She also remembers that the night after she was released, while I lay in the nursery beneath fluorescent lights to treat jaundice, she and my father went out to dinner at a restaurant called Le Mistral with his parents. This was a very fancy place in Manhattan that had recently been reviewed in the Times. The paper wrote: “This most recent addition to the town’s roster of luxury restaurants is a place of estimable charm with a kitchen of considerable merit.”
My mother was proud she was able to enjoy Le Mistral so soon after experiencing the physical trauma of having her first child. “I remember that sitting was uncomfortable,” she said. I’m oddly proud that my parents were able to enjoy this slice of swanky 1960s New York while their son, me, the most recent addition to the town’s roster of screaming infants, baked beneath hot lights a few blocks away.
The intervening thirty-three years had brought quite a few changes to the hospital, not the least of which was the modern ward in which Helene and I now awaited our first child with the television on. Like my mother and father, we didn’t know if we were going to have a girl or a boy. Helene had had an epidural, but it had no effect on one mysterious fist-sized “hot spot” on her belly, and she was still very uncomfortable. The nurse implored her to keep pushing as the sky outside lightened and Sabrina moved toward its conclusion. The doctor checked in on us from time to time. Finally, after determining that the moment was near, he disappeared for a few nervous-making minutes and came back with a young woman doctor pulling an aluminum cart covered by a sheet of blue paper.
They put on gowns and caps and clear plastic visors, and the woman doctor took the paper off the cart with a flourish worthy of The Price Is Right.
On it were two rows of scalpels and scissors, in descending size order, all gleaming in the bright birthing room lights. Helene could not see this, but I could. I leaned in close to her.
I said: “Listen, I don’t want to worry you, but you better push as hard as you can.”
The young woman doctor said: “Hey—I didn’t know William Holden was in this.”
Helene said: “Ice chips, more ice chips.”
William Holden said: “I was just helping you make up your mind. You ARE in love with her!”
Dean joined us a few minutes later, the scalpels and scissors unused, and then the screaming really began.
It’s all well and good and charming when a little baby gets here crying. When he takes his first nap it’s a relief—you think, hey, that wasn’t so bad. I relaxed as I looked at him sleeping there, black hair coming down over his forehead. He had at least one of my facial characteristics, an oversized upper lip; I gently pressed my little finger into the space between it and his nose and felt the same soft indentation that I’d felt on my own face for thirty-three years, only smaller. His eyes, when open, were giant and an impossibly dark shade of brown. But in my relaxation I was falling into the same trap as the three-year-old who goes to nursery school for the first time and then thinks that that was it, it was only a one-day thing. After forty-eight hours, Helene and I thought we had this parenthood gig in the bag—having a baby seemed easy enough. But on our way home from the hospital, as we drove along the river toward Brooklyn, Dean started screaming again, and it was a deeper, more resonant, more permanent kind of scream.
And it lasted for four months.
In a way, it was his first question, and it was not asked politely. What the hell am I doing in this cold place when I used to be in that nice warm place? Why am I in a big metal box on wheels (our Honda) hurtling down some type of paved corridor (the highway) with other metal boxes on wheels going the same speed in the opposite direction on the other side of a low metal barrier for a cumulative total of a hundred and twenty miles per hour—is this really safe?—with huge geometric shapes on my right (skyscrapers) and a weirdly shimmering and changeable surface on my left (the river)? And what is that other flat surface being held in the air by flimsy-looking strings (the Brooklyn Bridge)?
Helene’s mother was at the apartment waiting for us. For the nine years we’d been together, Helene had assured me that if we ever had a baby, her mother would be ready to pitch in and help take care of it, so much so that we’d barely detect a change in our lives. After all, she’d raised three children of her own, and helped out on four other grandchildren so far. Don’t worry, Helene said, my mother will take care of everything.
After three days, her mother shrieked: “I’ve never heard a baby scream like that!” and fled the apartment.
