Sunday, August 20, 2006

One A.M.

It's 1 A.M.. Trying to sleep, to no avail. I think I dozed off for a while but the pain in my back and upper legs just won't let me rest. While I have pain throughout the day, there are times when it is more forcefully registered, and unfortunately that time tends to be late at night when I am trying to rejuvenate. To sleep, perchance to dream.....

The pain in my lower back is constantly present. It is not searing, nor is it knifing. It is more of a dull ache which increases in intensity with certain positions or movements. I am able to bicycle without any noticeable increase in pain. The position needed to drive a car also does not seem to exacerbate it. In fact, driving tends to be one of my more low-pain times, except if I'm stuck driving Mary's standard transmission Honda. Fortunately, it doesn't inhibit my sexual function or enjoyment, although twinges of discomfort can happen at any time.

My chiropractor notes that the deep muscles along my lower right spine are over-developed and in a constant state of hypertonicity. Before he can adjust my spinal column, he must perform deep muscular massage to manage any movement at all within the facets of the spinal joints. His colleague, who specializes in lower extremities, adjusts my feet and knees and ankles and has prescribed orthotic inserts for my shoes, which do indeed decrease my leg pain, especially in the knees. However, there is a deep ache in the thighs---both anterior and posterior---which nothing seems to relieve. This tightness and aching manifests at its worst at night, just when sleep would be most welcome. It is not superficial. Rather, the ache seems to wrap itself around my femur, some tender points along the exterior tissue almost too excruciating to touch.

Many of my patients suffer from chronic pain, taking oxycodone, Percocet, long-acting morphines like Oxycontin and Oramorph SR, or methadone---which was traditionally used for pain management, not addiction. I am loathe to take anything other than non-steroidal anti-inflammatories (NSAIDS) such as ibuprofen or acetaminophen. Lately, however, I am resorting to a few Vicodin tablets---only at bedtime, and grudgingly accepted from my primary doctor---in the hopes of enough muscular relaxation to promote sleep. It's not fun, and I do not envy my patients their reliance on pain-killers, the side effects of such, as well as the long haul of physiological---and in some cases, psychological---dependence. Although a large part of my job is responding to my patients' needs for narcotic refills---not a favored task by any definition---I more fully appreciate my patients' desire to not run out of the pills which afford them some modicum of relief and succor.

Some thoughts run through my mind as I write: Do I ask for a trial prescription of muscle relaxants to help me make it through the night? Will they give me just too much of a hangover to be worth the relief? Do I continue to try very low-dose narcotic analgesics like Vicodin to take the edge off in a very miniscule way? Do I hire an acupuncturist to come to my house every night at bedtime and strategically place needles which will promote sleep, relax muscles and reduce pain? Do I continue to wander the house late at night, sleeping in various beds in order to toss and turn without waking Mary and also disturbing her well-deserved rest? Will yesterday's injection have any positive effect?

Writing about my own experience of pain and suffering---and yes, I would certainly categorize this as suffering---brings me to a new place in my blogging practice. Most of my writing has centered around my interactions with patients in the course of my work, their treatments, their failings, their victories, my experience of them and myself in the face of illness, medicine, and nursing. Writing of my own personal struggles is more intimate, more invasive, more challenging, and brings up emotions of vulnerability, fear of judgement, and deeper fears of becoming like them: complaining about pain, looking for answers, talking incessantly about my health, focusing on what's wrong, not what's right. I don't want to be a patient. That may be my bottom line. I like to be the giver, not the receiver, the one providing an opportunity for healing, not in need of such.

In my post of yesterday, I used a quote from a Buddhist website which I visit often, from where I receive a daily email meditation. The post concerns the future and the futility of worrying about it. If one were to be preoccupied with the future, the quote maintains, why not focus on the uncertainty of the hour of one's death? Thus, is fear of being a patient, of chronic illness, actually a fear of death? Is it mortality with which I am faced?

Fear of death has never been a piece of the puzzle for me. I have no fear of death or dying. While I would prefer a painless death, I am generally relatively stoic in the face of pain, and work with my mind when it rears its ugly head. Now, faced with pain that is more recalcitrant, my mind is struggling with how to wrap itself around this one, how to assuage this bump in the road towards actualization and enlightenment. I do not welcome death, but I also do not deny its inevitability. If some suffering along the way is my lot, then let's glean what we can from it before the final reckoning, whether there are four more decades, or five or six, or even only months. Death is not an ending to me, but a true beginning. The tired shell is laid to rest, but the essence enters a new phase, a new realm, freed of the body's vicissitudes and weaknesses. True freedom, but a freedom for which I do not long.

In my fourth decade of life, (fifth if you count birth to age 9), my body has betrayed me on some levels and is showing signs of wear: gastroesophageal reflux disease with a sliding hiatal hernia; chronic back pain with a newly discovered spinal cyst; prostatic hypertrophy; chronic depression; hyperlipidemia; arthritis with some degenerative joints; bulging discs with a few possible small herniations. Yes, it’s “just a body”, but it’s all I have right now, and would sincerely like another forty or so years of residence, thank you.

How will this capsule, this vessel of my soul, maintain itself in the face of these challenges? How will my mind and heart respond? How will I manage these challenges and maintain my equilibrium, my ability to give back to the world, to experience life to the fullest, to "repay the debt of my existence"?

These are some of the thoughts which drift across my fatigued mind at one a.m.. The answers? They will manifest themselves as needed. The questions? They will only multiply, providing an ongoing conversation for years to come.

Now to sleep, perchance to dream.........
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