Pain Don’t Hurt
The title of this is a line from Road House, one of Patrick Swayze’s finest tour de forces, and is basically the best summation of what 1980s action films were like: lone wolf individual overcomes seemingly impossible odds to defeat the bad guy(s) all the while evidently impervious to injury or pain. It created quite a notion of what masculinity means and what was expected of you as a man, chief amongst this an apparent need for ignoring or making mute the annoyance that is feeling anything physically or otherwise. The truth, of course, is that pain does indeed hurt as that is its very nature, and the ability to avoid or ignore pain is not nearly the same as being able to endure or overcome it.
This is another post about my burn injuries, fair notice on that. It’s been such an all-encompassing experience these past 2+ months that there’s really not much else going on in my life and, out of stress, boredom, sadness, guilt, or all of the above, I feel the need to write, and share some more about this experience as it is quite an awful one. And with it has come an incredible opportunity to study firsthand and reflect upon the nature of pain and its manifold manifestations.
Up until this summer I harbored a fairly ignorant and grossly naive notion that I had a high threshold for pain. The absurd belief in this abnormal trait reinforced by various accidents through the years that required stitches or casting, an affinity for tattoos and piercings, and a track record of bouncing back faster than expected when injured in sports or just everyday life. The worst accident I’d been in prior to summer 2016 was piling up a scooter in Thailand which found my left leg pinned under the bike as it skidded across the road, resulting in most of my leg being skinned, my toenails lost, and two puncture wounds damn near straight through my foot. Those injuries required daily visits to a small open-air hospital on the tropical paradise island we were staying on, where nurses would scrape all the skin off of my injuries, stuff cotton swabs in the holes in my feet, and rewrap my legs for me while I bit down on a towel and screamed my lungs out. The injuries I sustained this summer, and their resultant treatment needs, make that experience look just fun by comparison.
From what I’ve read and heard, my experience with burns is very common in that the shock and nerve damage lead to a grace period of several days in which you feel no pain at all. You feel pretty good in fact, other than seeing your body so injured and dealing with the mental aspects of treatment and recovery (e.g., boredom, depression, fear). It creates a false perception regarding where you are in the process, and the very nature and severity of your condition in the first place. I remember attributing this to the quality and strength of the medication they had me on, thinking it must be that the pain killers are strong that they have in fact killed all pain. For me this lasted about three days before reality set in.
Burns are so nasty that they continue working away at you for a long time after the initial injury. The doctors and nurses working on me kept referring to it as “evolving”. The burns kept moving, finding weaker spots on my body to engorge upon, and it takes a good deal of effort to keep ahead of them. Most notable of these efforts is “wound care” in which you soak in a whirlpool for a while before having all of the skin on your injured area(s) scraped off, at first with a metal device and then just a rough washcloth. I did wound care twice a day for the two weeks I spent in the burn unit and for the first four weeks thereafter. Each session takes about an hour all in: half the time for scraping everything off, the other half spent bandaging everything back up again. If you’ve ever had a bad brush burn (e.g., wrecked on a bicycle, slid in dirt, gotten tackled into gravel, etc) and had to clean it out with alcohol, you have a sense of what wound care feels like. Except rather than a few seconds, that agony goes on for a full hour.
When the pain first set in, it was crippling. No amount of pain medicine was sufficient and the answer to every, “On a scale of 1 to 10, how is the pain?” inquiry was a resounding, “10!!” with perhaps an expletive or two mixed in for measure. There is nothing to do: I was bedridden for days, lost in a drug-fueled fugue state punctuated with only the most basic lucidity during the excruciating wound care sessions. You go from one bed to another, and they even use a crane-like device to raise and lower you in and out of the whirlpool. Like some scene cut from The Matrix, you’re affixed to various machines around you via IVs, oxygen mask, and various monitors stuck to your chest and abdomen, and hanging off your fingers. You cease to be a person: you are a mass of pain and suffering with people experimenting with various permutations of medication combinations until they hit it right and you float back into oblivion, waiting in the dark until the pain comes inevitably to shove you right back into the light.
That pain gets easy to live with. You’re so ruined, and at so early a stage in the game that the doctors and nurses just pump you full of meds. The snag with this, which I learned the hard way, is that they cannot just give these to you whenever: you have to request them. At first I was getting injections of pain meds, supplemented by several other pill-form pain meds, every 4–6 hours. They staggered the delivery of these so it seemed like I was getting pain medicine every hour. This is great when you’re awake and can ask for them, not so much when you’re sleeping and, obviously, cannot. The first time I slept more than a few hours I woke up in agony, begging for meds and vomiting from the pain. It felt like every inch of me was on fire again, and that I was wearing skin five sizes too small over a skeleton made of fragile glass. Every movement hurt. This happened a few more times, but I got in the habit of setting my phone’s alarm so that I would wake up every time pain meds were available. This allowed for a constant state of exhausted numbness. There was a whole lot of pain, but it was sort of next to you and not sitting on your chest.
This doped up, bed-ridden paradise only lasted a few days, unfortunately. The one thing people should know about the treatment process for burns is that it is abruptly incremental. You go from one reality to another, quickly and violently. I was given several days of “pity party” time to lie around popping pills and watching television, but then physical therapy (PT) began.
