This article was first published in October 2009. There were many helpful and appreciative comments left at that first publication. Since pain seems to have become a bit of a theme it seems good to draw attention to this Guest Post.
Introduction Due to orthopedic surgeries and treatments I have been dealing with long periods of excessive physical pain. Because of my body’s condition, being without pain is a rare thing in general. So training with pain is a necessity. The following is an excerpt of sorts, some bits and pieces on my personal dealings with pain. I guess what I am learning in the process is in essence applicable to any form of difficulty or adversary we may encounter in daily life.
When in hospital, several times a day, you are asked to assess your pain level by giving it a rating between 0 and 10, zero being no pain, ten being unbearable pain. This made me reflect on the meaning of unbearable. There have been lot of times that the agony I was in completely filled the whole of consciousness, excluding all else, and I felt it was utterly unbearable. But having reached unbearable nothing much happens really, you do not drop dead, you do not explode to pieces, you do not vanish out of existence. Having reached unbearable you just continue to live, your heart simply continuing to beat. The truth is, despite the agony being unbearable you continue to bear it anyway. So however excessive, I thought it would be contrary to the truth to rate my pain a level 10, since if it was truly unbearable I reckon I would have dropped dead. I think this is an important distinction to be aware of when dealing with all kinds of stuff: to see clearly how something feels, how your experience of it is and then how that relates to the truth of how things really are, the bigger reality.
Room for complaint
There is a difference between mild to reasonably severe pain and truly excessive pain in the way it affects the mind. With excessive pain there is no escape, it nails your consciousness immovably to a single point, that is, the now, The Reality Of Pain, that reality excludes all else. One has no option but to face it without flinching and to endure, whether you think you are capable of it or not. With milder forms of pain there is more room for distraction, room for escape in familiar forms like being grumpy, feeling sorry for oneself, complaining. When I catch myself complaining sometimes, I smile and think “Actually, if I have room for complaint, I am doing not too bad!”
I should say that the above way of differentiating is for internal use only. I don’t think you can reverse it to make inferences about someone else’s pain based on their “complaint level.” That would be trying to step in another’s shoes, which — apart from being impossible — does not really help and can lead to a judgmental attitude, which in turn is bound to heavily tax what-ever is going on.
There is nothing that drains your energy more than chronic pain that lasts and lasts without giving you a break. This can be quite exhausting and depressing. What helps me to get through bleak times is to find helpful distractions that lift the mood like watching movies and television or chatting to friends and ways of relaxing the body as much as possible to minimize the accumulation of tension and stress. But by far the main thing that preserves your resilience in a situation of ceaseless pain is to not give in to gloomy thoughts, to stay focused and to keep looking at the distinction between the feelings, the experience of the now and the truth, the bigger reality of how things really are. Not losing sight of the bigger reality prevents the mind from getting into isolation where you feel all alone in your agony. I guess that loneliness is the most unbearable of all and can make you apathetic or spiral you down into the pits of depression and despair.
When dealing with pain, the night-time forms the biggest challenge, since for some reason everything is multiplied: the pain, the isolation, the loneliness, the arising fears. The nights in the first week after a major surgery for instance seem to last eternally.
I remember one such night about two years ago after a particularly extensive operation. I think it was the third night after the operation. By then, the pain is not only from operation wounds and fractures, but every bone, joint, muscle and tissue hurts after lying in the same posture for days on end, because you cannot move and bedsores start to kick in. Any sense of time completely lost in the mist of the morphine haze from the two morphine drips, I spend the time subsequently by dozing off a little and then looking at the clock on the bedside table, hoping maybe it has advanced at least half an hour, but always to find that it is only a few minutes later then the previous time I checked. Time has become like a rubber band, every minute stretches and stretches and stretches, to infinity, making the dark night last forever. A little after 1:00 am, when the pressure on my spine from lying on my back for days has become terrible, I tried to shift, turn a little to one side, but impossible, I cannot move. I decide to call for the night nurse and see if I can perhaps manage with some help.
This human being
It takes a while before the nurse answers, must be a busy night. When she finally comes, she enters the room only halfway, staying at a distance from the bed. Not a good sign. It’s dark in the room, out of the corner of my eye I can only see her silhouette against the light from the open door, I sense agitation emanating from her, something is not right at all. Throat bone dry and sore from the respiration tube my voice is a hoarse whisper. Trying to over bridge the distance, I ask if she can help me to shift a little to one side. She snaps: “You are not allowed to turn!” This is not true, she knows it and I know it. She is flatly refusing to do something. I’ve been on this ward frequently due to the unending schedule of operations. Notwithstanding the understaffed situation that seems to be common for most health-care institutions, usually the staff here is friendly and helpful, including this nurse, but she has the tendency to become snappy when she is stressed. It is a big ward and there is only one nurse during the night, and lot of patients recently operated on at the moment, so gathering from her reaction things must be rather tough tonight. But right now this nurse is the only human being in the whole universe that I’ve got to be there for me in some small way in this dark night, and yet she is not able to. She is very stressed and annoyed; her agitation fills the single-bed hospital room like a dark cloud, intensifying the shadows. I remain silent; I know I am in no position to argue the situation. She hesitates, not quite sure how to read my silence, she then turns abruptly and leaves the room.
I am alone in a hospital room 900 kilometres from home in a foreign country, everything and everyone familiar is far away. It is just over 1.30 am, worst part of the endless night still to come. A feeling of utter loneliness and abandonment engulfs me like a huge wave. My mind is trapped like a caged bird in this terrible now without escape. I focus to prevent it from being hurled into dark pits of desperation and existential fear opening up all around. The flat rejection of the nurse in a situation where I am most vulnerable and helpless is spiralling my mind into withdrawal, into isolation from sheer panic. I somehow need to find my way back. To reverse the withdrawal I use all the willpower I can summon to focus and to expand my awareness. First to the hospital bed: I feel its size, its robustness, how it supports my aching body together with all the many tubes coming in and out of it; I then expand to feel the space of the room — it is pleasant and spacious; expand to its walls and beyond, to the ward, the fellow patients — lots of them no doubt in pain and without sleep like me; to the whole hospital, the city, to my friends far away. When my awareness expands to include it all, I become suddenly aware of this stream of love and care coming towards me from all those thinking of me, wishing me well. They may be far away and at sleep now and yet this stream is still pouring forth from them like a river of light. The stream simply leaves no room for feelings of entrapment, despair, loneliness, abandonment, such powerful emotions a moment ago, and yet where did they go? They have simply evaporated in the light of the stream when I was able to reverse the isolation and reconnect. The darkness that fills the room, where does it go when you turn on the light switch? Like darkness, these feelings, despite their all-powerful and overwhelming appearance, don’t seem to have a real substance in the end.
Nothing has changed: the lonely hospital room, the excruciating pain, the endless night ahead, the terrible weariness and exhaustion, all still there. And yet my experience of it now is very different. There is a sense of being carried, being embraced, me and everything I am going through. It is all right to just be and endure without flinching or needing to escape.