Pain and Despair

I've been re-reading the latest Chronicles of Thomas Covenant in anticipation of the final Covenant book ever. The title is The Last Dark and there's a very good chance that the bad guy will win and the world will end. There's also a very good chance that this could be a happy-ish sort of ending. One of the major themes in all the Covenant books is that you can be beaten without ever shaming yourself. The bad guy, Lord Foul the Despiser is a Devil-like figure trapped on the Earth at the moment of creation by the Creator. He cannot escape unless someone messes up and helps him destroy the Earth.

It's more complicated than that but I find the books very inspirational. Foul's weapon of choice is Despite which is defined as contemptuous defiance or disregard in my dictionary. He helps people feel despair so that they will do anything to end that feeling. The good guys have found several effective defenses against despair but one of the most important is to accept that you have limits. Lord Foul might send his armies to destroy things that you love but you never give up, hope for a miracle and never feel despair because the guy who beat you was bigger and stronger. Another effective defense against despair is to find value in the things you serve and not your specific ability to serve them.

For the longest time, I had problems fighting off the urge to die. People kept asking things of me that were too far beyond what I could accomplish. I fell short and felt judged by the things I failed to do. Surviving chronic pain is a classic example of a fight that I cannot win. That doesn't make it an unworthy fight. I had to accept long ago that I have limits and that I do reasonably well when judged within those limits. Also, it's not just about the pain. I write my journals both public and private that I enjoy  I enjoy spending time with my beloved Melissa

The pain is fearsome but I have endured it before. That means I can endure it again. Maybe I couldn't if I were doing so for me but we joke that there's no choice. I won't list choices here but they exist and the best one available is trudging along one step at a time doing what my doctors tell me to do. Trying to exceed myself usually leads to bad things happening. I can be carried on by the exalted feeling of creating fiction for far longer than my actual endurance allows. Exceeding my real endurance is bad yet I've done it so many times that I don't know what my real endurance is. All I know is that there is very little of it.

In the books, Lord Foul always tricks his victims almost all the way to their doom. Then he has to stop because of the necessity of choice. I cannot be forced to despair in real life. Things can get very bad. Pain can seem like the most powerful force in my life, sooner or later there will be a new financial crisis but I will have more to lose now and my loved ones can sicken and die. My past didn't prepare me for a life where I had to sit by and watch things happen. When they do happen, I have a bad habit of declaring that it's all my fault. Of course, that's the way to despair. It can't all be my fault because I'm just one person. I am fairly resourceful but still just one person and my resourcefulness is marred by pain.

People have a mistaken belief in the glorious last stand. There's a tradition of saving the last bullet for yourself but that's despair. Don't give up and let yourself be taken but also don't do your opponent's work for them. In the battlefield metaphor, there must be some bullets left somewhere. After all, you wouldn't have a problem if everyone had run out. Don't let yourself be blinded to the choices you have left. I'm in terrible pain and my meds seem to be failing me. I can't use meditation the way I have for a decade and more because my furniture is still so heavily damaged. I need to get the house fixed in order to get the furniture replaced. Then again, I might not have to do it that way. That's the way I've been looking at it because it would be most efficient that way. I could be picking out a new comfy chair today and then making some poor guy carry it for me when the repairs start. That's how it's supposed to work but we've been trying to take a shortcut.

I think that's what needs to happen. This choice isn't working as well as I'd hoped so it's time for the next one. If that one doesn't work, then there will be the option of the next step in my pain treatment. I'm scared of the next step because there's outpatient surgery involved and I hate hospitals. I've held this point in my fighting withdrawal long enough. Something needs to give and I believe that something is a trip to a place selling furniture. There's always an option out there somewhere. We'll just see which one is best to take.

