A Journey Through Chronic Pain

A back injury is a funny thing. The pain is different than any other pain I had ever experienced. Different from the knee pain that dogged me for several years. Different in that it is debilitating. It steals your soul. You would do anything to make it go away. I spent many weeks going through all of the tests and x-rays only for them to tell me that it was “lumbar radiculopathy”. What the hell is that anyhow?? Not a herniated disk. Ligament tearing, soft tissue injury. In those days, the test that was diagnostic was an Arthrogram. Essentially what happened was a fairly large bore needle was inserted into the spine and dye was injected so that the disk spaces could be visualized (today accomplished noninvasively via CT or MRI) Again a trail of narcotic use accompanied the 3 months or so of treatment, which included PT, OT, spinal manipulation by some of the best D.O’s in the world, and accupuncture. As I gradually improved I was once again faced with the prospect of weaning myself from the rash of narcotics which had been prescribed. This time the task was relatively easy. A week of minor withdrawal at home, tempered by a bit of alcohol to ease the worst of the symptoms. One thing I wish to note. Through all of my bouts of addiction, in spite of the reason for taking the meds (chronic, acute pain etc) I never did become cross-addicted to alcohol.

I had grown up in an alcoholic household. My parents were not sloppy drunks, mean drunks but DRANK, daily, and a quantity that is in excess by anyone’s standards. I remember when I was younger, before the arrival of my younger siblings which started about the time I turned 11. I was an only child which was kind of cool in a way as I shared the spotlight with no one. Not that I was that kind of kid, but my father traveled for several years when I was in elementary school so my mother and I were left to fend for ourselves. She did not drive so we were relegated to go only places our two legs could take us. I had a bicycle which provided a venue for longer trips and a neighbor would take her to buy groceries about once a week. Otherwise we were confined to the street where we lived in middle-America.
During these years and the ones previous, my parents partied………..a lot. They had a wonderful circle of friends who were mostly either Irish Catholic or German Catholic with a couple of eastern Europeans throw in for good measure. The town we lived in had a very high population of German Catholics, all of whom like to tip a few on a regular basis. If they were not going out to the KC Hall or American Legion, they were at someone’s house or ours knocking back a few, usually more than a few.

I wish to make it very clear that I was never neglected or abused because of their alcohol consumption. I was always taken with, stayed with friends, or had a babysitter, one of whom I had a terrible crush on! Adolescents, go figure!!

As an ACOAP (Adult Child of Alcoholic Parents) it was not until later in life that the reality and implications of the effect that drinking had on my life were fully realized. It was not until I finally confronted my own addiction that did I confront theirs. Anyone who is an ACOAP knows that alcoholic parents (and children) deal with life on a different level than the rest of the world. I had a wonderful counselor a few years back who related the story of a young man who’s father was a raging alcoholic. He said the young man would come home from school or a friends and before he entered the house, would peer through the windows to see what kind of a day it was. If his father was on a terror, he would slip away until things calmed down or he passed out. Only then would he come home. I never had to do that, or at least never felt like I had to. My parents were for the most part, happy drunks. Sitting around our kitchen table, alone or with friends or relatives and drinking. Everyone in my existence drank. Aunts, uncles, parent’s friends, everyone!

The biggest thing in my life that alcohol affected was the way that my family dealt with life, dealt with the issues! Alcohol muted everything. It made them happy but in many ways isolated me all the more from them.

I had some issues as a child/young adolescent and I truly believe that it was in part the alcohol that kept them from ever dealing with them. Mental health was if anything less than an afterthought in those days and I don’t blame them for being incapable of dealing with my issues. I do wish that they had forced the issue to the point of getting me help. It might have gone a long way to saving me from what became a lifetime of feeling inadequate, of feeling never good enough, of lacking in self-esteem. I think my siblings, particularly my sister shares this horrible void of self-esteem. It takes time and must effort to bring yourself out of this mire!

I remember one night after I had been ill. I don’t remember the exact details but I do remember having an emotional meltdown. I was about junior high school age or a bit older. It was very late at night and I found that I could not stop crying and shaking, not really knowing what was wrong, but something was very wrong. My mom came to me and tried to calm me. Nothing worked. My dad was working the PM shift but should have been home. Mom went to the bedroom next door and called the local bar where my dad often went after work to unwind. I could here her yelling at him, telling him that I was falling apart and that he should be ashamed of himself for sitting in a bar while all of this was happening. She eventually called our family physician and laid things out for him. He suggested her giving me a sleeping pill or two, waiting about an hour and seeing if that helped. It did. We never again talked about that night or why I was so upset. I still don’t know. But it should have been a red flag for things to come.