Thankfully PT started slowly. All I had to do was stand up. Simple right? Well, not so much when all the skin is gone from both legs below the knees. There’s this odd rush of blood and fluid into your legs when you go from lying prone to a standing position. You only get about a second to ponder this weird sensation before the waves of pain come crashing into you. It genuinely feels like the skin of your feet is going to tear open, that there is no way your body could possibly hold in whatever this newfound fluid is. The first time I stood for about a minute before breaking into tears, bawling and begging to sit down. For the next 10 days we moved from standing, to walking a few feet, to walking across the burn unit, to walking up stairs. Each day’s new activity brought with it a new symphony of agony, and without fail ended with a rush of tears, both from the physical torture and the panic of having to re-learn how to walk and what that means in terms of a timeline for returning to “normal”.
Every few days the nurses would tell me that they’d have to ratchet back the meds a little bit more. First to go was the morphine for wound care, which was replaced by oxycodone and percocet pills. Now, both of these are outrageously strong painkillers but going from IV drugs to pills is like going from flying first class to riding the bus; it’s just nowhere near the same in terms of potency and the comfort granted from such. What’s really scary about the whole experience is that despite all of these powerful pain medicines, I never felt different. I wasn’t intoxicated in any tangible sense. The other thing that would vary is where on the pain scale the needle fell.
Wound care with less meds was simply awful. What was already enough to reduce you to tears and to demean yourself enough to beg for mercy, became amplified by several degrees. Time slowed down to allow for full appreciation of every scrape; each jostle of the gurney as it was raised or lowered into or out of the whirlpool jarred you to the bone. Even the lights seemed to burn brighter. Anything that could make the experience more challenging suddenly seemed to fall into concert with each other, mocking you for your weakness and promising more and more and more.
The physical pain moves around you. It starts everywhere, but soon settles on the places in which you’re injured the worst. It’s the penultimate bully in that it seeks out the weakest, exploiting its shortcomings with breathtakingly sinister and tactical precision. You become wracked with convulsions and spasming muscles when trying to relax, are cursed with heightened senses that morph the sanitized room lights and screams of desperation and agony from your neighbors into devices of torture, feel waves of heat when undercover and tendrils of cold wrapping around you when skin is exposed, and all the while you have this voice in your head telling you it will get worse, you will succumb, and that this suffering you are perceiving is all part and parcel of an inherent weakness that defines you. Pain becomes the Boogie Man, the monster under the bed, the Jungian scarecrow here to tell you that you are weak and that it is strong; that you will lose, and it will win; that there is no escape.
Each mundane, everyday act that you are able to pull off in spite of the nagging reminders of your condition are incredible victories. There’s really no other way to look at them. I had a nurse named Kyle who is arguably the most positive person on Earth and without whom I would not have stayed optimistic at all. The first time I walked from my room to the bathroom (about 75 feet away), Kyle saw me and wrapped me in a hug, cheering me on while the tears streamed down my face and I shook with relief in his arms. You start having more and more of these moments, while you take less and less meds, and the light at the end of the tunnel grows brighter and brighter until one day they send you home, and the process reboots.
In the hospital you are lulled into a level of comfort afforded to you by the retinue of medical staff readily at your disposal. In the absence of that, there is fear. And pain, of course; always the pain. You have to start doing everything on your own, all the while with less and less pain medication. It is scary, and the redundancy of it all is as depressing as anything I’ve experienced. It’s just more of the same, every day: wake up in pain, shuffle around in pain looking for ways to fill your time, tend to your painful wound care, and go to bed stiff and in pain from the day’s movements, only to wake up multiple times throughout the night because you moved in such a way to cause agony. And repeat.
After six weeks of treatment, the doctors take you off of opioid-based medicines. Which is to say, they take you off of painkillers. The rationale is that you are already addicted to the meds and any additional time spent taking them will just exacerbate the problem. The logic is sound of course, but the reality of it is astoundingly bad. I was unaware that this was the case until I went to get more pain medicine and they turned me away. It’s a junky statement, but the heartbreak of that denial was palpable. The problem with this approach to pain management is the simple fact that the injuries the meds are treating do not conform to the same timeline. For me, it’ll be another few weeks of wound care at least, with an estimated year to go before my skin is healed to any degree of normalcy. Further compounding this misery is the fact that your brain becomes a big fan of the opioids and, in their absence, makes the pain you’re experiencing feel worse in hopes that it will prompt a return to the medicine. That’s right: your brain tells you that you are hurting worse than you actually are in order to get drugs. If ever there was a case-in-point example of perception outweighing reality, it’s this.
And this is just to say what enduring the physical pain is like. The mental and emotional is far more daunting, and harder to treat. My burns are limited to my left arm and both legs from the knees down, so the overall impact of the aesthetic alterations is limited. This makes it far easier for me to take the high road of saying that the physical scarring is of little concern and that my health is all that matters; had the burns been to my face and other more visible parts of my body, I’m sure I’d be singing a different tune. Irrespective of location or severity of burns, if it’s bad enough to warrant a visit to the burn unit you’re looking at a long recovery period, lots of suffering, and a great deal of idle time thanks to the limitations on movement and fear of infection.
