I am a mother of four, but addiction is my ubiquitous additional child. My grandparents died of alcoholism. My father-in-law too. My brother, 43, died of a heroin overdose in May. He became addicted after taking prescribed OxyContin after an appendix removal.
When my 13 year old daughter needed hernia surgery when my brother hit rock bottom, it wasn't the surgery I feared. It was the opiates that would be part of her recovery. A 2018 study in the journal Pediatrics reported "persistent" opiate use in nearly 5 percent of patients aged 13 to 21 after surgery, compared with 0.1 percent in the nonsurgical group.
I wanted to find a way to help my daughter through the pain without resorting to opiates.
Days before my daughter's surgery, our family developed a pain protocol based on what we learned from a popular TEDtalk by Johann Hari, a journalist who believes that people avoid addiction through "bonds and connections."
He cites a study comparing two groups of rats. One group lived alone in cages, with only food, water, and heroin-infused water. These rats became addicted and quickly died. The other group lived in what Mr. Hari called "rat park". They had treats, activities, and interaction with other rats. They chose the plain water over the heroin water. They thrived despite the presence of an addictive substance.
The message I got from this was that affection and connection could help ease my daughter's pain. If we surrounded her with comfort, she might not need the drugs at all.
Our pain log included my daughter's favorite movies, books, and groceries. We have made a list of relaxing activities that form oxytocin: braiding hair, massaging, cuddling, and wearing cozy clothes. We listened to their fears. As a distance swimmer, she could endure discomfort, but feared the unknown of surgical pain. We agreed to bring the prescribed pain medication home but avoid using them if possible.
At the hospital, my daughter put on a pink cotton dress that was strewn with lambs and rainbows. I straightened her hair as a technician tried to put an IV on the back of her hand.
"It hurts mom," she pleaded. "I'm afraid."
A nurse offered a thimble with liquid Xanax to ease her anxiety. She looked at me for permission and then nodded her head. Moments later I experienced a powerful transformation from fear to nonchalance. She waved goodbye as a team rolled their bed around a corner. I thought of previous outpatient procedures my children had faced: tubes in their ears, a meniscus tear. I never received instructions on alternative pain management and didn't think about asking. The difference now was that my brother was addicted. What if I gave pain medication to my kids and they got addicted too?
Three hours later the surgeon blew through the waiting room doors. The hernia was deeper than expected, he reported, and she would be in significant pain tomorrow.
In the recovery room, my daughter was propped up in bed, sucking on a frozen rocket blast. "Mom," she said sleepily. "I'm done." She struggled to keep her heavy eyelids open. The ice popped upright in her hand.
I thought of my brother nodding off on a family ski vacation. waiting for an oil change in a parked car; during a children's egg hunt on Easter Sunday.
While my daughter slept, a discharge nurse told me how to change and watch out for a fever. Then she explained how to keep the pain under control with a prescription for 44 oxycodone tablets. My jaw tightened.
"I don't want to give this to her," I said, shaking my head at my own memories.
The busy hallway fell silent, save for the alarm of an empty drop.
"This is like heroin to me," I said. "My brother is an addict."
The nurse looked away. "My daughter too," she said, and began to cry. "She won't stop. I had to kick her out."
We exchanged the sad words of opiate families: "It's everywhere."
My daughter slept for the hour-long drive home. It was dark and cold outside, but our house was light and warm. Chicken noodle soup simmered on the stove next to a basket of warm sourdough. The couch in our kitchen / family room was an inviting nest of fluffy pillows and blankets. The siblings left a small pile of wrapped gifts and stuffed animals on the coffee table. I remembered the rat cages in Mr. Hari's lecture. My family had created a place to connect, our own rat park.
"Is that all for me?" she asked softly. She collapsed into the pile of blankets on the sofa, smiling.
The anesthesia kept the edge away from the initial pain. My daughter dozed while we watched episodes of MasterChef Junior. That night my husband carried her to bed, then I slept next to her, alternating Tylenol and ibuprofen. In the morning, I asked about her discomfort and hoped she wouldn't ask for a pill.
"It's just annoying," she said.
"Annoying how you suffer?" I asked.
"Annoying how can I have ice cream for breakfast?"
"Coming soon," I said. I offered her our house specialty: mint chips and a side of Advil. That day we nibbled on a wooden bowl with butter popcorn and M & Ms. in our sofa oasis. While I survived all three high school musicals, I stroked her skin, smoothed her hair and praised her bravery. We played Uno and worked on a puzzle. Greeting cards and balloons came from friends and teachers. The headmaster called. Not once did she complain of excruciating pain.
She winced carefully as she tried to turn the pages on the couch. We helped her so she wouldn't use her abs.
The discharge nurse had told us that walking would speed recovery, so we pretended their stuffed animals were babies and carried them around the first floor of our house.
On the third day, she didn't even want the over-the-counter medication.
"I'm fine," she said. "I do not need it."
I felt a mixture of relief and anger. Why were we sent home with so many pills? Without my brother's experience, I might have given her all of them.
Her recovery was so quick that it became difficult to keep her calm. On the fourth day she swayed on the back of the sofa with her arms wide, as if walking a tightrope.
"Have you lost your mind?" I snapped. "Get down from there!"
"Mom, I'm training," she protested. "Pain doesn't bother me, so I practice for the military. I turned the sofa into an obstacle course."
As I tucked them under a blanket, I thought of the twists and turns and pressures my children will inevitably face in their adult lives. My daughter's resilience gave me cause for hope. Together we defy our family heritage.
Jennie Burke is a writer who lives in Baltimore.