The random thoughts of an architect-turned- lawyer from the deep south living in Washington, DC...

Thursday, April 30, 2009

When physical pain leads to emotional turmoil

This has all happened so gradually that I didn’t really notice it. I have been living with pain for months and was obviously well aware of what it was doing to me physically. But it was not until recently that I comprehended the extent of what the pain was really doing to me. Or at least to the me I used to be.

When this all started over 8 months ago with a shooting pain down my left leg, I stopped for a moment. I took a deep breath, grasped a chair and waited for it to pass. And it did pass. "Oh,
I'm fine," I recall myself saying. I went about my day not giving it a second thought.

I began getting these shooting pains a little more often - once or twice a day. I started to be more cognizant of how I was sitting and tried to avoid lifting anything heavy. If the pain came while someone was around and they took note of my wincing face, I would simply explain "I think there's something wrong with my back messing with my sciatic nerve. I'll be fine."
I can handle this.

Over time, the pain became more frequent and much more intense. It no longer came just when I stood in a certain position. I was getting sharp pains when I changed positions from standing to sitting, from sitting to standing, from laying to sitting, etc. (you know all those functions you do all day). The pain was shooting down both legs now instead of just one. It was coming every day, multiple times a day. To make matters worse, it was waking me up at night. None of the doctor-prescribed muscle relaxers, anti-inflammatory pills or pain pills was working. This all came at the height of major career stress (my law firm dissolving, losing my job, getting another job, etc.) I figured once the stress subsided, the pain would become manageable as well. The pain wasn’t drastically life-altering, right? I just needed to slow down a bit. I quit going to the gym; I began to recognize situations that increased the pain (long periods of walking or standing) and avoided them; I began spending some of my down time at home resting instead of out on the town.
I can figure this out.

"You have an extraordinarily high tolerance for pain," said my new orthopedic surgeon when he looked at my MRI. 'Large central herniation' was the official diagnosis. (Although the report indicated a slew of other issues and used words like degenerative, narrowing, bulging, etc.) Okay, but how do we fix this so I can get back to normal? Since back pain seems to be one of life's great mysteries, it follows that fixing back pain is just as difficult. OrthoDoc recommended surgery (he is a surgeon after all) but I nixed that idea quickly. I firmly believed that there are way too many alternatives to surgery that I should turn to first. If it takes time, so be it, but no one is cutting my spine open.
I can deal with the pain a little longer.

After my first cortisone epidural, I was in heaven. For the first time in months, my pain was a 5 on a scale of 10. (I live my life on a pain scale these days since it is every doctor’s first question.) Sadly, it didn’t last. Over the next few months, I went in for two more rounds of epidurals with little to no relief. After that, I tried aquatic physical therapy, then regular physical therapy, then just lumbar traction.

During that time, I was lead associate on a really "hot" case at work that demanded 14+ hour days. This was a blessing for me since the pain was really limiting my activities by now. I threw myself into my work and spent day, night and weekend on this case. This was one aspect of my life that the pain would not slow down. I would not let it. The harder and longer I worked, the less opportunity I had to dwell on the pain. The partners would say "take a day off" or "leave the office and get a life." I didn’t think I needed a day off. I didn’t realize it at the time, but this case had become the shield I needed to hide the pain.

The case settled on April 14. It was very soon after that my mind caught up with my body and the emotion of what I have been going through kicked in. My willingness to put in so many extra hours was not just because of some hard work ethic. I worked so much because I didn’t want to face the pain. My alternative to working is not spending a day strolling around the monuments, or going dancing with girlfriends, or taking my dog to the dog park. Those would all be too painful. My alternative to work is to lie on the sofa and drink a bottle of wine. (Which I have done many-a-nights in the past 8 months.)

I also had time now to realize that the physical pain has really taken a toll on my emotions. I am so angry and short tempered. Every little thing pisses me off even when I know it is not worth a second thought. Plus, I cry over stupid stuff. Like the time last week that my secretary asked me how I was feeling. Of course, this is all made worse by my lack of sleep. I realized I don’t even want to be around people because I am such an emotional mess. Who wants to be around such a miserable person?

I am not fine; I cannot figure this out or handle this on my own; I cannot deal with the pain any longer. I realize this now.

A week after the case settled, I went to OrthoDoc to talk surgery. He introduced me to NeuroDoc and we scheduled my spine surgery for June 4. NeuroDoc said "there is a 90% chance you will be pain free after this surgery." I started crying.

"Pain, especially chronic pain, is an emotional condition as well as a physical sensation. It is a complex experience that affects thought, mood, and behavior and can lead to isolation, immobility, and drug dependence." September 2004 issue of the Harvard Mental Health Letter