“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 t
he 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.
THE PLACEBO DILEMMA
A friend of my mother’s told me he had a Q-Ray bracelet that warded off his knee pain with magnetic rays. Previously hobbled by pain, he could now run for miles. He had researched the bracelet and was dismayed to discover a study showing it to be a placebo, which he didn’t believe. Once, he took the bracelet off and realized he had forgotten to put it back only when the pain caught him by surprise.
“Perhaps your subconscious knew,” I suggested.
My mother gave me a look.
A woman in my building showed me the copper bracelet that had cured her arthritic elbow. She wore the homely piece of metal every day along with her art deco cocktail rings and diamond tennis bracelet. What do you think the connection between copper and arthritis exactly is? I started to say, but thought better of it. Why spoil it for her? Was I jealous of her relief?
One night, I stared at a candle and had the impulse to burn myself and remind my body what normal pain was—the kind that could be bandaged. I tried to understand pain through psychoanalysis. (Why my right side? Is it connected to writing, since I’m right-handed?) Was I looking for a subconscious excuse to avoid work—to feel literally pained when I did it? That was how the Victorian affliction of hysteria worked.
I tried positive visual imagery, using a workbook on illness and positive thinking, but the blue, celestial light with which I tried to imagine my pain turned to an evil, ashy gray. I tried acupuncture, massage, and herbal remedies.
“I’ll take all of them,” I told the surprised salesman in the health food store after listening to all his recommendations for pain relief remedies.
I had always been skeptical about natural remedies because, in addition to not having been tested for efficacy or safety, they aren’t natural. Although they derive from plants they are actually formulations of compounds isolated from plants and presented in hundreds or thousands of times the concentration in which they are found in nature.
But if I took these remedies with a dose of skepticism, would they definitely fail? I didn’t understand how placebo works at a physiological level, but I had heard many times that if you believe you are being relieved of pain, you will experience (deluded?) pain relief. Yet I always got stuck on what I thought of as the Placebo Dilemma: Knowing that the relief was a result of placebo, how could I believe in it? In order to work, didn’t placebo require precisely the belief that the treatment was something other than placebo? Yet, if the effectiveness of the placebo testifies to the transformative reality of belief, shouldn’t that make it easier for me to believe? I felt like doubting Thomas asking Jesus to remove his unbelief. In order for God to save me, all I have to do is believe He exists.
There is a story about a famous physicist who put a horseshoe on his office wall. “I thought you didn’t believe in that kind of thing,” remarked a puzzled graduate student.
“They say you don’t have to believe in it for it to work,” he replied.
If I wore a copper bracelet, was I revealing my desperation, my willingness to forsake the person I used to be, who knew that copper doesn’t penetrate skin (luckily, as it is poisonous), or was I demonstrating to the universe that I was open to being healed in any way, including ways I didn’t bel
ieve in?
I kept flashing back to a conversation I once had on a reporting trip in Addis Ababa, on a day when I was wandering around stricken by inexplicable pain. On a street corner I had seen a leper whose arm was dissolving. His right hand was dripping off like a melting candle; in his left, he held a mango. He seemed to understand my question, as he laughed shyly and said he was “okay.”
“No pain?” I repeated, staring at him amazed, and then went back to the hotel, ashamed, and got a massage. As the therapist put her warm hands on my shoulders, I closed my eyes and remembered how the leper ate the mango and laughed at me.
REPRESSED NEGATIVE EMOTIONS
I arrived to visit friends at their beach house for the weekend in a daze of pain. Although I didn’t want to explain, I had a neck wrap in my suitcase that I was longing to use.
“I have this—uhh—stupid pain,” I said. “I have this wrap that is heated in the microwave—”
“Chuck used to have back pain!” Erin said. Her husband’s back pain, she told me, had melted—melted— away when he enrolled in the treatment program of Dr. John Sarno, a New York physician whose bestselling book, Healing Back Pain, they still had in the house. He had told our mutual friend Daniel about the book, too; Daniel went to the bookstore to check it out, hunched over with pain, but by the time he walked to the cash register—having read only a few chapters in the aisle—he was standing straight.
Sarno explains that the major cause of most back, neck, shoulder, and limb pain is a syndrome that he terms tension myositis syndrome (TMS), which is a controversial notion. By assigning their pain a medical-sounding term (which means—more or less—tense, painful muscle syndrome) people can feel validated with a medical diagnosis. However, people with TMS pain are also reassured that (unlike for most medical conditions) the cure lies entirely within their control.
The Pain Chronicles Page 6