Burns can take months (or longer) to fully heal. For an adult that amount of “down time” is such a rarity that the first real challenge is what to do with yourself. Thankfully I can do a lot of work remotely for my job in India, but the recovery process is physically taxing; you just don’t have the same energy levels so the amount of time you can commit to anything is minimal. I’ve taken to painting thanks to the gifts of friends, I’ve been attempting to write more, and do the usual routine of watching television and keeping up with the news. Unfortunately, only so much of that can occupy the mind.
I’d never really thought about death in a meaningful manner. This I know because, upon reflection, I’ve never truly been in a situation that I could honestly say I was lucky to have survived it. That is, until this summer. I mean, it is absolutely miraculous that I was not more seriously injured or killed outright. I think that’s free of hyperbole anyways. That said, suffering second and third degree burns on 25% of my body is no small shakes. This thought haunts my dreams, and creeps into the quiet hours of the day too. You never see it coming on; it’s just a sudden blast of memory, an immediate transportation to the moment the fire exploded, and, worst yet, the recollection of what it felt like when you had to grasp the fact that you are very seriously hurt and heading into an uncertain future, but one in which it is safe to assume will be no fun at all in the short term. I remember the faces of my family, trying but failing to hide their horror and fear, the smell of my singed hair and skin filling my sister’s car en route to the hospital, and my vain attempts at reassuring myself that everything would in fact be okay.
The nightmares are perhaps the worst because there is nothing you can do to prevent them. They just come rushing in and punch you in the face whilst you are most prone. Evidently the pain medicines exacerbate the already unbearable bad dreams, but whatever the case or cause they’re bad enough to wake you in a panic, soaked in sweat, and experiencing the simultaneous contradiction of hoping to get more rest while begging to stay awake to avoid more of that nonsense. Prior to the accident, my infrequent nightmares would center around being chased, or falling, or any of the usual fare; after the accident and ever since, they have been about fire. Specifically, they have been about not surviving the fire, and they wake me up sopping wet and short of breath every time.
Burns are so bad emotionally and mentally that there are groups you can go to for therapy. It’s a form of treatment for post-traumatic stress, and one that most folks recommend. I do not do so and not because I feel it is unnecessary or that I am “tough enough” to deal with all this on my own, but mainly out of a sense of survivor’s guilt, really. Physically, I’ll be okay and will bear scars that a pair of pants could easily cover and, eventually, I will no longer limp about and regain my steady gait. My fellow residents at the burn unit were not nearly as lucky, with full-body and facial burns common. I know it’s wrong to feel this way, but I feel like those folks have a much harder time and don’t need to hear from someone like me how challenging the process can be. I write out my thoughts and talk to loved ones instead, and it helps.
That said, for the past eight weeks every conversation I’ve had is basically the same, with concerned loved ones peppering me for daily details on how this or that is healing, and what the pain is like. Many folks find it astonishing that I say I am still in pain this long after the injury. It’s really difficult to explain how grating that can be, and frustrating. That last bit can only come across as obnoxious and smacking of a total lack of perception on my part, I know: I should be effusive in my thanks for having so many caring people in my life, and I try to be to the greatest extent possible. But it is brutal sometimes. This is not what I want people thinking of first when I come to their minds, nor do I want anyone spending any time stressing about something we will all hopefully have a good laugh about one day. I also can’t adequately articulate what this is like, as it is one of those experiences that you have to experience to understand.
Being looked at as not a sum of your parts, but rather as a sum of one part is especially difficult. People don’t mean to do this, but it is inevitable when someone is badly hurt. If it’s not the sole focus of a conversation, it’s an hors d’oeuvres for sure. I imagine that’s a brutally frustrating part of life for people with scars that are not easily hidden from view: that you can’t just have a conversation without first addressing the 800-pound gorilla in the room that your scars have become. I’ve gotten a very small taste of that these past few months, and I know that each occurrence brings with it a figurative reopening of wounds. You can’t move forward in a meaningful manner if you’re always forced back to the same starting place. It’s safe to say that if and when you see someone with any sort of burn-related scars that they have been through hell, and are incredibly strong for having endured it and persevered, and that they are far more aware of what that means than you could ever be.
As with anything, you get stronger each day provided that your stay positive and keep at whatever you are supposed to be doing in order to alleviate whatever challenge it is you are facing. It’s a classic “if, then” situation: if you take care of your injuries, then they will heal and you can go on with life. What compounds this “if” in equal parts is the need to endure the physical torture of the wound care and to mentally prepare for having to put yourself through it. And not just once, but multiple times a day, every day, for weeks and months. What gets you through those moments is as unique as you are. Perhaps it’s family, or friends, or loved ones, or an overwhelming yearning for normalcy, or just plain old stubbornness. Whatever it is, you have to take hold and run with it, use it to overcome. It is in the endurance of pain that you discover just how truly strong you are, and can be.
Originally published at kevinshane.me on October 12, 2016.