They Numb Horses, Don't They?

My fourth visit to the Swedish Hospital Pain Center.  I'm sorry to say that the ever increasing doses of nortriptyllineplus the salve, compounded in Poulsbo for $148.00 a tube, have not yet done a thing except to empty my pocket book.  Nor did the rehab, the acupuncture, the botox, the surgical removal of the fifteen inch wire, the medical hypnosis, the series of spinal injectivions, the chiropractive procedures or the "forgiveness" entries, in case my pain was a case of repressed rage directed towards the urologist who surgically implanted the box and the wires or at myself, who allowed the entire botched-up to take place.  At any rate, I spent an entire month, writing letters of forgiveness to just about everyone I knew, to now avail.  Anyway, here I am, on the ferry from Bainbridge to Seattle, sitting on an absolutly flaming bottom, since yesterday I ended up sitting in my car for four and a half hours coming from Alan's place to mine due to an accident on the Agate Pass Bridge.

During my working hours, which are ever growing, I have taken to sitting on various stuffed animals which lie beneath a thin blanket beneath my bum. Throughout the many hours of each working day I only pray I am subtle as I arrange and rearrange the arms and legs of the arnimals in order to provide a continual sense of relief for myself.  My longterm patients know exactly what I am up to and so they go on, engaged inside their week, their histories, their relationships, never batting an eye.  Sometimes I explain, but mostly, I don't. I do worry, sometimes, that my newer patients must think I am playing with myself under my thin blanket but I am too tired, too bored with any explanations swirling around the subject of chronic pain, "You see, in 2005, blah blah blah blah blah blah blah............."

Blah. Blah.

So now I am one of the director of the Swedish Pain Center's patients because....well, it's some kind of  cliche' or law.....I just keep being bumped up because nobody else knows quite what to do with me.   Sitting in the waiting room I often feel "less than" or some kind of fraud as I look around and see patients in wheelchairs and the like.  The  lady I spoke with last time, for instance, the woman with only one usable hand who managed to rustle about inside her blankets until she brought forth a pack of cigarettes and then managed to roll up and out a lighter, wheel herself to the outside patio and light up.  If I were her, I told myself,  I'd do that. I'd smoke, I'd smoke, I'd smoke, so I went out and talked with her for the longest time.

But I am still here on the boat, we must be a bit more than half way across and I notice that we are all on the morose Woody Allen boat.  Somewhere out there is the gala Fellini-esque boat, filled with beautiful ladies with big breasts and big smiles, everybody having a good, no, a great time, and here are we, looking down, watching our inner images crawl across our inner screens, one two, one two, like grim soldiers who must get up too early.....Oh, what have we done to have been give entre' onto THIS sodden boat?  Are we all in some kind of pain?

So what do I hope for?  I hope for this:  I hope that Dr. Gordon Irving, five years younger than me, author of books on pain, will smile at me and wave his hand as if to say "No matter, no matter" when I report to him that I am "no better" - - and then he will pronounce, in a soft but firm voice, in a voice tinged with emotion, yes, just a tinge, "I have found it!  The exact place, the exact site of your pain.  And oh GOD, how you have suffered!  Do you mind if I publish a paper on your case?  I mean, once you are better, which you WILL BE, by the way, and VERY, VERY, SOON?  Perhaps I could write TWO papers!  One, on the anatomical systemology of your chronic pain and another on your absolutly spectacular heroism."  And then perhaps he might kneel down beside me, take both my hands in his and say with tears in his eyes, "Dr. Morgan, I have SO much to learn from you. Indeed, we ALL do.  So much so that we would like you to begin a series of lectures......"

The ferry is nearly ready to dock.  Apparently there is no grandious place my brain is not completely willing to go, and gladly.  Apparently I want both a cure AND applause. Yes,  I am the child, wanting the parent to say, "We can take care of you AND BY THE WAY, how BRAVE you have been!"

It is later.  My blood pressure is 116 over 67.  My weight is one pound above what it was three weeks ago.  There is a knock on the door and a big smiling doctor bounds in and introduces himself.  He is a Foot and Ankle Pain man.  He asks if he might talk with me for awhile.  I say yes indeed, although my feet and ankles feel very well.  He says he is glad to hear that.  He sits down and reads my chart, asking me this and that.  Then, right on the dot, Dr. Irving comes in, says Hello to Dr. Foot and Ankle, and asks me how the cream worked, plus the nortriptyline.  I say the cream needed more "numbing" ingredients and the nortriptyline seemed to have no effects at all.  "Oh, that's a shame," he said, "Well, I would still like you to continue going up on it, increase it to 50 mg for a week, and, if no side effects and no benefits, go on up to 75 mgs for a week, and if no benefits, begin to decrease and ultimately we will get you off it.  It's damned expensive, I know. "

He wants to talk to me now about the medicine Lyrica and at the mention of Lyrica I start to cry because I have been on Lyrica and went manic and then suffered some suicide ideation and I told him this and both he and Dr. Foot and Ankle smypathized and shook their heads and said No, no, of course, and Dr. Irving said, Well, there's only about a thirty per cent chance of it working, anyway.

"Can't you put more numbing stuff in the salve?" I ask.  "I grew up on a farm and sometimes we had to numb up the cows. Can't you treat me like a cow?"  He looked at me for several seconds and then said, quite thoughtfully, "Hmm I can't treat you like a COW, but there IS a cream that is given to horses and sometimes to people, called DMSO.  You get it from livery stable shops or on line.  I think that might be a Very Good Idea.  Yes.  I'm going to prescribe some of that and I want to see you back here in two weeks."  Dr. Foot and Ankle has gone from looking quite distressed to looking happy once again, now that he knows there is a chance that I might be able to take the horse ointment and that the horse ointment might help.

I say to Dr. Irving, "I'm sorry.  I think I must be one of your worst patients."
"Why ever would you say that?" he asked. He is from South African and everything he says comes out sounding British.
"Because nobody can figure out what to do with me?"
"But that is the very nature and challenge of chronic pain," he said. "That's precisely why I love it.  It is a horrible, horrible thing. If we could just cut it out, we would. But we can't. It is extremely difficult to treat. And, in fact, you are a most excellent patient. You have a sense of humor, which is wonderful. And you can sing! I've heard you! The thing is, you simply can't give up. I won't give up, and neither can you. I've written up a prescription for the compound with a more numbing ratio and I want you to find some DMSO. You can use the two together. Let's give it a go, hmmmm?  See you in two weeks."

    Well, that's it.  Life never goes the way one wants it to, or at least it rarely does.  But, as Teilhard de Chardin said, "It doesn't matter if the water is cold or warm, you're going to have to wade through it anyway."