Dean’s wails, his unformed questions of alarm, or of pain, prompted our first desperate quest for knowledge as parents. We looked for answers everywhere, beginning with the dozen or so books we’d been given about how to raise children. They all identified the problem as colic, and they all gave different reasons for it and suggested different solutions, usually in an amused tone that was infuriating at 4:30 a.m. We tried over-the-counter medicines, and tea, and putting Dean in his car seat on the dishwasher during the rinse cycle. We rocked him, we rubbed him, we walked the freezing December streets with him. I drove him around in the middle of the night; the screaming stopped only when we went above sixty miles per hour, which is hard to do in Brooklyn (but not impossible).
He screamed through Thanksgiving, he screamed through Christmas. His first pediatrician, Dr. Deutsch, looked at our haggard faces and said, “Oh, just let him cry.”
He was fired.
Olga, our fortnightly cleaning lady, suggested in a thick Russian accent that Helene’s breast milk was causing the problem. As a visual aid, she pointed to Helene’s chest.
She was fired.
Our mailman suggested a liquid remedy with a strange name. It sounded good, and my father, remarkably, found a bottle in a sketchy-looking pharmacy in a sketchy-looking neighborhood. It worked, sort of, but then a friend mentioned that he’d heard this concoction was illegal, and that its magic ingredient was a heavy dose of alcohol.
Stringent postal regulations and intractable union seniority rules, we learned, prevent the firing of one’s mailman.
Dean turned yellow, Dean got cradle cap, Dean didn’t gain weight as fast as the charts in our parenting books said he should. But most of all, Dean screamed.
I developed Screaming Baby Battle Fatigue. At the newspaper, in my sleep-deprived state, staring vacantly out into the newsroom, someone nearby crinkled plastic wrapping and it sounded like Dean’s screams; I nearly jumped out of my seat. Lying awake in bed, I worried that my son, my beautiful two-month-old son, was a rage-a-holic. I imagined my own infant-care product: Baby Sleep-All-Night, complete with a drawing of a blissfully sleeping infant on the cover, a high alcohol content and a dropper in the shape of a bottle of Scotch.
Eventually, we called in reinforcements. With me working nights, and Helene working at home during the days, we had figured we could raise a child without too much outside help besides our parents babysitting from time to time. A few weeks before Dean was born, my mother mentioned that a friend’s nanny was free one day a week. We said we weren’t interested. A few weeks after he was born, my mother mentioned this again, and we begged for the number.
Brenda was from Nevis and spoke with the gently lilting accent of that island. She came on a Thursday, sat for a brief “interview”—a technicality, really, because at this point we would have hired her whether she’d been armed, or toothless, or covered in blood—and then picked Dean up and cradled him while Helene went for a nap and I went to do errands that had been waiting for weeks.
It was quickly established that when Brenda was in the house, Brenda was in charge of Dean. She played with him, sang to him, got him to nap far more easily than we did, and dug deep into the drawers of gift outfits we’d received to dress him in the most unusual, colorful, even outlandish combinations she could devise.
While he napped, she folded his tiny clothes into the tiniest imaginable little squares. At the end of the day, she handed him to us cleaned and rested and fed, his nails clipped. The feeling we had for ho
urs after she left became known in our apartment as the “Brenda High.”
It would be exaggerating to say Brenda cured Dean of his crying. I don’t remember when the screaming stopped, but eventually it did. Her calming tone certainly helped, as did Helene holding him on the couch in the evenings, sometimes all night. Whatever the pain was, or whatever the frustration was that he couldn’t tell us about the pain—or ask us about it—finally faded. No more evenings being vibrated on top of the dishwasher, no more sixty-mile-per-hour midnight rides through the streets of Brooklyn. We may not have been able to ease the pain and answer, for ourselves at least, the question of what was causing it, but at least we had survived it. And so had he.
Dr. Sudhir Diwan is the head of the division of pain management at New York Hospital. He is an expert in all things pain—what causes it, which nerve fibers transmit it, and how to bring it under control. He grew up in a city in India named Ahmedabad, in the state of Gujarat, which is where, he notes, Gandhi started his activities—“so this is a very well-known town in the world.”
He was a surgeon and owned his own hospital in Ahmedabad, Diwan Surgical Hospital, but in 1988 he came to New York to study, and he became involved in the then relatively new medical field of pain management. He has stayed with it ever since.
