Sunday, July 24, 2011

The Broken King

When we are born into this world, we are unable to do anything for ourselves. All we have is our voice. When we are in need, we call out and our needs are met, we are fed, we are cleaned, and we are comforted. As we grow we learn to interact with our world. First, we crawl, then we walk, and then we'll run. We see a big new world full of things to discover. We learn to throw a baseball, to swim in the deep end, and to sled down the big hills. The spirit of adventure is born within us. As we grow older we refine our skills. We are no longer the children whose weeks were filled with after school activities. We become garage band musicians, budding athletes, and enthusiastic video gamers, and then we learn how to drive. We move off to college, every day building our education in the ways of this world, and our independence.

Waking up in the rehab unit, all of my needs are met. A tube that runs through my nose and down into my stomach provides a path for a nutrient rich paste. When I make a mess, my diaper is changed. If I need anything, I need only raise my voice. But as the time passes, there is no realization of what I can do, only of what I can't. I cannot crawl, I cannot walk, I cannot run. The transition is so sudden that it is impossible to understand the implications all at once. Each day brings a new discovery that something else is missing. So much is out of sight and out of mind, but what is in front of you cannot be ignored. When it is time for something new, everyone says that it must feel great. When a sling and a lift pull me out of bed and put me in a chair, they say that it must feel great to be up. I smile, but if they could only look deeply enough into my eyes, they might see the truth. A piece of me is dying, 25 years of walking, 25 years of running, 25 years of independence. The story repeats again and again, when dressed for the first time, when it's time to eat. Any conversation, or phrase, or word, can show me something new that I'm no longer capable of. It is the time of learning, it is a time of discovery, and when everyone else sees me slowly coming back to life, I feel like I'm slowly dying. In one moment, I cannot help but laugh at the grim irony. The nurse brings in a device aptly named a shower/commode chair and calls it the throne. When we have our freedom, we each rule our bodies. So there I was, sitting upon my throne, the broken king.

After a traumatic event like my accident, detachment is the name of the game. It is all too much to handle at once, and so we have to take it one day at a time. If I can just focus on today, I will make it to tomorrow. Everyone wants to be encouraging, but that doesn't mean they understand. If I had a broken leg, it would be great to get out of bed again; it would be great to get out of a hospital gown and into normal clothes; and it would be great to get outside. All of these things signal a return to normality. The difference is in the permanence of the injury. For me there is no normal to return to, only future that I do not yet have the strength to contemplate. I can stand being confined to a bed in a hospital gown. In a way, it helps me to deal with things on just this day. It helps confine things to just one day at a time.

Everyone takes this process differently. A nurse told me, during my second week, that I was not like other patients. I did not know then what she meant, but I think I do now. The guy in the room next door to me swears loud enough for the sound to drift into my room. He wants something, or he needs something, or things are just not going quickly enough. We all deal with the pain in different ways. I take much the opposite route. I say very little, other than thank you, and I wait. I want very little. I just want to lay silently in my bed, and let the emotions roll over me until peace presents itself. If I wait long enough, the water pooling in my eyes will evaporate, and I will learn what it means to live life as the broken king.

Sunday, July 10, 2011

Dark Thoughts In Dark Places

After a day or two in the ICU, the pain might be called under control. The pain is not really gone, but through long acting meds or IV drips, a new baseline is established. At this time different types of pain become distinguishable. Instead of a singular feeling, there are now sensations of burning, freezing, shocking, sharp, cramping, and aching pains. These come from nerve pain, physical damage, and muscular contraction. Each requiring a different type of medication. Each of these having an allowable dose and a different number of hours between doses. As a result, the pain is under control only until a particular medication begins to wear off, and one of these types of pain rears its head. At first I ignore it. Next I work to deal with it. Controlled breathing helps calm the mind and smooth out the instinctual reactions to pain. After that comes an attitude shift. We grow up avoiding pain, trying to get rid of it any time that happens. We learn to be miserable when we are in pain. Do we really have to be miserable? Only if we feel that pain is a miserable experience. If we take away all the connotations that we pile on to pain, it becomes more bearable. In effect, the belief that pain is a negative experience helps to make it one.

I have a limit. Some level of pain at which I ask the nurse for more meds. Inevitably it's too soon. Enough time has not passed to give them to me. She tells me they don't want to put me too far under. The voice in my head screams Do it! Do it! Anything but this, but the look of regret in her eyes is plain to see. I nod my head and go back to trying to accept the pain. I get much better at it over a few days, but for now it's just not enough. When the time does come, the transition is mercifully fast. Drugs administered by IV act quickly, releasing me from the pain.

Narcotic pain meds come with a price. The reality is, you are not all there. The higher the dose, the higher the loss. In most cases this is not a big deal. The drugs wear off and everything returns to normal. This was not one of those cases. Immediately after a dose, I was too far gone to contemplate my injury. Inevitably, the drugs slowly recede. The curtain draws open and the show starts. I find myself a head cemented to a lead anchor in the shape of my body. I stand naked before the reality. My defenses are gone, stripped away by the same medications that protect me from the physical pain. Had my mind been clear it would have been different. As it was, I had no future. We all think about our futures every day. It is only natural, but never in my wildest dreams had I imagined myself to be in this condition. How could I have? So there I was. The man with no future. If I could even be called a man. If I could even be called Craig. A thing with scant identity, stumbling forward deaf, dumb, and blind.

As the meds peeled back further, it only got worse. I began to remember my past, but the future was still in the dark. The thoughts that tumbled through my mind had a certain rhythm, a dark cadence kept by the bass drum, each blow driving the breath of life from me. What is left?... we are not meant to live like this... why did they save me?... I wish they had let me slip away... how cruel, to save someone so that they could live like this...here I am, not even able to kill myself, not yet anyway...

Ironically, knowing that you can kill yourself later, brings about a certain peace. Having a solution, you can put it out of your mind to a certain degree. A common tactic used by suicide hotline operators is to extract a promise. The caller promises not to kill themselves until a specific amount of time has past. Having made a decision the individual has less anxiety, and has time in which they can be talked out of it.

The cycle repeated itself as the pain meds were administered and then wore off. In the beginning they were mostly a repeat of the initial revelation. I just would not remember having gone through it only a few hours prior. It is a common thing for people waking up in the ICU to not remember someone telling them what happened. In those initial cycles, the return of the physical pain as the meds wore off was almost a mercy. Eventually I started to recognize and remember the people around me. Friends and family became the life preserver keeping my head above water. Even if I could not see myself in the future yet, I knew that those people would be there. I recall thinking that if anything could save me, if anything could make life worth living, it would be people. Nothing more specific. Just "people."

The dark thoughts, and the emotions that come with them, never really go away, but they become less frequent. As the physical pain reduced, and the medications were in turn reduced, the fog in my brain went on its way. I started to see not just what I had lost, but also what still remained. My family was still there. My friends were still there. I still had my mind. As I thought more about these things, I thought less about being broken. It was as if the darkness was just filling in the empty space.

We play an active role in how long we feel a particular emotion, but we have little control over their arrival. It is as if we constantly have strange visitors in our house. If we are mindful we notice them right away and know them for what they are. If we feed them they will grow and become more a part of our home. And so I name them and make a choice. Hello anger. Hello fear. Out you go. Hello love. Hello compassion. Make yourselves comfortable. Stay a while.

I must not fear.
Fear is the mind-killer.
Fear is the little-death that brings total obliteration.
I will face my fear.
And when it has gone past I will turn the inner eye to see its path.
Where the fear has gone there will be nothing.
Only I will remain.

the litany against fear from Frank Herbert's Dune

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.