worst for some reason. There’s construction everywhere as the hospital gets a couple of new wings and a tremendously expensive cosmetic face lift. Everyone wishes that the VA bigwigs would spend money on more doctors, nurses and equipment to handle the quintupling of vets seeking help, but the politicians are dead set on having the prettiest understaffed hospitals in the world. Still, the people working there, the doctors, nurses and techs are pretty good and dedicated. Within two hours I’d been xrayed and prodded and checked out. Pretty darn good for an ER with standing room only.

“Your suspicions were right.” said the doc. “You have two ribs that show fractures. Looks like lesions weakened the area. I have to tell you, and I know it’s shitty, but there isn’t much we can do. Just keep you as comfortable as possible and stay as immobile as you can. Use your pain meds as needed.” Lesions are extremely painful at best, often exposing nerve endings and irritating them. It’s similar to an abcessed tooth, the nerves of both the teeth and the jawbone get irritated. It’s some of the worst pain the body can develop.

“You can’t tape him up or something? Give him some support?” asked my wife from behind me.

“Nah. I mean, if he had a full separation we might use an appliance to immobilize or stabilize the ribs. But this is more like -uh- more like a spiderweb crack in a windshield. Putting pressure on it would just make him more uncomfortable and probably make it harder to breathe.” said the doctor. He shrugged. “I’ll send this up to oncology, I mean, I’m sure they’re going to want to know.” To me, “You should call them up tomorrow and see if they want to do anything. Like I said, it looks like a lesion there. They may want to go proactive with treatment of some kind.”

“This is going to happen again, isn’t it?” I asked. 

He shrugged again. “Maybe. But maybe not. Breaking ribs happens a lot with Myeloma cases. It’s just one of the aspects of the illness. It’s a bone cancer after all.” He bid me good luck and we were dismissed. The pain had been creeping up, becomming more intense and so I stopped by the drinking fountain and started fumbling with vials.

“What have you got there?” asked my wife.

“I’m popping some morphine and also some senna and docusate.” Morphine dries the system out and so constipation becomes a big deal. I’d learned the hard way to take laxatives and stool softners when I increased pain med doses. It helped most of the time, but others not so much. When it didn’t happen I would have to try lactulose, the Sherman tank of laxatives or at worst have to use an enema. Comfort definitely has its price.

As things sit now we’re waiting for a CT scan. My doctor ordered a hunting expedition to look for lesions or weak areas. We might be looking at radiation treatment to kill the lesions, but killing them kills the bone as well. I’ll have to wait for the fractures to heal before I can take that kind of therapy. If the bone is dead it won’t heal. Even so, with a lesion at the fracture site, healing may be a moot thought anyway. Plus, the cancer affects osteoblasts and osteoclasts, the body mechanism for creating and absorbing bone mass, so no matter what, this is a rough situation. No matter what, there are obstacles to healing. No matter what, this really sucks.