pain

guessing

No Bergman today. Tonight, instead of watching the unraveling of someone’s psyche onscreen, I’m going to get schwacked at a friend’s going-away party. Tomorrow you’ll be treated to my thoughts on either The Silence or Hour of the Wolf.

It occurred to me today, as a 250-pound man braced his weight against my shins and pushed my knees back over my head, that my physical therapist has no clue what’s wrong with me.

Really, not a clue. Every couple of weeks I go in, throw down my $45 and get electrodes attached to my back. Then he comes in and hauls me around on the table like a sack of flour. It hurts. It brings relief. It takes a day or two for my muscles to cramp up again and leave me bent over like an osteoarthritic old man.

I am given exercises to do and cautioned not to do them to excess. What’s excess? In this case, anything that aggravates my back. But movement of nearly any kind aggravates my back, so I push the exercises as far as I can, until a noticeable twinge stands out from the ambient background of pain. I’ve raised my baseline for tolerable pain considerably over the last six months.

For months now, I’ve been aware that no one knows precisely what the problem is with my back (there’s a very long waitlist for neurosurgeons here). I’ve managed to put that knowledge in the back of my brain and continue to wait for a date with the MRI. But today, the awareness suddenly hit me that these various specialists, these people whose job it is to align, realign, stretch, flex and mend my body have no idea, beyond a bit of guesswork, what has happened to my spine.

I could tell from the look on my therapist’s face. He was clearly thinking about something else the entire time – another patient, a utility bill, who knows – because he’d given up thinking about me. All he could really do was relieve my pain a bit with the electrodes and restore mobility and strength to my muscles. But he knew that no amount of this was going to straighten me up. Not even if I did the exercises like clockwork for the next ten years. I was thanking him for his help and he was already out the door, on to someone with a problem he could solve.

On the upside, it looks like I’ll be getting my neurosurgeon appointment before the end of the month. Which means I’m only a few weeks away from an MRI, a diagnosis and a decision. My acupuncturist actually told me the other day that he was ‘excited’ to have me as a patient, because my case was so exceptional and extreme. I carry a firm belief that the surgeon will tell me that I don’t need surgery, and that a steroid shot and a brisk walk each morning will take care of it. It’s fun to cling to because I suspect it’s utter bull, and that at some point I’m going to be lying face down on a table with my spine exposed. I only hope that the surgeon has something better than guesswork to go on.

lunch

A while ago I was talking with a friend about my experience with chronic back pain and I ended up delivering this pithy epigram:

Pain, I said, gives you answers to questions that you didn’t know to ask.

That’s pretty heavy, she said.

Yes, I agreed. I had no idea what I meant.

Xeno, the philosopher who came up with the neat trick of using infinite division to prove that an arrow in flight will never reach its target, must have suffered from chronic pain. Most of the time we live fluidly with our body, letting it get through the basic business of the day. We don’t need to perform any conscious calculations or make minute plans every time we want to get up from a chair and go fix a snack or grab a pen from across the room. Our bodies are full of automatic features, from the basics (respiration, sleep) way on up to the awesome add-ons that we take for granted.

Last Christmas I left the group behind and joined the small club of people who inhabit stripped-down bodies, the ones where most of the add-ons have been vandalized or stolen. I left my body in a bad neighbourhood, I guess. Some people have lost so much that they’ve Vadered up with wheelchairs, prostheses, oxygen tanks and tubes and leg braces. I’ve taken the cyborg-lite route with an extendable black metal cane.

My cane is the signal of my membership in the club of stripped-down bodies. People in crowds seem to sense the cane before they see it, stepping aside and offering a polite excuse me even from a distance of several feet. Everyone fixates on the rubber stopper at the end of the cane as they scoot aside. I wonder if they’re reacting to a primordial fear of something biting at their feet.

The stripped-down body changes your relationship to time. Time in its tiniest increments fills my mind, dogs me when I move and paces around me when I’m still. I spend as much time as possible completely still these days, partly to mitigate some of the pain I experience, but also to be relieved of an obsessive reckoning of moments.

Let me illustrate by way of lunch. I can only walk for so long before the pain in my legs forces me to stop and rest. That’s about half a city block. So my choices are limited to the coffee shop in the lobby of my building. Let’s say I want something better than a newspaper to read, a book or magazine. If I choose to take a book, then I can’t carry anything else. If I take a magazine, I can roll it up and tuck it awkwardly between the cane handle and the palm of my hand. Taking nothing leaves one hand free, but then I’m usually left with the business section from some paper. Taking a backpack or tote is usually too awkward, and the imbalance of weight makes it difficult to stand upright.