I wanted him to answer one of Dean’s more intriguing questions: “What would hurt more: getting run over by a car or getting stung by a jellyfish?”
Dean had asked me this when he was four, the colic screams long quieted, while we were standing on the dock of a little cottage we had rented on the end of Long Island. It was a little shingled summer house in a grove of trees. The dock jutted about ten feet into a shallow tidal estuary that was a favorite hangout for jellyfish: a globby red one languidly dragging red tentacles floated by as Dean asked his question. I noticed his eyes, already so large, widened even more when he wanted to know something. I laughed and said I didn’t know, but made a mental note to write it down—it suggested such a wonderfully dark view of the world; it made me proud. I showed it to Helene, and to my parents. It was the first question asked by Dean that I looked for someone to answer. And I knew it was special because it lingered in my head after I’d committed it to computer keys:
What really would hurt more, getting run over by a car or getting stung by a jellyfish?
So I returned to the place of his birth, the place of my birth. I walked beneath the same gothic arches as I had that chilly November morning, as my father had on that temperate May evening, and along the same polished marble floors, the lobby and corridors busier with patients and white-coated doctors than they had been at 5:00 a.m. as I pushed Helene in a wheelchair, her hands clenched on the armrests. I took an elevator in the M bank up to the third floor and found my way to M 322D, to Dr. Diwan’s tiny windowless office. After sitting down and waiting a minute while he finished a phone conversation, I repeated Dean’s query.
“This is a very good question,” he said, “because these are two completely different types of pain.”
Dr. Diwan had a very, very thick Indian accent—for all I know, an Ahmedabad accent—and many of the words in the preceding sentence were initially difficult to decipher. He happily repeated words for me whenever I got confused.
“With neuropathic pain your nerves are irritated, so whether they are irritated by snake venom or a scorpion or a jellyfish it is pretty much the same. Some neurotoxins cause spasms of the muscles and some neurotoxins cause irritation of the nerves and severe burning pain.”
So that’s the jellyfish: neuropathic pain, pain coming straight from the nerves, traveling on the C fibers, which transmit constant burning pain, and the A delta fibers, which carry more sharp shooting pain.
Getting hit by a car, on the other hand, causes somatic pain, he said; that is, your bones are crushed, your muscles are torn, and these damaged parts transmit their own pain messages to your brain.
In other words, the jellyfish pain is pain for pain’s sake, pure and simple, and the getting-hit-by-a-car pain is a side effect of an injury. Dean had asked about two injuries that represented the two types of pain a person could experience.
Dr. Diwan was careful to explain that Dean’s question includes many built-in variables: the type of jellyfish, the location of the sting, the size and velocity of the car running over you.
For example, getting hit by a 2006 Hummer H2 going sixty miles per hour would surely cause more damage and hurt more than getting brushed by the jellyfish, a sea nettle, that Dean and I had seen.
But if it were a highly toxic bluebottle (Physalia utriculus) jellyfish, or a Chironex fleckeri—which, according to the Medical Journal of Australia, has caused sixty-three deaths since 1884—and the car were a Mini Cooper going, say, thirty-five miles per hour, then the equation would be much different. In those cases, and in cases where all the variables were more or less equal, it would be the pain itself, racing from nerve to nerve around the body, and not the pain stemming from the crushed bones, that could send a patient into shock and even result in death.
Dr. Diwan declared the jellyfish the victor.
We moved on to other issues: the worst pain either of us had ever experienced (he suffers from fibromuscular dysplasia; I had recently steam-scorched my hand while boiling water); how he came to be a pain specialist (a beloved professor had told him, “You will never understand pain until you feel pain”); and the larger issue of children and pain.
Here Dr. Diwan became quite expansive. To begin with, because their little bodies are all they know when they are born, whenever anything isn’t quite right it takes on a somewhat exaggerated importance in their overall worldview. Treating pain in a child is one of the biggest challenges for Dr. Diwan and his colleagues, because children have such a tough time putting their pain into context. So they have the Wong-Baker Faces Pain Rating Scale.
