On Pain

Regular readers of this blague have got to be wondering -- where have you gone, Dr. Metablog? A hungry readership turns their lonely eyes to you (woo woo woo}. We're missing your pithy and astute commentary. All these athletic contests come and gone, even including the World Cup, and all those political follies, and not a word of commentary?  How can it be, Dr. M? Cat got your tongue? 

Well, dear blogreaders, the fact of the matter is that Dr. M. has been sidelined with an injury and has been languishing on the disabled list. Ruptured his disc, he did. L5 if you want to be specific. On his back now these last two weeks, gulping the oxycodone, enduring a series of trips down there to the regional hospital. Dependent on family and friends for succor and sustenance

Lying here, solitary for longer periods than is his wont, Dr. M,, who never had a mind for philosophy, has had an opportunity to meditate on a subject of particular relevance to his condition. He's been thinking about pain. About dealing with pain.

Sometimes even Dr. M has to deal with very practical problems.

At the hospital, various "providers" ask me, over and over again, to "put a number from 1 to 10 on the degree of your discomfort."  "Imagine," they say, that 10 is the worst pain that you can conceive, what is your number?" For me, this becomes a very difficult question, and one to which I don't know how to respond honestly or accurately. For one thing,  I have a rather vivid imagination, and for another, I've read more than is healthy about ingenious systems of medieval and "renaissance" torture. It's true that my back hurts, and the pain is real, but it's nothing compared to the worst that human beings have endured or can be compelled to endure. I'm sorry to say that I can imagine pain an order of magnitude beyond what my questioner can begin to conceptualize. 

But if I should say, "one" on a scale of one to ten, they'd throw me out of the hospital and give my place to a more deserving patient. So I say, "eight and a half" or "nine" -- not because such a number has the least bit of meaning but because I think I've given my interrogators the magic number that will allow me to get the care I need.  

I have a friend who had a very painful form of arthritis, but couldn't get the attention of the medical establishment for many horrible months -- until he answered the pain question with "I'm going to go out in the backyard and shoot myself." Then he was diagnosed and put on medication in an hour.

Moreover, I don't know how to measure my pain against another's. My eight might be someone else's five, or vice versa. I don't want to be theatrical (I can't bear to be a spectacle), but I also have no desire to be excessively stoical. A ruptured disc hurts. Ask anyone who's been there. Is it equivalent to childbirth? I suspect not. I know that burns are supposed to be infinitely more agonizing. I got to the point of wincing and moaning and feeling faint, but not to fainting or writhing or screaming. And I could always get relief from oxycodone, which is not always the case in more serious situations. I even had some morphine, which, at the time, was surprisingly ineffective. Now I'm on the road to recovery, I believe, and the pain is very much handled with those horse-size ibuprofen. But ten days ago it was all narcotics, all the time. And I was grateful for them. Very much so.

I am reminded once again that pain is isolating. It separates you from your friends. You live in the pain, and with the pain, and you deal with the pain. You can't communicate it and you don't want to communicate it.

I fault myself for not having been sufficiently empathetic during my lifetime to the pain that other people have experienced.   

While I've been lying here, I've read two books by daring people who do not hesitate to court pain. The kind of person who decides to climb an unclimbable mountain, break his leg and then drags himself miles, freezing, starving, crippled. The kind of person who leaves warm hearth and happy home to walk to the South Pole dragging a two hundred kilogram sledge. These folks endure all sorts of horrors, voluntarily. Then they write books about their pain (whole paragraphs which I involuntarily skim and skip). When I read these stories, I feel like a wimp to complain about a ruptured disc. On the other hand, I feel sane -- not to have deliberately injured myself for the sake of some wild, inexplicable impulse.

Comments

[CKNC]

Dad, I encountered the same dilemma when I was in labor with granddaughter #1 and was asked to rate my pain. I chose 7. An arbitrary number. I remember the look that passed between your son and our midwife. I guess I overstated what felt like to me at the time real discomfort b/c at 3 cms a rating of 7 is laughable. I only really know that now after experiencing a super fast, med-free labor and delivery with granddaughter #2. More recently, the ER doctor kept insisting that I must not be passing a kidney stone b/c if I were I would be begging for narcotics. He was trying to reassure me. Well, I was and I did eventually pass a not inconsequential pit, and if I hadn't just experienced childbirth I might have rated those last two hours as the jagged edges of that stone passed through my ureter to my bladder an 8. Pain is personal. Pain sucks the lifeblood out of you, but once it subsides or is dulled or completed erased you feel euphoric. I hope euphoria visits your bedside soon.

[Chris Casey]

Glad to hear you're managing it now. I had a very similar experience a couple years ago when I learned my C4 & 5 are burst, and two others are bulging. I learned after a long day in the Emergency saying '8', and '9', when they at last administered a morphine IV and I felt no change an hour later, that it just doesn't work for everyone (serious letdown that was). Pain is now managed with regular doses of Naproxen, with the alternative being surgery which I'll gladly put off as long as the pills allow.

To my happy surprise, my Dr. did not advise that I stop running or any other activity. My four marathons and recent hiking have all come after learning about my disc issues.