Wednesday, June 29, 2011

An Education In Pain Pt. 2

Heavy eyelids open to an unfamiliar place. Realization follows immediately. I am still alive. The inevitable trailing thought, but for what, is saved for another time. My surroundings reveal my situation. A small room with a single bed in the center. The screen to the right displaying what could only be a set of vital signs. IV bags dangle like fruit from a steel tree, slender lines carrying their juice down out of my sight. The collar wrapped tightly around my neck restricts my movement, denying me a chance to see more. My limbs remain unresponsive. The sedation continues its steady retreat.

Outside my door doctors and residents discuss the case. Male, age 25. Brought in after a diving accident. X-rays revealed heavily damaged C4 and C5 vertebrae. Incisions were made in both the front and back of the neck in order to remove all of the bone fragments. C3 and C7 vertebrae were then fused in front and rear using donor bone, metal plates, and screws. Surgery completed in eight hours. Patient is stable with breathing and feeding tubes in place. Antibiotics and pain medication are being delivered through IV. Pain medication must be administered with a careful balance in mind. Use too much and the vital signs will slow to dangerous levels. Use too little... well, more pain is the safe option. A relatively new pain med is being tried, but it will take a few days to kick in.

The first night was the worst. Or was it the second? Impossible to say. The pain in my neck is a crackling fire. Continually burning away, but never deep enough to kill the nerves as a real fire would. Moving hurts. Staying still hurts only slightly less. I think back to my previous experiences dealing with pain. Over the years I have worked with Zen methods of dealing with pain. They are a kind of meditative technique that allows you to drop under the pain. Like diving under the surface as oil burns above you. With enough practice and meditation you can go deeper for longer. It has allowed me to sit in freezing water, walk barefoot on frozen ground, and drive calmly to the ER as my appendix swelled close to bursting. This pain is like nothing I had ever felt before.

As the hurricane sweeps over me I search for the eye. I reach for my place of peace. It starts with controlled breathing. The tube pressed into my lungs denies me that control. Thick goo fills my nasal cavity, choking me as I try to breath. The fire burns hotter, mocking my attempts to dive under it. The bed begins to move. First it starts to vibrate, then it starts to tilt. A voice at the back of my mind tells me that this is supposed to help with bed sores, but all I can feel is the vibrations stoking the fire in my neck. The vibrations become more violent, the bed pitches me from side to side. Is this part of the medical process? Is this supposed to help me heal? A nurse is always on duty. Sitting just behind the glass, glancing up occasionally. How am I supposed to say anything with the tube in my throat. I guess no one can hear you scream. The vibrations are out of control. The bed stands me on end. Is this a new torture technique? Am I the test subject? My thoughts begin to stretch and twist. They break apart, the words blowing away in the wind. I reach for the center, and am swept away by the storm.

Sometime later I came out the other side. Words forming back into sentences. Thoughts forming back into me. It took me some time to figure out where I had been. Or rather, where I hadn't been. If someone ever tells me that their pain feels like a 10 out of 10 I will smile sympathetically, but inside I will shake my head. If you are there, you simply would not be able to tell anyone. It is a place where your personality breaks apart, and all that is left is pain. In that place there is no I. No one to feel the pain. No one to tell about it. Perhaps that is a good thing.

There are many more stories from the ICU that I could tell. There is the one about the respiratory therapists removing the breathing tube and sucking the goo out of my nose. I could talk about the hallucinations I saw over those four days. Hallucinations that make a vibrating, tilting, bed seem oh so normal. I could talk about how I got out of the ICU in four days when they said it would be 7 to 10. I could even go on about the rest of my fight with the pain, but I think it can all be summed up by one memory that stands out clearly in my mind. Sometime after the breathing tube had been removed, a nurse leaned over and asked if there was anything I needed. All I could say, was "hope..."

Wednesday, June 22, 2011

An Education In Pain Pt. 1

The concept of pain seems so simple. Something either hurts us, or it doesn't. Looking closer, there is so much more. Pain is both necessary and unwanted. In reality pain is information, knowledge for a price. Pain tells us about our boundaries. We experience pain when we push into the boundaries, on purpose, accidentally, or forced by an external source. When we run, our muscles and lungs tell us when we approach the limit of our strength and conditioning. In the case of athletics, we seek to push that boundary ever outward. When we are hot or cold, our bodies tell us that we are approaching the limit of our temperature tolerances. When we are injured, our bodies use pain to inform us that the damaged area requires urgent attention. Where would we be without these kinds of pain? There are, in fact, people who have full control of their bodies while having no sensation. In effect, they can do everything a normal able-bodied person can do. They just don't have a sense of touch. As it turns out, these people are very injury prone. What if you set your hand down on top of a hot stove and did not notice? What if you stubbed your toe and broke a bone? What if you stepped on a nail? Pain allows us to reflexively remove our hands from hot surfaces long before the smell of burning flesh could warn us. Pain tells us that our toe hurts long after it should have stopped hurting, and maybe we should see a doctor. Pain tells us that we punctured our foot and need to take care of it before we get an infection. Pain is knowledge for a price.