By the time I get to the café counter, having used the shortest possible route, I need to sit down again and let my muscles relax. The relaxation is actually a set of spasms throughout my limbs as the muscles try to hold on to the tension. It feels like water boiling under my skin. I usually sit at the edge of the pool with the koi and the man-eating turtles until I can pull myself up again with my cane.

At the counter I order, say, a coffee and a sandwich. The cashier places coffee and sandwich on the counter in front of me. In order to pay, I have to put down the magazine and put my hand in my pocket, but the slight shift in position sets off the nerves in my left leg and I can’t support my weight. I have to prop the cane against a vertical surface and grip the edge of the counter, leaning my hip in to ease some of my weight off my feet. At this point the spasms in my leg have risen to my arms, and they’re starting to shake. My fingers lose their fine coordination and I’m reduced to pulling bills and coins out of my pocket and slapping them on the counter while the cashier, who is used to this display, waits for me to lay down enough money. Finally I’m done and she hands me the change. I stuff the change into my pocket with a jerk, and when I’m lucky it all goes in my pocket. Usually something escapes and hits the floor, which gives me the comparative relief of squatting down to pick it up. Sometimes the cane hits the floor too, which causes anyone nearby to hop backwards. The story about Moses’ staff turning into a serpent must be the expression of a deep-rooted equivalence buried in our hindbrains.

Once the money is taken care of, I’m faced with the dilemma of having ordered one more item than I can carry. The distance between the counter and the table is relatively short, but the act of paying for the food has set off too many spasms, and the best I can hope for is a forward rush to the nearest seat, using the cane as an intermittent brake more than support. The woman at the counter takes the coffee and I take the sandwich. I have to wrap the magazine around the cane handle to get everything to the table in one trip. If it’s a book then I need to take the extra trip or ask for help, which I do frequently.

Once at the table I need to let the tensed muscles in my legs, back and stomach relax once more. After a few minutes I’m okay to unwrap the sandwich without dropping it or sip my coffee without showering drops on my wrist. Even as I read the magazine and eat my sandwich, I’m thinking of the maximum length of time I can spend in my seat before getting up becomes too painful.

Aside from the particular details of pain, this is still pretty much the same decision tree that everyone climbs when it hits lunchtime. In my case, I need to think carefully about every decision I make, because each action produces a degree of greater or lesser pain, greater or lesser convenience. Time is measured out along nerve impulses. The upside of all this is an increased concentration, a more intense attention to the tiny details of my day. It sets me slightly apart from everyone, leaves me free to think about whatever I please. Pain is probably the most backhanded gift I've ever received. Like the time my friends bought me six Guinness, drank five before I showed up, and packed the remaining Guinness in a nest of shredded pornography with a little figurine that broke the bottle, so what I got for my birthday was a box of broken glass and soggy porn and a figurine that somehow had a smug look on its face.

sarah michelle gellar and the unbounded agony

I've spent the last several days getting in touch with my feelings. By which I mean constant physical pain. My back, which has been dodgy for years and has now decided to get really dodgy around the L4 and L5 vertebrae, has been giving me weeks of ever-increasing pain. It's like a dial being slowly and steadily turned up until I'm whimpering and cursing at 4 am, trying to wrestle my consciousness into sleep from the grip of the pain.

I'm not complaining here. And I'm not looking for advice. Everyone has advice. Everyone's advice is well-meant, based on hard-earned experience, and ultimately not much practical use to me. Go to a chiropractor. Don't go near chiropractors. Get acupuncture. Needles are a joke. Massage is wonderful. Massage is useless. Go to Dr. X, he's the most experienced back specialist in the city. Avoid Dr. X, he's a noneganarian butcher who's so palsied he looks like he's doing jazz hands. Dr. Y is the best. Dr. Y is the worst. Try ice. Try heat. And so on.

I have tried this and that. I have gone to three doctors and booked an appointment for a specialist. I have tried ice, tried heat, tried chiropractors, gone for massages. My physiotherapy starts Wednesday. The only thing I haven't tried so far is acupuncture, which is probably the magic solution to my troubles.

And I have tried drugs. I have not shied away from assaulting my nerves with chemicals. Weeks divided into alternating days of Robax Platinum and days of acetaminophen-caffeine-codeine tablets. You have to ration out the codeine pills because pharmacies are stingy with their narcotics. In between, wherever prudent, alcohol in all its body-numbing varieties.

