No pain, no gain

Greetings, everybody! Hope your weekend is going great!
I have just finished my pain rounds and am on the way home. Nobody gave me any trouble today, except one kid - 16 year old after Nuss procedure. This surgery has changed the pectus repair forever. It is a defect in one's chest when the sternum (middle bone) grows inwards - does not look very good and may result in serious health problems. With Nuss, (name of the guy who came up with this procedure) a metal bar is inserted under the chest wall, and it's a bent bar, so after it is placed the chest wall kind of pops out and it does look much better right away. The problem is it hurts like there is no tomorrow. One of the most painful surgeries we do. The solution - high thoracic epidural along with some IV supplementation. Since we've started using epidurals we have much better postoperative course.
But this kid even with his epidural going full speed, even with IV Toradol (ibuprofen type of pain medicine), and occasional IV narcotics continued to rate his pain at 7-8 on 10 point scale. When I walked into his room, he was peacefully sleeping, he woke up, saw me and started grimmacing right away. Teenagers..I do belive he has pain, but it is not 7 or 8 or 5 for that matter. I guess, the common misconception that we can comletely avoid pain associated with surgery, and of course, that would be ideal, but it's not always possible. This kid is not properly informed and therefore prepared to this or any kind of surgery. I don't blame him or his surgeon (who is excellent, by the way), but the system. To buy a car we go through tons of research, we check multiple websites, blogs, we stop at different dealeships, we do our homework. But our health care is in the hands of others - insurance companies and hospitals. It's time to take personall responsibility - do your homework! Work with your doctors, know what to expect. www.surgerytomorrow.com