Panic

Gee. I guess I tempted fate by ending the last post with an admonition not to panic. My Wednesday began pleasantly enough. I hardly bothered to get dressed because my brain was sending out loud warning signals. "Sleep or else!" While I wasn't able to sleep, I was having a decent time playing basketball on the PS3. This relatively easy start came crashing to an end with someone banging on my door. My next door neighbor was upset because she had water in her garage. After having her water heater replaced, the water in her garage didn't go away.

This is just the latest in a long line of exchanges where something from her garage has seeped into mine and vice versa. Actually, you might just call a spade what it really is and note that this is the first time the water damage has hurt her. She doesn't know me at all so I bet she interpreted the long pause after telling me this as me not caring. These are the neighbors we see so rarely that I hold a half joking belief that they are a husband and wife team working for the CIA. Melissa isn't quite as kind about it. She wouldn't know that I was standing there trying to process the concept of what was going on.

Unfortunately, the path to the closet where the water comes into the house happened to be where we stored all of our most fragile things we're getting out of the way so that someone can fix our floor, wall and ceiling. Each tote is beyond the safe limit of what I could move. I climbed past and saw that there was a relatively small puddle in that closet. It might have gone from her house to mine for all I knew since I had no visible damage on my side.

I told her that I would fix the problem if it were coming from my side as quickly as possible. For that, I needed a second pair of hands and eyes. That's when I realized that Melissa was still home. She could help me and so she came down to take a look. Some time very quickly after she went into the closet, she started crying out in distress. This is very unlike my beloved stoic and so I rushed out to see what was wrong. Between the two of us, we got her back into the house and the emergency cutoff valve closed. I wasn't so sure such a measure was truly necessary but my neighbor was politely insistent that I do something.

Once we got Melissa to the couch, I called our doctor. It was their lunchtime, of course, so they called back and told me to call 911 for an ambulance. I did so and began running up and down the stairs collecting what we might need for an extended hospital stay. When the EMTs arrived, it took at least a minute to convince them I wasn't the patient since I was out of breath, sweating and trying to bounce off the walls. Once they realized that Melissa was the actual patient which involved her crying out in pain, half their efforts seemed to stay on preventing me from becoming the next patient.

I could tell how much pain Melissa was in by the way she responded to simple choices. Can you walk to the ambulance or do you need a stretcher? Ouch! I can...(near fall)...walk...(lurch to a stop from pain)... I cut her off and asked her to ask for the stretcher. I swear they spent more time stowing me in the ambulance than they did her. I'm not counting the time spent putting her on the stretcher and belting all the safety belts so it was actually much faster to point me to a seat directly behind the stretcher and to get me belted in. My neck brace caused them a little concern.

Melissa told me in the hospital that our dear neighbor asked the EMTs what I had done about the water problem. She's lucky that I didn't hear her live because heads might have rolled. Let's get our priorities straight here. Woman being loaded on an ambulance or the possible trickle of water? I thought about how worried I had been about the water in the ambulance and almost laughed. A later inspection after everyone was home safe revealed a pinhole in a minor pipe coming out of the water heater. It was under pressure but a towel taped in place is allowing us to use the water for brief periods of time. A length of plumber's tape might be enough to let us run the water 24/7 for a while but we're not that recovered yet.

We arrived at the hospital where Melissa was confirmed as the actual patient again. She was left to suffer in the ER for a while but it was no longer than necessary. My own quick triage while waiting for the ambulance showed me that there was no blood gushing anywhere. We waited our turn like good little inmates...err...patients while a nearby man was yelling at the top of his lungs for pain meds. I can understand the urge but he was triggering me by screaming f-bombs. He was triggering my fight or flight reflex and I couldn't run with Melissa helpless. (It was not a real concern but there is a level of animal response in us that is not so practical.) Over the next few hours, I heard some of the worst drug abuse behavior that I've ever heard. He was in agony and then he was high as a kite (his own words) from the pain meds he was given. An hour or so later, he was in agony again but his behavior told me how high he remained.

