What a pain!

 

There’s a good chance you already know and love the tale of the Black Knight from Monty Python and the Holy Grail. If you don’t know it, or if you just need to see it yet again, here it is for your pleasure:

Monty Python - The Black Knight - Tis But A Scratch

Now, if you don’t think that’s funny, then deep inside, you are probably lacking some basic human sickness; you are missing a fundamental depravity that most of your peers possess. All I can say is I’m truly sorry.

My Mom is a 92 year-old, 114 pound Black Knight. In February, while walking her Shih Tzu in the ice and snow, she slipped, breaking her pelvis, wrist and elbow. “Hmm,” she thought to herself. “I could press the emergency button on this thing I wear around my neck, or I could drag myself a quarter mile across the ice and snow to get home. Ice and snow it is, then.” She dragged herself home and called my brother, who took her to the ED, where she finally got some attention when she started exhibiting signs of shock.

After a spell in rehab, she was back home taking care of herself and getting stronger until she decided to take out the garbage, bonked her head on the garage door, and fell again. We had dinner with her that night (Monday) and she said she thought she was doing fine. A few days later (Friday), she called me and said, “Dan, I’m really hurting, I think I need to get some X-rays.” She had a new compression fracture on her spine and had broken her other elbow. My brother-in-law, a retired primary care provider, didn’t think the oxycodone she had left over from the previous fall would be enough to mitigate the pain, but by the next day she was off the oxy and just taking tylenol. In her mind, it was a good thing she didn’t have any broken bones–only fractures.

My brother got her to spend a week with him, then guilted her into spending a week with me– “It would be almost selfish of you to go home because we’d be worrying about you.” Brilliant strategy, bro–probably the only thing that had a chance of working. She insisted it didn’t hurt when sitting or lying–only standing or walking. I took that as, “it’s not excruciating when sitting or lying–only standing or walking.” For my part, I would say helpful things like, “No, you can't carry both salad dressings and the trivet back to the counter–sit DOWN!” By the end of that week she was mostly off the tylenol, itching to go home and start doing her own laundry. BIL said medically she’s not ready for that but, what can you do. He’s had patients like that. 

Me, on the other hand: I sprained my ankle in my early 20s and it took me ten years before the pain went away. They found I had a bone spur and removed it, but that didn’t really help.

Pain: it’s one of the great mysteries of medicine. Unlike blood pressure and HbA1c, it’s impossible to measure objectively. Does my mom really feel less pain than I would in the same situation, or does she just interpret and respond to it differently? I lean toward the latter. To me, pain screams, “Stop, you’re damaging something!” whereas to her maybe it’s more, “Oh, that’s part of the healing process.” We do know that chronic pain often persists in the absence of any identifiable physical damage; we can even, in the case of phantom pain, feel pain in places that no longer exist. Doctors hate seeing patients with chronic pain, because they can’t see it, feel it, objectively assess it, or treat it effectively. There’s a newer trend in medicine that focuses on helping people get their lives back despite the pain rather than trying endlessly and ineffectively to remediate the pain.

Pain: What a pain!

How about you? What stories have you got?

(OP by Dan T)