Here’s a link to my September column in Emergency Medicine News.  The text is pasted below.  I hope you get a laugh.

Thanks for all of your kind readership and encouragement over the years.  I don’t always do a good job of responding when you contact me, but I write for you and appreciate you more than you can ever know!

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If the pioneers loved pain medicine the way we do!

(This is the full-text version, as the EMN version required a bit of editing)

even the oxen are in pain

even the oxen are in pain

The wagons were still, as the wind blew from the West.  Family after family was waiting for a word, a signal, any sign that the journey of their lives was about to begin.  Crows circled overhead and flies buzzed.  But no signal came.  Children played tag in the streets, and weathered trail-hands checked and rechecked the harnesses that held oxen to the Conestoga’s they would pull to Oregon.  Women in long dresses fanned themselves, and scouts stumbled out of saloons, kissing pretty girls goodbye till next time, assuming they once again survived the road across the plains and mountains of young America.

‘What’s holding them up, young man?’  asked Parson Shealy.  The young man he addressed was a helper to Captain Morgan, head of the entire wagon train.

‘Same as always,’ he said and spit.  ‘Trying to lay up a full supply of Lortab.’

‘Praise be!  My lumbago is terrible!’  The parson sat back on his throbbing gluteus and whispered a prayer of thanks.

Everyone knew that the narcotic wagon was the most important wagon of all.  Second only to the water supply (which was obviously needed to swallow the treasured pain medication), the ‘drug-cart’ as they called it, would never be left behind.  It was guarded at all times by sturdy, trustworthy men who were always diligent, though apt to fall asleep in the saddle from time to time, and frequently given to complaints of saddle-soreness requiring pain medication.

The word passed down the line, and everyone agreed it was worth the wait.  They all knew the terrible stories, some published as dime-novels in the bustling cities of the East, others told round campfires to frighten small children.  Stories of brave explorers who twisted ankles, were shot with arrows, or were attacked by bears…and who had not so much as a Darvocet or Ultram to take for their suffering.

Only last year, a train made it two days out of Independence, Missouri, supplied with vast barrels of hastily purchased anti-inflammatories, only to discover that every adult on the trip was allergic to Aspirin, Motrin, Aleve, Advil and Toradol.  They returned to the city to wait another year.  Their moaning could be heard for miles, and when they arrived back in town, the pharmacies were scenes of chaos and fist-fights for 16 hours.

It just wasn’t worth the risk, traveling without enough pain relief.  It was said that old Panther Dan, greatest of all the early Mountain Men (and called ‘Blue Speck’ by natives who traded with him), had very nearly put his Hawken rifle in his mouth when he realized he was snow-bound in the Rockies, and discovered to his horror that his hidden supply of Fentanyl patches had been deftly lifted by a painted lady back in the Dakotas (who subsequently failed to wake up one morning after a night of debauchery and severe pain).  Fortunately, Blue Speck found the body of a US Cavalry Scout who had been killed and scalped, but whose pouch was full of Veteran’s Administration Oxycontin that had been overlooked by the band of Cheyenne who had left their arrows in his body.

So it was with a great ‘hurrah’ that Captain Morgan put his knee on a wagon-wheel and announced, ‘we have enough drugs for the crossing!’  Of course, in hoisting his knee to the wagon-wheel, he immediately strained his back, winced and reached into his pocket, popped two Demerol into his mouth, and took a swig of the fire-water he keep in a flask.  ‘To Oregon!’  he cried, and the ladies wept, the men cracked whips over the backs of their beasts, and one of the guards of the drug-cart snored loudly and fell from his Appaloosa, landing in the dust with a thud.

The first few days were happy ones.  The enthusiasm of the company was punctuated by laughter, songs and drowsiness.  The bouncing wagons left everyone uncomfortable, of course, but the daily ration of narcotic that made the inherent discomfort bearable.

A week out, trouble showed its head for the first time as a band of outlaws road into the camp in the night, their leader holding pretty Mrs. Lecroy at gun point, as he asked for prescription drugs.  Captain Morgan suspected it was ‘Thick-tongue bill,’ a long feared, drug addicted highwayman.  ‘Giiivvv ustht thome of yooor Lorrtabs.’  ‘What?’ the company asked?  ‘Donnn maaakk me thaaay ittt aggin.’  At this, Thick Tongue Bill drifted to sleep and dropped the canteen he had been holding as a pistol, and his band found themselves at gun-point, captured by the travelers.  ‘What’s your pain scale?’  they asked his helpers.  Each of them, little more than boys, looked to the dirt and said, ‘we didn’t mean no harm.  But it’s a ten; maybe even an eleven!’  They kicked the ground, expecting to be hung.

No one had the energy to hang anyone,  nor indeed even knew where the rope was.  Before long even the outlaws received a box of Dilauded for their trouble.  Everyone agreed that if their pain was really a ten or eleven, well, they deserved some help.  Robbery was hard work, and apt to produce pain.  There had, indeed, been lawsuits in which thieves had sued the wagon-companies for not treating their pain. Captain Morgan knew it wasn’t worth the trouble to resist; and dang it, he could relate.  His neck was killing him!

Bill and his band road quietly into the dark, constipated but satisfied by the generosity of these kind, pain-afflicted travelers.

The next few weeks were uneventful.  The pioneers endured bumps and bruises, thanks to the ministrations of their assorted opiates.  Babies had been born to women who screamed far less than in the old days; babies that were themselves drowsy little angels.  Only once or twice did arguments break out; but when they did, no one was worried about gun-play.  No one could hit a darn thing with a Navy Revolver while taking a proper pain pill.  The noise of gunfights did trigger an epidemic of migraine headaches, for which the party stopped three days to recuperate and sit in blissful silence, as the oxen lowed for forage and the horses dragged sleepy riders who hung from their stirrups.

But in Chimney Rock, Nebraska, the trip came to a grinding halt as a troop of cavalry ambled sleepily off the trail and made their way into camp, bearing a crate full of government forms.  ‘We’ve been trying to catch up to you since you left Independence!  Didn’t you hear?  Most of y’all qualify for disability!’  Well, if there was a whoop and holler over the initial drug supply, this was even louder.  Couples kissed, old folks with urinary retention wept and children (drowsy from cold medicine) looked up in confusion.

Major Medical, of the 6th Cavalry, looked down from his fine horse and gave the best news of all:  ‘being as you qualify for disability, we’ve got a whole band of hard-working folks in Wyoming who have to take your wagons west for you, while you just take it easy in the back.  If you can make it the rest of the way to Fort Laramie, someone else will drive your wagon and work for you!  You’ll never need work, or hurt again!’

The families were ecstatic and Capt. Morgan was reflective.  Another successful crossing with as little pain and effort as possible.  The parson whisper a garbled prayer of thanks, and the band traveled on, sleepy and satisfied.


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