Melissa had her own panic reaction and I don't blame her. I was there to hold her hand and coach her the way she coaches me. After we had been there more than an hour, her pain level dropped quite a bit. I got to (not in the sense of enjoying it) observe one of my guilt reactions from her. Once she was no longer in agony, she questioned everything she had done that day from calling the ambulance to staying and "wasting" the time of doctors. What had happened was that her body caught up to the intense pain. We produce endorphins from pain and exercise which help control pain and induce euphoria with what's left over. I remembered how I felt all the times this happened to me and I told her to relax and enjoy it. We share a bit of gallows humor between us to say the least so I told her to enjoy the pain relief because it was temporary. I hoped I was wrong but I wasn't.

Shortly into her second bout of extreme pain, a doctor arrived with IV dilautid. After taking a few blood samples, Melissa got the dilautid and let herself enjoy it. With the meds in her system, the endorphins left her feeling tired but okay. My adrenaline reaction was slowing down and there was pain on the other side of it. One of the nurses got me some water and I took my pills while we chatted about Arnold Chiari Malformations and the fun they can cause. Melissa was out of agony and I was almost comfortable. Compare that to some of my previous hospital experiences!

Okay. I need to note that the staff at the Christiana Hospital part of the Christiana Care System including triage and the Emergency Department were wonderful to us. All I wanted was for Melissa to be okay and then I wanted water for my pills and a bathroom. Normally, I get sent to cool my heels all over the place while Melissa has to go through these things by herself. This time, the good ole husband card got me through every door. Even when I wanted to lose my temper in an unpleasant looking test, the staff never gave me cause. They were top notch.

Speaking of top notch, Melissa's job and her friends came through for us. We were stranded at the hospital but I got on the phone and sent the balloon up. We were in need and the friend who came to her rescue was merely the first in line. If she hadn't been able to help, others would have done so. I'm pretty sure that I can get help for the plumbing issue as well. I think I wasted 30 seconds thinking about how much easier this all would have been had I been able to call on a parent. That's when I remembered how much worse they made so many things. I don't know about you but I can live with limited access to water for a little while anyway.

I suppose when you get down to it, I never truly panicked. There was a problem and I had responses ready for the problem. The fact that my heart was racing and all does not mean panic. It just means I was scared and there's a big difference.

Basic Pain Management

Recently, I read that there comes a time in any learning process you pursue long and hard enough where the only way to continue learning is to teach the subject to others. This came from a book of fiction but it is not fictional. In a line from his book series "The Dresden Files," Jim Butcher actually explains why this is true. I'm an oddball because I never seem to be able to believe in or remember something until I understand why it is true. Butcher wrote that teaching relative novices in a field where one has a lot of experience forces one to go back to the basics and look at them with the benefit of experience.

Pain management has some very basic rules to it. Society actually seems geared to make us forget them even though some were taught to us as children. The first rule I'd like to go over usually requires someone saying it aloud before it makes such sense that it's almost embarrassing. "If it hurts, don't do it." My brain can only take so much concentration and/or stress before it gives me a bad headache. I used to be a second chance debt collector for a credit card company. My coworkers and I specialized in accounts that were more than 90 days past due. If you get behind by 90 days or more, you have a good reason for it or you think you do.  That meant nearly every call I made at work got a hostile reaction which led to disabling pain.

My first brain surgeon certified me as temporarily disabled (unable to work my current job) based on that fact. If it hurts, don't do it. I know some people will talk about slogans like "no pain, no gain" but we're not talking about the same thing. On a very good day, I am in the degree of discomfort that slogan is meant to describe. When you exercise, you can expect to have a certain degree of soreness/burning based on the specific exercise. That soreness is not intolerable and goes away with a dose of what healthy people call painkillers. Those of us suffering from chronic pain experience worse than that getting out of bed in the morning.