Not all pain is physical. Perhaps even a majority of the pain we feel in our lives is emotional. Where does it come from? What does it tell us? A complete exploration of these questions could fill volumes. To keep this from going on forever, I will try to be brief and only say a few things about emotional pain as it relates to my situation. We have an image of ourselves. A person that we believe ourselves to be. We also have an image of the world around us. A belief in how things are supposed to work. These two things are interrelated. When one of them is challenged or changed, the other often is as well. It can be very distressing to face change. To find out that things are not as you thought, or that they can no longer be as they were. In this case, pain is a matter of resistance. Do we bury these challenges inside us, letting them fester? Do we deny a truth because it is different? Do we face our reality no matter how terrible or unthinkable, and acknowledge this is real, this is now, what next? Our pain, in this case, is a measure of how hard we cling to the past.

It can also be said that physical pain and mental state change each other in positive or negative ways. Our past experiences can help us deal with physical pain, or leave us extremely distressed with minimal provocation. A standard practice in hospitals is to ask patients to rate their pain from 1 to 10. The pain scale on my wall lists 0 as no pain, 2.5 as mild, 5 as moderate, 7.5 as severe, and 10 as the worst pain possible. Some hospitals say that 10 is the worst pain you can imagine. This is true at the hospital where a friend of mine works in the ER. A sample of the stories from the ER include a man with a stubbed toe who claimed to normally have a high tolerance to pain, but his toe definitely rated a 9 on the scale. A woman also claimed to normally have a high tolerance to pain, apparently this is a pretty common preface, but the cut on her hand rated an 11 on the scale. Either these people have no experience, or no imagination.

At times I have wondered if the scale is linear. Is a four twice as painful as a two? Is an eight twice as painful as a four? The answer is no, not by a long shot. What is the worst pain possible? What does it mean to have a 10 on the pain scale? It was beyond my imagination. Perhaps if I relate my experience to you, it will no longer be beyond yours.

My memories of the ICU are spotty at best. I cannot say in what order some things happened. Perhaps the only marker of time that I have is the breathing tube. Half drowned in lake water, with weakened lungs, and requiring extensive surgery, I had a tube inserted into my airway. As the name implies, the tube helped me breath. It also prevented me from speaking. As I woke up, I remembered the accident, and still could not move my limbs. My paralysis was readily apparent, but so was the physical pain. I could not deal with both at the same time, and the physical pain was not going away. This began my education in pain.

to be continued in part 2...

Sunday, June 12, 2011

And Like That, He's Gone

Saturday, May 21, 2011: approximately 1:00 a.m.

The sky is clear as a late evening becomes an early morning. The moonlight reflects off the calm lake water, bathing the shoreline in a soft glow. As the hours tick by those gathered slowly trickle away, and a fire once well fed burns low. A deck made of plastic and steel pushes out into the water. Similar fixtures jut out from many of the houses that push up against the lake, allowing residents to swim or dock boats. Two of my friends stand on the nearest dock and listen to the fish jump. As others joke about how cold the water must be, I am captured by a thought. I slip quietly away. The chairs once warmed by the neighbors have long since grown cold. I press out onto the dock that stretches out here. I smirk silently as I strip down. It is better that my clothes remain dry. A ladder on my left has no doubt seen many swimmers climb its steps back onto the dock. The water line is perhaps a foot or more below the dock, but I estimate that still leaves me four feet of depth or so. Easy enough. I started swim team at an age when all the kids are still dog paddling, and it wasn't until quite a few years later that I moved on to other sports.

As I had so many times before, I dove with hands outstretched. As I broke the surface of the water, my past life was stripped away. I felt a sharp shock to my neck, followed by no pain at all. In times of extreme stress our brains are capable of astonishing things. Under the water, in a place where I should have seen nothing at all, I saw myself. In my vision I floated face down below the surface, pale skin illuminated by the moonlight, my hair floating freely. My mind churned... gotta swim up... my arms will not move, my legs will not move... this is it... I am going to die...

Two of the girls came over to investigate the splash, and found me floating face down. They told me to stop messing around. I could only slip farther away, disappearing below the water. The guys commented on how large a fish it must have taken to make such a big splash. This lasted until they were called over. When they pulled me out I had been underwater for two or three minutes. The police were close by and arrived quickly, and an ambulance soon followed. Eight hours of surgery later, and many more spent unconscious, I woke up in the intensive care unit.