Sunday, August 4, 2013

Thoughts on Pain

I used to say that I had a really high pain tolerance.  I know lots of people say that.  My mother works for an orthopedic surgeon and she told me she has patients call up all the time complaining that they are in terrible pain and need more pain meds and they insist that they have a very high pain tolerance so the fact that they are in pain at that point means it really, really hurts.

Still, I think I used to have a very high pain tolerance.  For real.  I had a natural childbirth when I was 17 years old.  I was in labor for 19 hours and did not want pain medication.  Yes, it hurt, but I would do it again.  It was unpleasant, but bearable.  That's how high my pain tolerance is.  Or was, anyway.

I think I am also good at tuning out painful sensations.  I think I learned to do that as a child, when I was abused.  People with PTSD often do that.  There was no way to escape the pain as a child, other than to tune it out.  To not think about it.  To not feel it. To not recognize it.  It's a form of dissociation.

It's similar to what happens if you take Lamaze classes during pregnancy and they teach you to focus on  your breathing or on a focal point, like a picture or a teddy bear, and to focus on that and not on your contractions.  The contractions don't go away. They don't really stop hurting.  But if you do it well, you don't realize how painful they are.

Adults might have to take a series of Lamaze classes to learn to do that (there are other methods of prepared childbirth that work on a similar principle, as well as methods that work on other principles), but some children, especially young children that are abused repeatedly, figure out how to do it on their own.  It's a pretty creative way to deal with pain that would otherwise be intolerable.  Yay for creative coping skills, right?

But as an adult, that coping skill doesn't always serve you so well.  In November 2008, I had gastric bypass surgery.  A week later, I noticed I was getting a little short of breath pretty easily.  I thought I was just in poor shape, that I needed to exercise more.  I wasn't having any pain with breathing, wasn't coughing, no chest pain, no other symptoms.  I was nauseous a lot, though, and one night I thought I was dehydrated.  I asked Mike to take me to the ER because I thought I needed IV fluids.  We went to the ER, and they did indeed say I was dehydrated and give me IV fluids, but they also said I had pneumonia.  I was surprised to hear that.  They gave me a prescription for oral antibiotics and sent me home.

A week later, I had been up all night vomiting.  I was sure I was dehydrated again and when Mike got up for work, asked him to take me to the ER for more IV fluids.  He seemed annoyed at having to take off work to take me, but I was too sick to drive myself.  I was weak and dizzy and couldn't stop throwing up.  So off to the ER we went.

Again, I was told that I was indeed dehydrated and they hooked me up to an IV for fluids.  They also listened to my lungs and seemed concerned.  They wanted to do a chest x-ray, and after that, they got really concerned.  They wanted a CT scan of my lungs, an ultrasound of my heart.  People were bustling around in a big hurry, looking very worried.  The  ER physician told me they  might have to put a tube into my chest to drain the infected fluid away from my left lung.  He said they might have to put a tube down my throat to help me breathe.  I thought he was nuts.  I did not feel that sick at all.  I thought I just needed IV fluids.  I couldn't understand why they were all so worried.

I was admitted.  They had me on oxygen.  At one point I needed to get out of bed to go to the bathroom and I started to remove the oxygen to do that, and the nurse said oh no, put that back on!  It will reach into the bathroom!  You can't take it off.  The next day, they  moved me into intensive care.  They were rushing, packing up my few belongings and pushing my bed through the halls really fast.  I didn't understand what was happening.  I did not feel that sick.

I understand now that I was, in fact, very sick.  Deathly sick.  Like, if I hadn't been dehydrated and gone to the ER for IV fluids that night, I might have died at home on the couch in another day or two.  As it was, I spent 21 days in the hospital, a good part of that in the ICU.  They did put in a chest tube to drain the fluid away from my left lung, but the fluid was so infected and clotted and congealed that it would not drain.  They ended up having to do lung surgery to clean out the infection.  I was on a respirator for four or five days.  I was really out it, remember very little of those days, which I think is a good thing.  They kept me pretty sedated because I kept trying to pull out the respirator and they had to tie down my hands to keep me from pulling it out and then I freaked out from being restrained like that.

You know how unusual it is to spend 21 days in the hospital anymore?  People have open heart surgery and maybe spend a third of that time in the hospital.  I was horribly, horribly sick, and I didn't have any idea.

Why didn't I know I was sick?  I think I was dissociating.  I think I was tuning out the pain and discomfort, like I learned to do so well when I was a kid.  I can do it so well, I don't even know when I'm doing it anymore.  It makes it really hard to know if I am really sick or injured.  And I worry about going to the doctor and being told nothing's wrong.  I worry that they won't believe me.

Since my experience in the ER last November, though, when I had seven staples placed in my arms with no pain relief at all, I am afraid of pain.  Being afraid of pain makes it hurt more.  That's one of the reasons prepared childbirth techniques work.  The classes take the mystery out of the process and allow women to relax into the pain and open up instead of tensing up and fighting the contractions.  But since that experience in the ER, I am afraid of pain.  I fight it.  Even though I know that fighting it makes it worse, I can't help it.

I woke up early this morning with a very sore throat.  Now my body hurts all over.  I know that when you're sick, you often get achy and sore all over.  But I hurt in places I do not think are related to a sore throat or respiratory virus or something like that.  I think some of the pain I am experiencing is in my head.  I just don't know how much.  And it makes me hesitant to see a doctor because I'm afraid they will just tell me I am not really sick.  That's not the only reason I am anxious about seeing doctors after my experience last November, but it's part of it.  I just can't rely on my pain signals to tell me whether or not something is wrong.  And it's really hard to get health care professionals to understand that.

I came across an interesting article today about the perception of pain and other feelings in people on the autism spectrum.  I don't think I am autistic, but I think I have sort of a similar thing going on and I found the article interesting.

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