Monday, February 10, 2014

Pain, Health and Existentialism

I am being referred to our local pain clinic.  I'm not exactly sure what it will entail, or what outcome I should expect, but one thing has been made clear.... I will NOT get an appointment without filling out their forms.... (Referral to a chronic pain clinic; question on form: do you have pain? Well, at least that one was easy to answer.)

However the question that has caused all kinds of strife inside my head tonight was this:

It seems simple enough, but really............ it is not.  Is is just not.

First, my brain screams - define health? Do they mean pain, my life, my quality of life, my health in what context... actually, HEALTH in what context?

I think the problem is perhaps the word 'imagine'It kind of works in my brain the way saying 'don't think of an elephant' does for everyone - it's impossible not to.  So when someone says 'imagine' my brain is very very good at just taking that instruction literally.  And of course, imagination knows no bounds....

Then.......... Answer everything about TODAY

What if I feel worse tomorrow; next week? By the time the appointment comes? Surely THAT would be a better time to answer. That's usually when they give you these forms.  Then at least you know you have put your 'right' answer on that day, and can explain it when asked.

My brain goes into overdrive...... all by itself.  I am really trying hard to think 'first number that pops into my head; first number that pops into my head'.......... but there is no number. 

Instead there is................................. Phenomenology; existentialism: is our only reality the moment in which we currently exist? (I curse my undergrad dissertation.)  If that is the case, then do the future and the past truly exist?  What about living in the moment? Zen? Pain being subjective?  How can I compare something subjective to the "worst I can imagine" or "the best I can imagine"

OK, reel it in....  So what is the worst imaginable state of health I think of?

  • Locked In Syndrome, I definitely think that could be the worst. Ignore the could.  Just start need for a whole list of alternatives.... So, that's at zero.

  • A coma with no awareness would technically be a worse state of health (I think - considering HEALTH, not LIFE), but there would be no awareness about what was happening, therefore where would that actually stand on this scale?  How many times have I said I wish someone could just put me in a coma, let me heal, let the pain go away, and I could wake up when it was all over. A lot.  I even dreamed this. It was a very disappointing dream to wake from.

  • Does that make my current state of health worse than being in a coma?  Is a coma preferable? (Yes, right now it holds some appeal.  For me - purely because I wouldn't be aware of my pain.) Does that mean if I would prefer to be in a coma, then I should consider my health to be almost as bad as I can imagine?

  • Except I can imagine much worse - terrible things happen all the time.  I'm not facing a terminal illness; I still have the ability to think and use my brain (not scoring high on the positive scale at this exact point in time).  The possibility of intractable pain for the rest of my life is still a horrifying possibility - a lifelong disability.... does that count as just thinking TODAY?  Or is that imagining the worst I can imagine.  I think the instructions are somewhat contradictory.

  • Reel it in again....nobody knows where the pain path is winding; I prefer to just maintain a positive outlook on that one (My nerves will heal; my nerves will heal.... they are not damaged beyond repair). I would just quite like to be in a coma until my nerves do heal; or they figure out a way to take my pain away (that doesn't involve suggestions of experimental treatment with bio-terrorism agents)…….. circle back to this idea.... not really making progress....

Again, I wonder out loud  (yes, I am talking to myself) how HEALTH is defined…. Is it simply the ability to live a 'normal' life? (Does anyone do that?)  Should I be thinking about the best life possible versus the worst possible - in that case, I consider myself very lucky; there are people all around the world dealing with unimaginable challenges simply to survive every day.  I have a sore shoulder and very limited use of my right arm.  It's not good, it hurts like hell; but it's not like I suffer life-threatening discrimination for my beliefs, or the fact I'm female; or am a refugee fleeing war in my country - does that count as quality of health?  I suppose that would more be LIFE, not HEALTH.  So where does HEALTH lie between LIFE and PAIN?

….. But, if I'm supposed to imagine MY best health possible compared with MY worst health possible - subjectively - and mark that on the chart, then I'm not very happy with my health just now - not at all happy, so should I put a really low number?

What do the numbers mean?  Using the word PAIN would have made this a bit easier...

I wonder if everyone finds these things this difficult……? (I doubt it.) I try so very hard to do the 'gut instinct' thing here - it's always what the questionnaires tell you to do.  But my 'gut instinct' is all these thoughts.  Really.  They just jump in my head all at once and the only reason it takes so much time is because I have to try to sort through them.

