Understanding pain in my patients

I've been through some painful things in my life (not some of the ones I've been told in medical school are the most painful -- childbirth, kidney stones, peritonitis, or bone cancer), but none-the-less painful.

Most recently, I herniated my L5 disc.  At least, the docs are fairly certain I did -- no MRI was done, but symptoms all pointed that way.  And between visits to the chiropractor, visits for OMM, and doses of Advil and Prednisone, I'm doing better.

But better doesn't mean pain-free, and anyone who's had a back injury knows that pretty much everything you do (from yawning and coughing to walking and sleeping) involves core muscles.  Which means everything you do involves pain.

I wear a pedometer, and lead a fairly active lifestyle.  Even with medical school studying, I manage to average well over 10,000 steps a day, and that's not including runs.  The first couple days of my injury (until I begged some family to come help me out), I basically laid in bed in excruciating pain, preferring dehydration and hunger over the possible need to get up and use the bathroom.  I averaged only 300 over those early days . . . and when you think about my bed being 50 steps from the bathroom, that's saying a lot.

I finally spent a half hour on the treadmill yesterday, just walking and testing out the waters.  Of course, by the time I was done, I was sore and tired, and not just from the back injury, but also from the disuse and stiffness my muscles had accumulated after a week flat on my back.

Even now, walking is 85% back to normal, and sitting is at least 50% there.

And I'm laying flat on my back as I type this.  Even though the pain isn't extreme, it's there.  It nags with every movement I make.  Every action requires a little extra preparation, a little extra thought and planning.  Instead of hopping out of bed in one smooth movement, I carefully execute three.  Standing for an hour has me exhausted.  Sitting for two hours had me wracked with pain.  Everything I do adds just a little pain, and takes just a little effort.  And it all adds up -- to pain, and to exhaustion, both mentally and physically.

I know that getting up and going for a walk will feel good, and that it's better for my body.  Half of me is antsy to be up and jogging again.  But the part that's winning as I type this is the part that knows that as long as I just lay here, I won't hurt for now.

There's immediate cessation of pain if I just lay here.  IMMEDIATE.  If I move, even though it'll pay off in the future, it'll mean I hurt today, add to the growing overwhelming exhaustion, and have to dive back in.

I think I might finally understand how patients with chronic pain syndromes feel.  

Studies have shown that exercise greatly improves health of those suffering from most chronic pain syndromes.  And in my mind, I always thought, "Well, if they KNOW it'll help them, and it's THAT bad usually, why not do it?  Wouldn't you give ANYTHING to feel better?"

Dear patients . . . I'm sorry.  I get it now.

In no way am I trying to say that what I'm going through is as debilitating as month after month or year after year of symptoms, but sometimes someone just has to make their own "ah ha" connections.  This is mine.

This is not a well-researched article on chronic pain, or a well thought-out position piece on treatment.  This is the largely unedited stream of consciousness from someone who's been subsisting on Advil, Flexeril, and Prednisone for a week, and got a quick and fleeting glimpse into the life of someone with chronic pain.

Some surprises I've been spared . . .

There are some surprises I've been spared in medical school.  And I'm grateful for that.

For example, one of my classmates spent this last Saturday morning at a clinic for the underserved population of our local downtown area.  Thing big city, little money.  Anyhow, her comment was how surprised she was about how many little kids were there, who obviously had no money, poor nutrition, and poor care in general.  I wasn't surprised at all.  I wasn't horrified.  This didn't phase me a bit.  And that's a bad thing.  When did I become so used to the scores of children transported from hell holes into a busy ER that I stopped understanding what it really meant?

But I know why I'm like this.  What if you walked into a trailer home on a freezing cold winter night and saw pizza boxes stacked 3 feet high by the front door?  The (very well fed) mother is taking care of twins, who are both about 2.  One has a seizure disorder.  Neither twin is clean, and the trailer is filthy.  The huge (I mean HUGE) television is hooked up to a Nintendo Wii (the mother states the state bought it for her as part of the seizure therapy for her daughter) and both kids seem sick.  Fever, flu, you name it -- and definitely nothing good for the one with the seizure disorder.  We recommended taking both kids to the ER -- mom was fine with that.  As a matter of fact, she was hoping we would, because she didn't have a car to take them herself, and didn't feel like calling a friend, so she just dialed 911 even though she knew it wasn't immediately life-threatening. Today, I'm okay with that.  As we try to load the kids into car seats (thank God she at least had those), we realize she has no socks for the kids.  It's about ten degrees outside and snowing, and no socks.  Then, we realize she has no blankets we can tuck around them either.  Then we start getting angry.  We run to the ambulance, grab a couple of our own blankets, and I make my partner ride in the back with them.  He's a good guy who watches his nephew as a son.  I know he'll be good with them.  And frankly, I can't look this lady in the face anymore.  You can buy pizza and televisions and gaming systems but no socks for your toddlers.

I guess that's when I stopped letting myself get really angry about the way kids are taken care of around here.  Hopefully one day I'll find a happy medium where I can feel the anger and not let it affect my professionalism.  It's just hard with kids.