Real pain makes it almost impossible to continue what you did to trigger it or to do a good job of it anyway. Society tells us to soldier on and go back to work despite the pain that saps our concentration at best. My mother-in-law, Judy, is a bus monitor. Her job requires her to assist handicapped children on the school bus. She needs to be able to move around, assist and, on some rare occasions, restrain children just enough to keep them safe. She needs her full concentration, judgment and physical strength available to do her job in the event of a crisis. Normally, she is more than just capable of doing so. She's a real pro.

Unfortunately, she sustained an injury. I won't go into specifics to keep her privacy intact but the pain is significant. It has deprived her of sleep even while not working. (She was on vacation at the time.) She was instructed to do a number of things that also fall under her business but one of those instructions was to rest. Moving around normally is painful enough without lifting children. The obvious question she might ask me is what could she do without her job. I hate to say it but losing her job is not the worst case scenario here. I don't have intimate knowledge of her job which she has said is less physical this year but what if she dropped someone's child? Pain is a warning sign and the warning is to take some damned time off and heal before someone gets hurt. If she tries to ignore the warning, the best case scenario is that someone very important to me gets hurt...her.

As a writer who experiences pain associated with concentration, I am all too aware of how frustrating this is. At some point (likely soon), my normal background pain which already requires narcotics to be tolerable will flare up and force me to notice it. At that point, it will be time to stop writing. If I stop while the pain is comparatively mild, I might not be forced to take my breakthrough meds. I might even be able to return to my writing project in a few hours. One of my problems is that I am stubborn. Yes, I am stubborn. I know that writing can lead to instances of extreme pain but I write anyway. That's a reasonable amount of stubbornness. Forcing myself to keep working through the pain until I cannot write another word is stupid.

On my unreasonable days, I will act unreasonably. There are days when I shouldn't try to write a single word. (I do many other things but I'm trying to keep it simple.) There are days when I will keep going until I need my breakthrough meds because of writing, wait for them to take effect and then start again. Guess what? The pain always comes back and I will have already taken my dose of breakthrough meds for that allotted time period so I have to admit defeat and suffer for hours on end. I will find myself in my broken chair kicking myself metaphorically only because I can't do it physically. Hindsight is usually pretty accurate and I will agitate myself into more pain because I'm blaming myself.

Blaming yourself is the next lesson. I've reached that point where I need to stop or suffer the consequences. Let me just conclude by reminding everyone including my dear mother-in-law that most of the pain we chronic sufferers feel just happens. It isn't because of something we did. Knowing when to stop helps a lot around the margins and might be the difference in whether your pain meds take full effect or not. Don't blame yourself. Even the worst self inflicted pain is a mistake and mistakes happen.

Ouch, Double Ouch, Really Now!

It's always nice when my in-laws get involved in my life. I'm not a loner by nature and they are among the few who will dare the potential wrath of me when I'm doped up on pain. No. I don't mean doped up on pain medication. That's only happened to me a few times and those were mostly in the Recovery Room of a hospital after neurosurgery. I guess you can include the intensive care ward in that as well but lesser medication has only doped me up a time or two in my life and that was always immediately after a doctor increased my dosage of pain medication.

This time, even they only visited with me for a couple of hours. My house is still in a post-apocalyptic state while I wait on the contractor who will be fixing that. That's not a complaint. He waited an unreasonable time for me to declare myself ready to be put on his schedule so I can wait for him now. It's only fair that any number of individuals' homes will be finished before mine because they moved faster. Things aren't very comfortable in here right now as they have not been since the great flood. Thus, my guests spent most of their time at their hotel with Melissa visiting them.

I have the lovely combination of a personality that needs to be busy doing something and a body that needs lots of rest. Every time the two come in conflict, I end up in severe pain yet I have yet to learn an effective strategy to deal with it. Every effective strategy I had in place involved my comfy reclining chair or one like it but it was damaged from years of me landing awkwardly in it and the flood finishing it off. It was one thing to deal with the back falling off halfway about one in five times I reclined but now back simply falls off. Thus, I don't recline it and I learned that the top isn't exactly placed right for my neck upright possibly more so since the additional damage.