I wonder if I should just write an explanation instead of picking a number.  Picking a number is too hard.  I really do not believe humans should be broken down into numbers to be entered into a binary computing system.  We are too complex. (SEE!!?)

I want to pick a low number; I am NOT satisfied with my health right now at all…. It prevents any kind of normality… the surprise of 'waking up' and not knowing if today I will be attacked by the firey raging pain monster; exhausted because pain has prevented any kind of beneficial sleep; or feel (apprehensively) that maybe today I can finally at least LOOK at my to-do list without collapsing onto an ice pack.  But I hate seeming negative; I have coped with this entire thing (actually, that 'entire thing' would be my life....) by trying to focus on the positive. It goes against my attitude to pick a low number…. but I don't think that has done me any favours in the past -  unfortunately I think I am too good at slapping on some make-up, a cool hat (to hide the unwashed hair) and faking it.

Plus the girl on the phone laughed at me. (Yes, she actually did. It was a definite chuckle, to be specific.  It is impossible to give me an appointment without this terribly important form, apparently.)  If she needs this in front of her before she can assign me an appointment, then they must give it some degree of importance (hence my deliberating!).  Therefore I should probably pick a low number - be realistic instead of....... i don't know, what do I usually do?  I don't really lie........ my Mum once said she didn't think I was entirely honest about the severity of my pain.  I just assumed the various shoulder/ physio therapists knew, at that point - but here they don't.  I know they don't, so I really DO need to remove this innate desire to appear strong, and be honest about all this (possibly the best advice I've been given this week).  I DO need to be seen by someone at the pain clinic as soon as possible…. I DO have severe pain.  But I don't want them to think I'm a drama queen and a weak female, as seems to have been the general (clearly unjustified, as physical evidence later showed) opinion of other medical professionals.  Crap.  I have been emotionally scarred by too many judgmental medical professionals and it has rendered me incapable of actually picking a number on what is possibly an entirely arbitrary chart.  There's a cheery thought.

I wonder if I just declare I'm a phenomenologist and I can't answer this question on grounds of my philosophical beliefs, I could skip this one (hey, it works for religions).  I really don't see how rating ONE day on a scale, when realistically my appointment is going to be weeks (hopefully not more than weeks, but that possibility does exist) from now, is so important…. I could just write: I believe we live in the moment and exist purely in that reality and therefore cannot imagine anything other than what I feel now, making it impossible to compare this moment to anything else.

It's kind of my 'medically enforced zen' (i.e. don’t think about the future or you WILL begin to freak out and question the meaning of everything).

It's kind of true…. I've spent two years being told NOT to compare my pain today to, for example, how my pain was immediately after my surgery (which is definitely the WORST I can imagine, based on my own experiences).  Pain is subjective (so I am repeatedly told).  And right now, tonight, as I was filling in that form, I felt like someone had embedded a giant axe deep into my scapula that was cutting right through my shoulder blade area, all the muscles around it, and into the back of my ribs…. And somehow it was sending out little electric shocks from the axe-head in all directions.  Should I put something REALLY low?

That's not exactly what the instructions say…. I have experienced worse than this - should it go on my experience, rather than an imaginary best and worst?  I struggle to think where that would put me either.

I think back to the existentialist/ phenomenologist get-out clause……. I then consider just writing the link to the blog I wrote when I tried to meditate…. That seemed easy compared to this….

I look at the clock and realise it is nearly 2am; I am quite sure I have been having this conversation with myself for well over half an hour, longer maybe.  Perhaps I am crazy….

I decide my life is not 50% of what I would like it to be, nor is it closer to Locked In Syndrome than to 50%, and choose the number 40.

I imagine being asked why I chose to write 40.  I wonder if explaining it was 2am, I had been having existential arguments with myself for too long and I had to get to bed because I had physio the next day would be an acceptable answer for arbitrarily picking an arbitrary number on an arbitrary scale that someone I don't know, and who doesn't know me, will use to judge me. Or more likely, enter into a computer programme designed for that purpose.

I wonder if that is better than writing 'I'm an existential thinker.'  I really don't know.

And now, after I have written this all out, completed the formS (yes, that was just one) and sealed the envelope, I realise I should have written 42.  If asked to explain, that would have been simple.

"There is a theory which states that if ever anyone discovers exactly what the Universe is for and why it is here, it will instantly disappear and be replaced by something even more bizarre and inexplicable. 

There is another theory which states that this has already happened." 

     ~ Douglas Adams

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