After those ran out and the pain hadn't lessened noticeably, I switched from off- the-shelf and over-the-counter to begging-the-doctor. Flexeril as a muscle relaxant (warning: dizziness, concentration problems) and Arthrotec as an anti-inflammatory (warning: dry mouth from hell, upset stomach, nausea, possible diarrhea), which left me a befuddled, burping mush-mouthed mess for the first day or so. Then, after a week, when I realized that I was stiffer and in more pain, hydromorphone in 3mg doses, a ramped-up version of morphine. Warning: constipation. So along with the little green morphine pills, laxatives. "That's right," Schmutzie said when I told her about the side effect, "Junkies don't shit".

Hydromorphone is my first experience with narcotics of this stripe. I can claim an acquaintance with drugs of all kinds, from the familiar to the downright weird (and I'm not counting the time me and my friends all smoked darjeeling tea, based on a rumor that it was a cheap and legal high) but I've avoided opiates in all their splendor (codeine tablets being the exception). I refuse to believe that any junkie with dignity would stoop to this stuff. After two hours, one pill produces an icy numbness in the affected area, a sparking cold running down pain-inflamed nerves. I can still feel the pain; it's just put on a different suit or something. Two pills produce a weird mental fog and turn my consciousness into a cold slippery thing that feels slightly repulsive to the touch, and even with all that, I can still feel the cold lines of pain streaking from my hips and spine down into the soles of my feet.

The pain is worst at night. All of my muscles from my lower back to my calves, are tense and screaming, and rebel at the thought of relaxation. They spasm, quiver, lock up and pull me upright every time I try to find a comfortable position. I shove pillows between my legs, under my back, prop up my shoulder, hold up my head, whatever will give me a moment's relief. And moments of relief are all I get. A twinge will bloom into a radiant ache, a slight pull on a muscle will suddenly tense up a leg, and a tiny shift in weight will flood my lower half in pins and needles. When sleep comes, it ambushes me.

I've discovered that constant pain is boring. To put it another way, pain and boredom have the same effect on my mind. Time is forced open by pain; moments are pried apart and pain pours itself into the spaces. Under this condition, the pain becomes weirdly bearable, because after a while you have to start thinking about something besides the pain. Even though it won't distract for long, strings of thought start weaving in and around the pain, but in the emptiness and sheer monotony of pain, the existential lightness of pain, my thoughts throw their weave over empty spaces.

For example, Sarah Michelle Gellar.

I saw a picture of Sarah Michelle Gellar the other day at the Tribeca Film Festival. The night before last, as the pain and the morphine were beginning to get together and make things really loopy, I thought about the picture of Gellar, bony and dark-haired and barely recognizable as the star of some pretty crappy movies and one good TV show from the early 2000s. I wondered what she'd been doing between the end of Buffy the Vampire Slayer and the 2007 Tribeca Film Festival - not what films or jobs she'd picked up in the last few years, but what she had been doing. I tried to picture her in a kitchen, waiting for her toast, or walking down a street, or flexing an elbow or standing in a huge empty room full of plastic-covered furniture with her husband - and none of it seemed plausible. I just didn't buy the notion that Sarah Michelle Gellar had done anything between early 2004 and two days ago.

I don't think that Gellar is a bad actor, although her attempts at seriousness and depth on Buffy felt pretty flat to me - she had a habit of registering torment by bulging out her eyes, as if she were coming to grips with an intense need to vomit. She just struck me as one of those people who deactivate the moment they're not being looked at.

Normally this is the kind of thought that pops into my head and vanishes again before I can wonder if it's even worth writing about, but in bed the other night, with pain strongarming its way into my consciousness, the thought filled up the empty spaces in my mind. It seemed to stretch and fill everything, spilling over into all kinds of categories that Sarah Michelle Gellar should never spill into. Gellar, I thought, as a real person, the one we don't see, the one that I refuse to credit with existence, is absurd, and if she's absurd, then so are other people. All the other people and the things that they do, the clothes they wear and the children they pick up from daycare. And I was implicated, caught up in the same absurdity, the same stretched-out emptiness. I was as implausible as Sarah Michelle Gellar and the whole universe. None of it, not even the thinking of it, was worth the effort of belief.

Except the coffee. Suddenly I remembered that I was looking forward to coffee in the morning. A bodum's worth of the strong black stuff. Coffee concentrates time, knits moments together and reinvests the world with substance. This is something that non-coffee drinkers don't realize. Even the hope of a cup of coffee was enough to dispel the existential horror of Sarah Michelle Gellar.

It was a close call.

Physiotherapy starts in two days.