The Pain Chronicles (6 page)

DESTROYER OF GRIEF

I wanted a holiday from pain—an hour or two, smooth and round as my old hours. I did not want aspirin, Motrin, or Aleve. I wanted the ancient medicinal herbs that date back, the Rig Veda explains, three ages before the gods were born, or the wine potion that Helen of Troy gave grieving visitors—what was it called?—that lulled pain and brought forgetfulness of every sorrow.

Those ancient medicinal herbs . . . Cannabis, the vapors of which, writes Herodotus, caused “the wounded Scythians to howl with relief and joy” in healing huts where the seeds were thrown on hot red stones. Black henbane, the “killer of hens,” whose yellow-veined flowers crowned the dead in Hades and which was used in witches’ brews to induce visions and convulsions and to confuse memory of pain. Mandrake, whose twisted human-shaped root was said to grow under scaffolds from the ejaculation of hanged men’s final death spasms. When uprooted, it shrieked in pain, killing those that heard its cry, yet it could be made into a potion that eased the pain of the living. According to a medieval heresy, it was mandrake mixed into vinegar that caused Jesus to fall into sleep for three days, after which he awakened in the tomb, as if resurrected.

But the “key to paradise” has always been opium, the ancient Sumerians’
hul gil
(“plant of joy”) that “induces deep slumber and steeps the vanquished suffering eyes in Lethean night,” as Ovid wrote. Opium was said to console the goddess Demeter herself when she wandered the earth to search for Persephone, for when she suckled its milk, she momentarily forgot her grief and fell into the twilight sleep that is halfway to Hades. How did mortals figure out the secret of how to extract the drug from the white opium-rich
Papaver somniferum
(“the poppy that brings sleep”)? Only in the brief interval in which the petals begin to drop can the fat, round capsules containing the unripe seeds be tapped, through an incision out of which the “Milk of Paradise,” the cloudy fluid also known as “poppy tears,” seeps. But it is not until it dries and oxidizes that it turns into a sticky, black opium-containing gum.

“I possess a secret remedy which I call laudanum [‘to be praised’] and which is superior to all others’ heroic remedies,” the sixteenth-century alchemist and physician Paracelsus proclaimed. Laudanum—and other potions of opium dissolved in alcohol—soon became a staple of a well-supplied cupboard. There are a number of versions of Paracelsus’ recipe, calling for opium mixed with such ingredients as henbane, an Arabic drug called mummy, oils, amber, musk, crushed pearls, coral, stag heart, and unicorn.

In my medicine cabinet I had a few tablets of Darvocet—a narcotic pain medication that Cynthia’s husband, Jim, a physician, gave her for cramps, which she had generously saved to share with me. One morning I stood in the bathroom holding a fat magenta pill in my palm, as anxious and excited as a teen taking drugs. Milk of Paradise, Hand of God, Destroyer of Grief. “How divine this repose is,” Coleridge wrote of opium, “what a spot of enchantment, a green spot of fountain and flowers and trees, in the very heart of a waste of sands.”

I took half a pill and then went out to do errands. I felt a dizzy nausea and had to find a bench to sit down. But as the pill dissolved in my stomach, I had the sensation that a genie emerged, looked around at my insides, and said,
I know what you want.

It wasn’t the key to paradise, but it did seem to offer a modicum of blurry magic. After a few hours, though, the genie wearied of my wish and left me with the pain again. I tried taking a whole pill but became so dizzy I had to lie down on the couch. But I was not in pain.
I must appreciate not being in pain
, I thought. But I felt too vague to do anything but flip through an old magazine and wait for the drug to wear off.

I thought of how medieval love potions were made with poppies, as the flower was sometimes said to spring first from the tears of the goddess Aphrodite as she mourned her lost lover Adonis. On Saint Andrew’s Day, in one tradition, a maiden could write a secret question about love on a piece of paper, tuck it into an empty poppy pod under her pillow, and have it answered in a dream. Sleepless with pain one night, I took the last magenta pill and fell into a brief, restless sleep. I woke before dawn from a dream in which I had told Kurt that my arm was hurting and he suggested that I cut it off. I did, but then I needed to use it, so I tried to reglue it with Krazy Glue, but I couldn’t make the nerves align, so it didn’t stick, and when I tried to use it, it toppled off. Then I remembered reading about phantom limb pain—terrible, intractable pain. I realized with particular dream-horror that I had made an irreversible mistake.