So here I am about three years down the road from the initial insult to my knee and things are not going well. I am in constant pain, have been working with the aid of crutches, one or two, and am being told that my knee is shot. That there is bone-on-bone and that I am too young, too active and too big to consider a total knee! This news is not in any way what I had expected. I was of a mind that I would, when necessary, be the recipient of a shiny, new knee joint. WRONG!!! The technology at the time, 1979, was such that my surgeon predicted that if a replacement were done, it would last fewer than 5 years. And at the age of 23 the prospect of having a knee fusion was becoming more and more of a reality.

I visited my surgeon one last time before the scheduled day. He assured me that once healed, I would have a stable, pain-free joint, albeit one that didn’t bend. The first surgical date was sometime in March of 1979. I remember that day like it were yesterday. I went to the hospital very early for the prep and was taken to a patient room to await my time slot. About 30 minutes before it was time to go to the OR a nurse came in and gave me an injection. It was a drug called Innovar, a combination of Fentanyl and Droperidol and a separate shot of atropine to dry secretions. Within about 10 mins of this injection I began feeling really weird. A deep sense of paranoia and dread came over me and I felt as though the wall of the room were closing in on me. Jeanell was with me, and she went to get the nurse. I told her that I could not have surgery today. That if I did something awful would happen. She assured me that everything was fine and proceeded to call the ortho resident. He came in and I related the same concerns to him. He in turn called anesthesia and the doc came over. By this time I was about to crawl out of my skin. I told them I was going home and that the surgery was off. The attending finally came in and said ok. They later came to the conclusion that the drug they had given as a pre-op med was to blame. Some years late I had a similar experience although not quite as intense.

So, in mid-April the surgery was rescheduled. This time, the pre-op cocktail was modified and things sailed right along. After 4-5 hours in the OR I found myself awake in the recovery room, in so much pain I could not stand it. No PCA back then, only the requisite IM injections (Dilaudid I believe to start) and it was tolerable. The surgery was performed with external fixation which required me to lie in bed, flat on my back in something called a Thompson Splint. Essentially a metal frame that supported my leg, which had two steel pins extending through the surface of the skin, one above and one below the knee, for about 3 inches on each side. The plan was simple. Approximately 6 weeks in the hospital and I would be fitted with a full-leg cast and discharged.

The logistics of spending that much time in bed are daunting. Without the ability to turn, I was relegated to doing everything on my back, eating, bathroom duties, sleeping etc. It became a miserable existence. My coworkers made the time as tolerable as possible by passing the time when their schedules permitted visiting, playing cards, watching t.v. I went through about 5 roommates in the time I was there, two of them hospital employees with whom I was friends. My days and nights became a haze of narcotics. Enough to dull the pain, never enough to totally alleviate it. One day several weeks in, the attending decided it was time to “wean” me from the narcs. No problem. Only thing was I began suffering withdrawal symptoms. The nights were the worst. I couldn’t sleep, suffered the typical body aches, muscle twitching, itching, and assorted other wonderful manifestations of my bodies’ craving for narcotics. Several days later I was liberated from this nightmare.

Side note: On the long days when I was still taking narcotics, every afternoon I would get my “dose” and nap, but did so thanks to some killer music. Sleeping in a hospital has it’s own set of problems. Overhead paging, constant in and out of staff, etc. I had setup an 8 Track tape player in my room pre-op along with a set of good headphones. One of the guys I worked with, Matt, brought me a whole box of tapes to use while I was incarcerated. My favorite was the Eagles’ “Hotel California”. I must have listened to that nearly every day I was there. I still like it!

Being a patient in the hospital where you work is an interesting phenomenon. There was a steady stream of characters who graced my doorway. One that I will never forget was a guy named Lee Warrington. He was a NJ native who found himself transplanted to the mid-west. He was argumentative, funny, fiercely loyal, an all round great guy. He would come into my room and play Rummy when he had time. But his crowning glory was, before leaving every day, on cue, he would walk toward the head of the bed and fart! A big,huge, wet fart!! He would then scurry out of the room and I could hear him laughing all the way down the hall!

Another was Shahab. He was this huge, lovable Iranian. Huge, thick , flowing coal-black beard, long wavy black hair. Very imposing looking, but with the heart of a lamb. He may just be the best cook I have ever known. His amazing dishes, new and wonderful to my mid-western palate, nearly brought tears to my eyes. We became fast friends following him rescuing me several years earlier. True story.

