How Tough is Tough?
When I had my frozen shoulder, and then shortly after that when I went through cancer treatment, medical professionals seemed to always be asking me about my level of pain. They'd say, "On a scale of one to ten, how would you rate your pain?"
This question always made me crazy because it sent me into a tailspin. I'd never say ten because, well, it could always get worse, right? I mean, someone could shoot me in the gut at close range and I could be bleeding to death slowly while trying to tuck my insides in, and that would probably hurt worse, right?
Just as the meaning of "ten" eluded me, I never got the "one" right, either. Kathy was with me when a nurse asked me to rate my pain during an allergic reaction and I weakly murmured, "I don't know...six?" Kathy heard to the reedy sound in my voice, looked at the way my hands were clenched on the arms of the chair and my eyebrows knit together while the sweat broke out on my brow, and she rolled her eyes. Once the nurse was gone, she talked to me about my rating and pointed out that "one" didn't mean "I'm hurting but I think I can cover it up okay." One meant I'm okie-dokie. And thinking I might scream the next moment? That was pretty high up there. Maybe even higher than six.
Subsequently, when I was asked to rate my pain, I'd stop to think about it. I would try to imagine what "one" meant while reminding myself that "ten" didn't necessarily mean almost dead. It made my head hurt. It would be easier if I followed the advice of my friend, the Lovely and Gracious Mrs. Dodge, because then I'd just say nine out of habit. (Why? Because then they give you the good stuff, or so she says. You don't say ten because the people with the keys to the pain killer cabinet will see right through that.) But I wanted to be accurate, so I'd try to figure it out each time as the nurse tapped her foot impatiently in front of me.
Honestly, what I really wanted were examples of each level of pain, and then I could work it out. Only, that's exactly what you can't get and precisely where I got it wrong, because it is all subjective. We can only answer this question based on our own experience of pain - how bad is it?
And yet, this desire for objective evaluation continues to haunt me.
Recently, I've been in a lot of pain due to some sort of critical mass of maladies. My bum arm is acting up, flaring pain throughout the day. (I now call it a "bum arm" because each visit to the orthopedic surgeon generates a new and separate diagnosis, which I think adds up to bum arm syndrome. Only, there is no diagnosis code for that, so they keep writing down other crap.)
At the same time as having my arm act up, I appear to have pulled a chest muscle, possibly when I was carrying a table against my chest whose top unexpectedly swiveled. My body swiveled the other way to catch it, and it's my guess (though I am not sure) that this caused the intense pain on what I think is my pectoralis minor.
As it turns out, the bum arm and the strained muscle are on opposite sides of my body, ensuring that there is no "good position" for sleep. And in between the two, I have a chronic cough. This means that each time I cough, I have to swing my bum arm across my body to compress the side of my chest, or else I make a very silly "hack-hack-OW" sound over and over.
(It's tiresome even to write about, making me feel like a grandma who constantly rattles off a list of her ailments. Blah, blah, blah, and you don't know how much it hurts.)
While in the grips of pain, I found myself wondering...what if it doesn't really hurt that bad? What if I just think it does because, well, I am a sissy? What if I don't have any sort of high pain tolerance at all? What if my tolerance is startlingly low and that's why I hurt so much?
Maybe I just need a stick of wood to bite down, on combined with a bit of backbone, and then I'll get through the day just fine?
What if? Maybe?
After a couple of days of ruminating on the idea that my suffering might actually be a flaw of character, I suddenly thought: so what?
What is this desire we have to tolerate and be strong? Why do we feel like a failure when our pain cannot be ignored? I mean, this goes beyond the fact that we hurt...it goes into what we think our hurting says about us.
Maybe all our hurting means is that we are injured or sick. Why is that something we should deny?
[Insert long pause. A three hour-long pause, to be exact.]
Okay, so, after writing up to this point, I stopped and thought, this is stupid. I probably really am just a sissy and now what am I doing? Trying to rationalize my sissiness on my blog and turn it into some statement about how we view illness. What am I thinking? But I didn't have time to re-write it or else I'd be late for the doctor, so I flew out the door to head for San Francisco.
On the drive over, I listened to my new Doctor Who soundtrack while fiddling endlessly with the air vent settings because it was so damn warm. What is this? We get one warmer day and I'm an oven? While waiting in the exam room, I tried to fan myself with my 10-lb Photoshop book. It didn't work so well but might have counted as exercise. I hope.
When the doctor strode in, the first thing she asked was, "Are you warm in here?" I wondered how she knew because I put the book down when she knocked.
"I ask because you have a fever."
"Oh," I said, "I just assumed that was a really long hot flash or something."
She shook her head and had me take off my T-shirt for the exam. She asked to see my radiation tattoos (they are like registration marks for the technicians) and I pointed to the discreet marks. "I think that maybe on the tenth anniversary, patients should get a tattoo that connects the dots." I nodded vigorously, saying, "I want to do a string of pearls across my breasts. Ooooh, and it could be a coffee table book, all of post-radiation tattoos." Ever helpful, she listed off the types of cancers that use these tattoo dots for radiation. You know, just in case I wanted to get started.
She continued the exam. Lungs: fine, cause of coughing not obvious. Bum arm: needs an MRI with an orthopedic surgeon, as I figured. Strained muscle: I probably strained the intercostal muscles (if not the one I thought) and this might heal slowly because of radiation.
"Normally, you rest a strained muscle," she explained. "But in this case, you can't exactly stop breathing. There's just not much you can do. I'd prescribe a cough medicine for you, just to give the muscles a break, but you wouldn't take it, anyway."
I started to protest and she held up her hand. "I've been your doctor for over seven years. I know you. You won't take it."
Well, yeah, she's right. I mean, the cough isn't going to kill me and I know it.
She suggested I try Claritin in case it is an allergy. I explained that I'd tried it, but then came clean and said yeah, I just tried it for one day. She said, let's try two weeks. Then she suggested I take 600 mg of ibuprofen every 6 hours to help with the muscle, and maybe even the bum arm, too.
I straightened up, feeling smart for a moment. "Actually, I started doing that. Only, on Saturday night/Sunday morning, I got horrible stomach cramps and diarrhea, which I thought might have been caused by all the Advil, so I stopped taking it. But, come to think of it..." I trailed off.
She looked at me expectantly.
"Um, did I mention I've had diarrhea for six days? No? Well, normally I wouldn't because compared to chemotherapy, it's nothing, but...I guess that means it's not the Advil."
One side of her face turned up in a smile. "Nope, not the Advil. Fever, diarrhea...you have the stomach flu, my dear, like almost all my patients from the last two weeks."
As she walked out the door, she let me know that it was great to see me, as always. I can only assume it's for the humor factor. As in, how can a relatively intelligent patient act so stupidly? She's gotta be sassy to have a patient like me.
I laughed as I got into the car to head home. Isn't this the way of it? I spent days mulling over the meaning pain tolerance and the nature of my character, meanwhile meanwhile completely overlooking the fact that I had a fever and the stomach flu.
So, my point? I don't know. Except that we should be gentler to our bodies, physically and mentally - that part, I'm sure of. And, I'm really looking forward to my string-of-pearls tattoo.
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