“I didn’t say you
should
cut it off,” Kurt clarified coolly in the dream. “I said it was an option.”

The only question in my heart—the one I wanted to tuck into the empty Darvocet bottle—was,
Why am I in pain?

The pain I had felt lying awake that first night with Kurt had seemed then like
poena
—the price for what I imagined would be the happiness of the relationship. But, as the happiness had failed to materialize, the pain had metamorphosed in my mind into a symbol of unhappiness: a mysterious unhappiness, mysteriously conjoined to mysterious pain.

THE PLAN

The months turned into a year and continued to accumulate. When I think back on the time that elapsed between the day the pain first settled in and the day I finally got a diagnosis, I think of the joke about the drunk looking for his keys under the streetlamp—even though he has lost them farther down the block—because “that’s where the light is.” For me, the light shines most appealingly on the self. I wanted to imagine it was a problem, just like my other problems, best solved by me.

All the things on my to-do list, big and small, got checked off. I moved to LA for a job teaching fiction writing; I moved back to New York; I moved to a cheaper apartment in New York. I published several long, difficult magazine articles on murder. I located a Depression-era jadeite reamer, which also served as a measuring cup, to replace a favorite I had chipped. But pain—which topped my thoughts continuously—was somehow never on that list. Rather, it was on a different list, an invisible list that went something like this:

Plan A: Ignore it.

Plan B: Try alternative medicine. Since I didn’t really believe in alternative medicine, if it didn’t work, I didn’t need to feel I had exhausted all the good options. I could still move on to:

Plan C: Find a doctor and get treatment.

Plan A had failed. Plan B would fail. As long as I didn’t try Plan C, I could believe that I could still get truly serious about getting well, click my heels like Dorothy and say,
I want to go home
—home, home, home to my normal body—and wake from the dreamy delusion of pain. I didn’t want to try Plan C and find that medicine would not offer me ruby slippers.

Like most people, I had never heard of a pain specialist or a pain clinic. So by the time I resolved to see a doctor, I had no idea what kind of doctor to see. I didn’t know that one’s choice of doctor partly determines one’s diagnosis. I went to see an orthopedist who specialized in athletic injuries, which is what he found me to have.

The other patients seemed unsurprised by the two-hour wait to see him, as if they knew that to have a medical problem is to be cast out of the realm of busy people (like the doctor). The sick have no schedule, their time is of no value. “Illness is as much a failure as poverty,” wrote the Parisian syphilitic Xavier Aubryet in 1870. The patients waiting with me had the resigned shabbiness of the unemployed waiting to see their caseworkers.

The orthopedist had the hearty self-assurance, square jaw, and heavy build of a former athlete. But he wore an incongruous gold necklace and a large decorative ring—a tiny, opaque bit of self-expression that I fastened on as a positive sign.

“Rotator cuff injury,” he announced after examining my shoulder. He scribbled a diagram with a ballpoint pen on the white paper covering the examining table. I had no idea what the diagram said, but I sensed that he felt he had exerted himself to explain this. He had drawn an illustration for a patient—the kind of thing one of those mandatory touchy-feely continuing education courses suggests:
Patients need to see it.

I didn’t see it, though; it was just a mess of lines.

“Could I tear this out?” I asked timidly, thinking that perhaps if I studied it at home, it would reveal its meaning, the way a difficult poem sometimes opens up late at night.

He waved away the idea, as if I had asked something absurd. Then he wrote me a prescription for eight weeks of physical therapy.

“That should—” My voice cracked as, half naked in the paper gown, I revealed my deepest desire. “That will make it better?”

“Yes.”

_______

Years later, after I figured out that patients should always request copies of the notes doctors make after a consultation, and as I was gathering my old records, I called the orthopedist’s secretary to request my notes. Although I had seen him numerous times, she said she could locate only two of them, an initial impression and a follow-up. The history was brief:

HISTORY:

Patient, for approximately a year, has had pain in and about the shoulder secondary to a bicycle/pedestrian accident.

PHYSICAL EXAM:

Physical exam demonstrates the patient to have lack of range of motion of 20 degrees in all planes, with crepitation in the subacromial space. There is pain on palpation of the greater tuberosity and bicipital groove.

IMPRESSION:

Adhesive capsulitis

RECOMMENDATION:

Patient is advised as to her condition . . . She is referred for physical therapy.