I was a sophomore in college rooming with a hometown friend, Dan. He and I had been out running around one evening, talking mostly, and headed back to our dorm. As we were walking toward our building, his girlfriend at the time drove up behind us. Sheila was a force of nature. In fact I had met her my freshman year and we had become good friends. Never dated mind you, but were always up for a late night pizza and some good conversation or whatever when the rest of the campus was deserted. Anyhow, I had introduced them. She drove a blue Karman Ghia (http://en.wikipedia.org/wiki/Image:VW_Karmann_Ghia_Typ_14_-_BJ_1967_Cabriolet_-_von_links_vorne.jpg) (for the youth reading this it was something like a Porche Speedster) made by VW. He hopped in with her and she offered me a ride the two blocks to my dorm. So I hopped on the left front fender which was not all that far from the ground. She accelerated up the slight hill toward Missouri Hall and as she I approached my door she slowed a bit and I hopped off. Problem is I couldn’t get my footing. I suppose she was moving faster than I thought, but at any rate, I stumbled and feel against a storm sewer inlet on the curb……………with the left side of my chest.!!
I thought I had just had the wind knocked out of me. No biggie. Well, I couldn’t get up from the street. I kind of half-sat, half-laid, trying my best to breathe. Dan and Sheila jumped out to check on me. About this time, the back door to MO Hall opened and this imposing looking bearded man walked out, smoking a cigarette. He looked at me and said “Are you alright, man?” I told him I wasn’t sure. He asked what happened and we briefly told him. Well he said he worked at the hospital and that he thought we should call an ambulance. So he did. As it turned out, I had fractured multiple ribs and had a hemo/pneumothorax. So anyone out there who has ever watched ER knows what comes next. The dreaded chest tube. Of all the pain in my life I think this was the most acutely intense. A third year Orthopaedic resident inserted a foley catheter in my left chest with a pair of hemostats! No nice pointed trocar, no “real” chest tube but a freakin’ foley. True story. I am lying there writhing in pain, struggling to breathe and the resident tells one of the med student to get a particular size of foley. So he does, he approaches me with a tube of KY and begins relating to me what he is about to do. I looked at him and said something to the effect that if he came near me with that thing I would break his arm!! The resident intervened and things progressed as planned!

So after this long saga, the point of it all was that Shahab had been my rescuer. And it wasn’t until a few years later when I started working at the hospital that I was able to properly thank him.

Six and one half weeks after my surgery I was ready to go home. I had come in mid-April and it was now early June. A whole different season. I went home with a full-leg cast and crutches. I spent most of the summer hobbling around, mostly sweating my brains out! Finally I was weight bearing again and the cast was off! I now had to accommodate to living with a knee that was fused in about 11 degrees of flexion. Walking, sitting, sleeping, screwing, all became more complicated. Driving a car was more interesting since I could not use my right leg. I remember the first time my mother-in-law rode with me after the surgery. She is a very nervous driver and more nervous passenger, secondary to an accident she had been involved in many years before. Normally she didn’t ride with much of anyone but my father-in-law and then under some duress. So she gets in the car with me, something she had done only a few times before and takes one look at my leg slung into the passenger foot-well. I thought she was going to freak out. She asked several pointed questions about my ability to drive like that before allowing me to proceed. I don’t think she ever really got used to the idea!! And not everyone I have chauffeured has been totally comfortable with it. I guess having had my knee like this since 1979 and never having an accident is something of a testament to not being much impaired. (I have been rear-ended twice, but through no fault of my own)

Life got back to normal. I was back to work, back to school, doing all of the normal things that I had done before. To say that this operation altered my body image would be a gross understatement. But I was young and healthy and got on with life. One of the things I hadn’t realized is how much having a fused knee would alter my body mechanics. Even though I was strong and healthy the alteration in my stride began to take it’s toll on the rest of my joints. One day while I was working (about a year later) an ambulance came in with a patient who had required Oxygen. I got a call to change out the cylinder in the transport vehicle. The ambulance bays were right next to our department so it was not a big deal until the crew got another call as I was wheeling the tank out to the truck. Normally, two people install the new tank. It is an “H” cylinder which is about 5 feet tall, and very heavy! The cylinder must be dead-lifted into a compartment about 4 feet off the ground and barely the width of the cylinder. Well I hustled the tank down to the waiting ambulance and rolled it off of the cart. I then bent over and hoisted the tank into the compartment. Now lifting was something I hadn’t considered with a knee fusion. Normally I would lift with my legs when moving something heavy. Now that was nearly impossible as my legs could not work in concert with one another. As I reached the top of the lift I felt something “pop” in my back. I largely ignored it. I went about the rest of my night and went home.

Two days later I could barely get out of bed. My legs were tingly and my back was wracked with pain.

So opens the next chapter.