Pain Management Has Come a Long Way, Baby.
When I was a sophomore at Beloit College, back around the time Woodrow Wilson was in office, I jumped out of the third-story window of the girls dorm (the law was coming) and did all the damage you might expect to my right knee, so part of my year’s suspension was devoted to having surgery. Back in those days, partly in reaction to the kinds of abuses chronicled in A Long Day’s Journey Into Night, morphine was regarded as a deadly, dangerously addictive painkiller that had to be doled out in miniscule doses, one small shot every four hours, and the rest of the time you were just expected to tough it out as best you could.
Today, doctors realize that controlling pain is one of the best ways to speed recovery, hence my own private morphine drip in the hospital, hence the other painkillers that were freely administered—and gratefully accepted—and hence the shunt in my back and the goiter-like bag of topical anesthetic I went home with. And hence too a wide range of powerful opiates that were prescribed for me at home and intended to be taken in various combinations. Unfortunately, there is no such thing as a free ride…
I guess every form of refuge has its price
…and all the various opiates had various unpleasant side effects: drowsiness, dopiness, sluggishness (so what’s different, I hear Darleen say) constipation, a sense of experiencing life through a wad of cotton batting. So after about ten days I decided, with all my usual forethought, to go cold turkey. The doctors reacted in horror to that suggestion and prescribed powerful NSAIDs, and I made the switch to those. Again, there is no such thing as a free ride. One of the side effects of those drugs is intestinal bleeding, and I was warned to monitor bodily functions more closely than I had ever really wanted to. For about a week, nothing happened.
And then one day I shuffled into the bathroom. Darleen had bought a raised toilet seat, complete with arms to help me get up and down, an appallingly geriatric item that reminded me of time’s wingèd chariot hurrying near, something I am far too young and… and… vital, damn it, to need yet, something whose very presence in my house offends me. When we discussed it, I told Darleen that if I absolutely, positively had to have it, I wanted her to get me one with a manual transmission and a seat belt, but apparently they don’t make them like that. As I stood gazing at this thing and contemplating all the dreadful implications of it, I started to hemorrhage. Not internally—that would have been far more serious, but not as visually frightening—but from my nose. It was not a nosebleed; it was a cataract, and within seconds there was large puddle on the floor. To put this in perspective, I boxed for five years, and because I was a simply dreadful boxer, possibly the worst in the entire recorded history of amateur pugilism, I stopped an awful lot of fists with my face, but never, even when I sparred with professional fighters who used me as a heavy bag, did I ever have a nosebleed. Even when I broke my nose in college, it didn’t bleed, and now I was afraid I might have to take soundings before I could navigate my way back out of the bathroom.
Poor Darleen. She had to clean up the mess while I lay in my chair—pushed back as close to horizontal as it would go—with a rag on my face, coughing and choking and trying not to drown in my own blood. The rule of thumb for this sort of thing is a half-hour. If the bleeding lasts longer than that, get yourself to the nearest emergency room. Fortunately, as we hit the half-hour mark I could tell the flow was beginning to taper off, and so was my love affair with NSAIDs. I went cold turkey.
It was not easy. It was not fun. It was like trying to bull through the pain of standing and moving. The topical anesthetic delivered by shunt was the only thing I had left and by comparison it felt as if it had stopped working altogether. I kept reminding myself of injured pioneers being hauled for miles on bouncing buckboards without anesthetic of any kind. I reminded myself of soldiers after the Battle of Waterloo who prided themselves on being able to hop down unassisted from the surgical wagon after having a leg amputated without any anesthetic beyond a shot of brandy and a wooden dowel between their teeth. I reminded myself of my friend Bodo Winterhelt, the dog trainer, who marched back to Germany from the Russian front holding his intestines in his hands, and who then had surgery while tied down on a wooden table because there was no more anesthetic to be had in Germany in 1945. I thought of all of them, and told myself I was damned lucky little wimp.
For inexplicable reasons, the pain seemed far worse at night, and I would spend long hours standing in the dark at the kitchen window, looking out at the occasional car in the distance creeping down the hill that links our valley to larger one where the nearest town lies. I would try to distract myself by making up stories to explain the cars at three AM: a teenager, who had sneaked out of his girlfriend’s bedroom in her parent’s house and was now sneaking home; a less innocent version of that scenario…
On the other side of town a boy is waiting
With fiery eyes and dreams no one could steal.
She drives on through the night anticipating
‘Cause he makes her feel the way she used to feel.
…and kindlier, old-fashioned fantasies of James Herriot-style vets heading for bed with the sweet smell of a new-born foal lingering on their hands; husbands and fathers with bleary eyes forcing themselves through the last few miles to see a beloved daughter, to wake up beside a beloved wife; a debonair jewel thief with a bag of rare gems slipping home with his booty. That was one of the least effective fantasies, because I could never come up with a realistic scenario that would explain where the hell he had found jewels worth stealing in this impoverished rural county. Cannes and Monte Carlo are many a long mile from my little ranch.
But I would limp slowly through the dark, or stand at the window, waiting for exhaustion to trump pain. Sometimes it would and I would get an hour or so of fitful and unsatisfying sleep before I was awake again, back in my chair, my brain every bit as useless as it had been on drugs. Other times pain trumped exhaustion and I drifted through the days in a haze.