Had he hesitated, feeling a slight annoyance as he tried to recall my story, or had his mind automatically invented a narrative as he dictated the notes, in the same way my mind invented narratives for my pain? Had he confused me with another patient he had seen before or after me? By the time I read his notes, it had been years since I had seen him. I wasn’t going to go back to complain, so there was no one to blame but myself for not insisting that I be understood. Still, I found myself mentally protesting:
A bicycle accident is the one kind of accident I have never had
.

If the orthopedist’s office had looked like an unemployment office, the physical therapy office to which he referred me looked like a place where the unemployed received pro forma job training—the kind that didn’t seem like it was going to help them find jobs any more than basket weaving helps the mentally ill. Just as these attempts at help only underscored the recipient’s helplessness, lifting small weights that were now too heavy for my hand seemed to be turning me into a cripple.

I shrank away from the other patients, afraid to be grouped with the tired, old, sick, disabled, and sad. Although there was a stray college athlete with a chipped bone, en route to health, most of the patients looked like inhabitants of a village of the damned.

I disliked my physical therapist, a married, middle-aged German woman. I could see in her eyes that she thought I was one of those pathetic thirty-something waifs—a New York City breed, a decade too old to be a waif, but still lost.

“You live alone?” she asked the first day.

She nodded knowingly at my answer. “There is no one to take care of you,” she announced.

I could have said I had a boyfriend. I had Kurt, after all. But I told myself that this wasn’t any of her business. And something in me also knew it wasn’t true. The true answer was that I was alone.

“What have you eaten today?” she often asked when I came in. I would stammer, realizing it was something weird, like a piece of shrink-wrapped deli pound cake, because that was the only thing that had appealed. I had lost a lot of weight, which I attributed to pain curdling my appetite, but I now realize the nausea was more likely to have come from the Tylenol, Advil, Motrin, aspirin, and Aleve, which I believed worked best in combination, with a dash of Maker’s Mark at night. I can’t recall if I noticed the warnings on the drug labels not to combine these medications, not to take any of them regularly for more than two weeks, and not to consume them with alcohol. I didn’t believe anything sold over the counter could be all that dangerous, and anyway, what was fine print compared with the urgency of my pain?

“Do you think you’re fat?” my physical therapist would ask patronizingly, her smug, well-fed face assuming the faux concern and veiled contempt of a high school gym teacher for an anorexic girl sitting on the sidelines at a soccer match.

“No,” I would say. “My shoulder hurts.”

I did not
not
do the exercises. I said I was doing them, and I sort of did, for a while. At home, I occasionally picked up my Thera-Band—a piece of rubbery material that was supposed to provide resistance for stretching—and I certainly looked at those heavy weights that I had placed on the mantelpiece. But my arm no longer seemed suited for lifting five, or four, or even three pounds, and whenever I tried, the pain sparked like kindling set on embers. Since I didn’t understand the logic behind physical therapy, I had no framework of belief that would have encouraged me to do something that not only didn’t seem to be making me better, but felt like it was making me worse.

Since pain is an alarm bell—or, as Patrick Wall put it, a perception about an action that needs to be taken—the body responds to pain by going into its emergency mode. Muscles contract and joints stiffen in order to immobilize the area of injury. When the injury heals, the pain goes away and the muscles return to their normal state. But when pain persists, these changes begin to be a source of pain themselves. Contracted muscles clamp down on nerves and cause pain. The rigid muscles cause postural changes that strain other muscles. Using the affected area hurts, so one guards it, which deprives it of exercise, which makes the muscles atrophy, which in turn makes it harder to use that area and causes more pain. Physical therapy aims both to strengthen muscles and to relax them, through heat packs or massage.

In my unhappiness, I discontinued even the daily walking I had done. Walking would not have hurt me; in fact, aerobic exercise has been shown to stimulate beta-endorphins, which anesthetize one against pain (as well as stimulating serotonin, which elevates mood and also mitigates pain). But since I didn’t know this, and the idea of exercising a body part that was in pain felt completely counterintuitive, I’d show up late for physical therapy. Since I hadn’t been practicing, I wasn’t getting stronger. Yet the therapist continued to graduate me to heavier weights and more resistant Thera-Bands, so that the exercises hurt more and more. Under her disapproving gaze I’d have a slight feeling of paranoia, as if the exercises were designed to hurt me and to keep her—in collaboration with the orthopedist—supplied with weak pain patients.

I didn’t want to be a weak pain patient; I wanted to walk out of there. And when I did, I successfully put the experience out of my mind. I came late and left early, and in between appointments I tried not to think about physical therapy.