Melissa, who is smarter than I am about these things, tells me to go to bed when I'm tired. That makes perfect sense except that I seem to have forgotten everything I learned about relaxing in the early years of being sick. Either I do something that occupies my mind and suffer from broken chair induced poor posture or I lie down in bed and suffer what feels like a phobia about doing nothing. Emptying my mind allows worries and doubts to creep in. I end up lying down and then hurrying to get up out of it when the worries become mortal terror and the doubts become self loathing. I'm afraid I have too many reasons to dislike myself to rest easily these days. I've done things that were inevitable and the best available choices but it doesn't mean that I liked doing them.

I'm not ready to tell you all about my personal take on the emotional pain of being an adult who has made choices for approaching 39 years. Sometimes, my intentions were noble, other times childish and then there were the purely nasty things I've done. Most of the last category took place in my first two decades when I was much healthier and far less secure of my survival.  I would rather stick to the physical. The physical can be much less painful in so many ways. The main exception is that physical pain hurts a lot more visibly to the senses. Physical torture may not be the proper way to break someone but it sure is mighty unpleasant.

I got worked up enough that it reminded me of that insane post-op pain that my mind couldn't even categorize at the time. I just remember an ICU nurse rushing toward me with a syringe. I demanded to know what was in it and she told me after she put it in my IV. It was morphine and it knocked me all the way out. The nurse had probably been warned of my fears involving drug addiction. If she had given me a choice, I might have injured myself thrashing about in the pain. Instead, I grew a healthy appreciation for medicine. I take it as prescribed and only as prescribed while accurately describing my symptoms to the doctor once a month.

There was a terror that came with the pain this time. The terror told me that I simply could not survive hurting so much. An hour later, it told me I couldn't survive another hour. Hours later, it told me I'd lose it if it got worse. By that time, I had tensed up and cramped up terribly. The cramps were in my chin and I had new medicine prescribed exactly for that. When I took the muscle relaxer, I went into something much like my post-op experience. I endured pain, had meds kick and drifted off into something close to sleep. I was conscious enough to know that time was passing but not how much and afraid of the pain I could still feel on the other side of the lovely meditative wall I'd built.

On the other side of this horrible pain, I can tell you that I survived without going crazy or falling prey to addiction. I used my medication strictly within the prescribed guidelines and it worked. My doctors are smart enough to leave me some wiggle room in their orders. I'm smart enough to tell them exactly what I did with it. I'm smart enough to realize it probably wasn't a good idea to try out a muscle relaxer with a beer and the experience was pleasant enough that I won't do it again. Anything that feels quite that peaceful has to be dangerous. The stupidity to not realize I'd tried it until after both were down the hatch was a side effect of so much pain. That's one for the "coach" to help me remember. Never have a beer and muscle relaxers within reach at the same time.

That wasn't the time I went to sleep. When I went to sleep, it was just the muscle relaxer and the fatigue of severe pain. When I realized I'd doubled down on the chemical relaxation techniques, I was alone and decided not to sleep. Part of me was afraid of going into a coma or something. That should tell you how good I am at staying awake or how bad I am at sleeping. It's the same thing depending on how you want to look at it. Apparently, I was in no danger but I don't know what factors that depended on. I am pledged to avoid attempting to even toe dangerous lines much less crossing them.

There's a reason to stay alive beyond simple self preservation which I've developed over the years. Melissa loves me. I should have seen it but I always thought my childish greed was her reason for bringing things home to me on the rare occasions when she goes out with friends and/or family without me. I should have known better but she forgives me and that's good enough. She brings things home because she would rather have had me with her most of the time. That's because she loves me. She knows only a disintegrating amount of pain would deter me from being with her.

On another note, maybe chewing gum with such sore jaw muscles might have been a bad idea. It was worth a try since I can't set my jaw in a stressful pose while chewing a piece of gum. Even better, it's sugar-free.