pain

     The proctors shuffle sideways through the tight rows and begin to pass out the exams.  The last one, which is actually a two-fer-one test.  A total of four versions for the test, each person gets a random version to lessen the likelihood of cheating off your neighbor.  Even the earplugs are supplied by the school to prevent any earpieces that could allow for cheating.  I thought the school was just being nice. 
     I roll up the earplug and shove it down into my ear canal.  As the spongy material decompresses against my ear canal, it's a bit like walking into a tunnel.  All extraneous sounds, and thoughts, fade away into the background as my mind approaches a zen-like state.  Except one sensation.  There's pain in my left ear radiating up from my jaw.  Right before exams started I had a tooth flare up.  Bad.  No time for dental appointments, I numbed it up with vicodin.  I discovered that while I could NOT study while in pain, I COULD break through the fog of opiates with enough caffeine and enough will power.  So each day, I'd wake up in a haze and start pouring tea into my body by the gallons, hoping that by the time the exam rolled around I'd still have enough pain relief on board while simultaneously having enough caffeine to counteract the mental fog.
     I know, I know.  It was less than ideal but when your back is up against the wall, you do what you gotta do.  All those rules and guidelines about not self medicating go right out the window when it's three am, you have exams, and you're in severe pain that laughs at the notion of ibuprofen controlling it.  The memories of my brother were quick to haunt me, too.  How many times had I watched him wait for the pain meds to kick in...waiting....waiting....waiting....ahhhh, relief.  It always took about 30-40 minutes.  So at three am, I'm frantically digging through our house looking for pain meds.  I got them for my hiking first aid kit.  They must be there.  Nope.  Medicine cabinet?  Nope.  After a half hour finally breaking out in a cold sweat due to the pain, I finally find them, pop them, and then plop myself onto the couch in front of the tv.  It takes two South Park episodes on Netflix for them to kick in.  Waiting....waiting....waiting...ahhh, relief.  44 minutes, just like my brother.
     Blissfully, I can fall back asleep hoping that my brain will begin to function on a higher plane by exam time at 1 pm.  And so I repeat this ritual for 7 exams over 10 days and amazingly, it works.  I am able to study.  I am even able to drive, much to my wife's consternation and worries.  And to top it all, I am able to do well on exams.  I wouldn't recommend it and if I had the chance to do it all over again, well, there wasn't a lot I could do.  But I can say that being visited by the specter of my brother's pain at three am is a powerful teaching moment.  If I didn't already have enough appreciation for patients with pain that is not well controlled, I now have another personal level of empathy and understanding.  Opiates get a bad rap because of some bad people but for the majority of patients who really have pain, they are a life saver.  I don't know what I would've done without them.  They got me through my first round of exams and made me a more caring doctor on top of it.