Dr. Diwan stood up, shuffled some papers around on an upper shelf and handed me a xeroxed piece of paper. The Wong-Baker Faces Pain Rating Scale, which anyone who has ever accompanied a small child to an emergency room knows, is a series of drawings of six round faces, ranging from a smiling face to a straight-mouth face to a frowning face with multiple tears squirting out of the eyes. A doctor shows a child these drawings, and the child points to the one that seems to best represent the pain being felt.
The Wong-Baker Faces Pain Rating Scale. From Marilyn L. Hockenberry, David Wilson, and Marilyn L. Winkelstein, Wong’s Essentials of Pediatric Nursing, 7th ed. (St. Louis, MO: Mosby, 2005). Copyright © Mosby. Used by permission.
I looked it over closely. Strangely, the first person who popped into my head was not Dean but Helene: number two, the straight-mouth face, was actually quite reminiscent of her expression when she wakes up in the morning; the saddest face looked like she did when she gave that final push to get Dean out; and number three was not unlike a look she had given me a week earlier when I put an entire orange skin in the garbage disposal, jamming it.
“That looks like my wife!” I told Dr. Diwan.
“I do not understand.”
“You know, when she had a baby.” I pointed to the last one.
“Ah yes, this is very interesting that you say this, very interesting.”
Labor pain, the pain of the birth of Dean and all the other children in the world, is the proto-pain, the über-pain, the base pain against which all other pain is measured. “That’s what we compare pain with,” Dr. Diwan said. “Not only is the intensity of it very high, but the frequency of that intensity is also very, very high. Everyone agrees that this is the worst. And this is what we start from when we want to know how much pain someone is experiencing, whether it be a child or not.”
I thought of my mother: “I remember that sitting was uncomfortable.”
And I thought of Helene: “Like being turned inside out.”
Even with the epidural, by the end the pain must have been nearly unbearable. Probably way off the Wong-Baker Faces Pain Rating Scale. I remembered the tray of
scissors and knives, the nurses and the young doctor, Sabrina on the television. I felt a little guilty for paying so much attention to the movie, and to Audrey Hepburn.
I thanked Dr. Diwan and started walking back to the office. It was a chilly March day. As I crossed the big avenues, I told myself I’d have to do better. Helene and I had two children and didn’t plan on having any others, but I could still find ways to improve my behavior. I’d try not to put any more orange skins in the garbage disposal, and I’d never dillydally with the ice chips again.
“What would hurt more: getting run over by a car or getting stung by a jellyfish?”
—DEAN, on a dock on Long Island at sunset
Dr. Sudhir Diwan, director of the Division of Pain Medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center:
“These two things are totally different: one is called somatic pain—the run-over injury—that means it’s coming from the tissues, from the bones, from the cartilage, from the muscles. The pain secondary to injection of the venom of a jellyfish is most likely called neuropathic pain. That means the pain is coming because of the irritation of the nerve, and that could be generalized all over the body where the nerves are. That pain itself could be reason for shock and death. I would imagine the jellyfish pain would be stronger than the run-over pain.”
“What does it feel like to get stabbed?”
—DEAN, after being prodded with a plastic Power Rangers sword wielded by his sister, Paulina, age two
Marianne Slack Wells, who was stabbed in the back with a hunting knife wielded by a deranged man on August 4, 1980, in Portland, Oregon:
“My first reaction was that somebody slammed me in the back as hard as you could with a fist; it just felt like that. I was seventeen years old, going to St. Mary’s Academy downtown, waiting for the bus. The person who ran up to me afterward said, ‘Are you okay?’ I said, ‘That guy just hit me in the back,’ and he said, ‘Well, he had a knife.’ That’s when I reached back and, you know, there’s blood everywhere. It punctured my lung. I couldn’t breathe, then I went into shock; I collapsed because I couldn’t breathe. He was a really big guy; it was really more of a blunt force hit, no cutting feeling. Even now, anytime anybody will come up behind me, you know, to slap me on the back or something, I’m still pretty sensitive. It is a sort of fear-based adrenaline rush that happens to me. I get very anxious.”
Father Knows Less Or: Can I Cook My Sister? Page 4
