He sat there overflowing the high stool at the front of the room. For all the world he reminded me a rather dishevelled Toad of Toad Hall. He looked rather like someone who would take out the garbage, or be pushing a broom around. But patients adored him. It was thirty years ago. For some reason I had been invited to a small seminar run by a small company that was to go on to be a major force in oncology in Australia. At that stage they made a range of what is called orphan drugs - drugs where the use is too small for a major company to bother. One of these was a drug used in pain control to reverse the side effects of morphine. The speaker was the person who can only be described as the father of pain control in Melbourne - the late Wally Moon. In his unique way - no slides or lecture aids, just sitting there overflowing the stool, he talked about pain control. How opiates work, how pain was the antidote for the addictive effects of morphine. How bad cancer pain was and how he had patients walking round Melbourne on what the textbooks would say was a lethal dose of morphine. It was an hour sitting there realising that you were in the presence of a great person. That was my introduction to pain management and I have never forgotten it. Later on I was to attend many seminars and to have a member of my family suffer chronic neuropathic pain and to see just how debilitating it is. I was also to see the appalling treatment people who suffer pain receive from so many of the medical profession. To sit in Emergency and see someone treated like scum because they are in pain and the triage nurse has the mindset that anyone presenting with pain is a drug addict is not pleasant and you are so powerless. The attitude that it is all in your mind and therefore not real is appalling. The sense of relief when a pain specialist tells the family member - ‘your pain is real and we can do something about it’ is energising. It took five years and a huge amount of trauma before we finally saw that pain specialist! I have learnt about Cognitive Behaviour Therapy - it helped the family member, at $105 for each weekly visit for eighteen months and no Medicare rebate. However, the best help has been morphine, properly controlled and in large dose. With my learning has come the knowledge that no-one has the right to deny someone else’s pain, or to imply that it is all in the mind. Somewhere in there is also that many of the medical profession have a lot to learn. Housebricks? A side effect of morphine is constipation. For many people our toilets are too high, we are not in the ‘natural’ squatting position where abdominal pressure helps things. So Wally used to recommend housebricks put in front of the toilet to put your feet on and get into a better position. He also told how elderly female patients used to crotchet covers for them, so they looked more decorative! Sailor 22/6/10 He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. William Osler
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