Some Intriguing Facts About Pain

"I don't feel funny anymore. I've started to wonder if I've changed," she said.

She's one of the funniest people I know. I'm sure she hasn't lost her wicked talents. But grief is pain and pain is work and she's not done with the work yet.

I don't doubt, though, that she's changed in a different way. Pain -- physical, mental, spiritual pain -- changes us.

This winter I've lived in a physical house of pain. I broke my leg before Christmas and had surgery to put in a plate and five screws on January 6. The physical limitations of crutches also brought on a lot of emotional pain. They robbed me of my main anxiety coping mechanism, exercise, as well as my freedom of movement. I can't carry anything using my crutches, I have trouble with stairs and I can't drive.

After my surgery, I had a nerve block for the first eighteen hours. The doctor told me to start taking the Oxycontin before I went to bed because the block would wear off during the night. It did, and not even the Oxy could touch the flames shooting up my calf. I ended up calling a pharmacist in the morning and asking if I could take anything else on top of it, something that blew my mind since normally I don't need much painkiller at all. Two Advil on top of Oxy later, I finally fell into restless sleep.

That whole next day passed in wave after wave of red-hot burning pain where the plate was. It felt like labor contractions, only in one little 3"x2" area. I willed myself to just bear this part, because at least the surgery was over and the path to healing finally seemed clear.

I'd get through this post-surgery week, then I'd be on crutches a while longer, then someday, I'd be able to put weight on my leg again. And then I'd walk. And then I'd run.

Soon after that horrible day, my pain turned a corner and I was able to drop down to one pain pill instead of two every four hours, then one every eight, then just two Advil, then one Advil, then, finally, no Advil. The only pain left now is the muscle ache in my shoulders, neck and arms from crutching around and the psychological frustration at not being able to exercise or drive. I don't depend on others well, nor do I like relying on other people to be able to leave my house.

In the midst of all this, I read Dan Ariely's THE UPSIDE OF IRRATIONALITY. In this book, Dan reveals a lot about his own personal experiences with burns over 70% of his body from a military accident as well as his adventures as an academic researcher. He really caught my attention when he delved deeper into pain.

I told my grieving friend about Ariely's studies, thinking it might help her, because what Ariely found was fascinating. After recruiting and testing a bunch of ex-military people who had either been injured, not been injured or had a disease, he wrote:

Moreover, we found that there seems to be generalized adaptation involved in the process of acclimating to pain. Even though the people in our study had endured their injuries many years before, their overall approach to pain and ability to tolerate it seemed to have changed, and this change lasted for a long time ... I suspect that people with injuries like mine learn to associate pain with hope for a good outcome -- and this link between suffering and hope eliminates some of the fear inherent in painful experiences. On the other hand, the two chronically ill individuals who took part in our pain study could not make any connection between their pain and hope for improvement.

It's fortunate I read this book so soon on the heels (ha) of my surgery when my memory of that searing bone pain was so fresh, because I really think Ariely's onto something. Yeah, the pain sucked, but I completely associated the post-surgery pain with progress, much more so than I did the fresh-break pain. This in turn made it easier psychologically to muscle through post-surgery even though the magnitude of pain was far worse. It's like the pain of childbirth, I suppose -- pain we deem necessary.

Maybe that's it -- maybe how we feel about pain depends on whether or not we deem it necessary.

I told all this to my friend, and then we sat on the phone in silence for a minute. It was one of those moments you get maybe once in a week if you're lucky when the workday bullshit lifts and you see the world for real before the computer dings or the phone pings or the kid walks in through the front door.

We hung up and the bubble of meaning popped, but I'm looking for the growth in all pain now. And I'm still very eager to run again someday.

Someday I'll Be 18 Going on 55

When I write, I usually listen to headphones even if I'm alone so the music can go straight into my head without mingling.

I remember when an old boss gave me an iPod shuffle as a Christmas bonus. It could hold 100 songs, which at the time seemed an insanity of musical abundance and variety.

My current writing playlist has around 500 songs on it, and yet I still hear a lot from Bryan Adams. The last few times I heard "18 Until I Die" (a song most helpful when you're 41 and writing fiction for the 15-23 year-old set) I wondered if Bryan is yet 18 going on 55, like the song says.

I just looked it up. He's 56.

With the cultural and artistic icons we've lost this month, I (like everyone above a certain age) have become acutely aware of the mortality of my youth, of being a young old person on the shallow end of my forties.

And yet I still listen mostly to the music of my youth. I still identify better with 18 than 55, even though I'll be 42 in about two weeks. Thirteen years from 55, 24 from 18.

Holy shit.

Better get out of this cast and get both feet in it.

Someday I'll Be 18 Going on 55

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Notes From the Orthopedic Surgery Waiting Room

33 days since I broke my fibula.

14 days since the surgeon put a plate and 5-6 screws in my leg to fix the unstable break.

Yesterday I went for my surgery follow-up appointment. The PA and I talked about how putting screws in bones was pretty much like hanging a flat-screen TV -- you better put the screw all the way into the other side of the bone or you're not sinking it into the stud. I stared at my X-rays in horror and fascination.

They took out the stitches. The skin puffed around them like flesh pie crust, rather inhuman.

As I left with instructions to come back in three weeks and start moving my feet around three times a day, I both cursed another four weeks on crutches and thanked God once again this is injury and not illness. I view injury differently than illness, and I'm not alone in that.

I'm reading THE UPSIDE OF IRRATIONALITY, by Dan Ariely, who at 18 was burned over 70 percent of his body in a military accident. His experience gave him an interest in people's ability to tolerate pain and the events preceding their tolerance. He hypothesized, for instance, that those who had bad injuries could tolerate pain longer because they would equate it with healing.

He and another researcher set up a study in which they recruited folks to stick their arms in hot water for as long as they could stand it (they had to pull their arms out before they really hurt themselves). However, they forgot to exclude people with illnesses from recruiting and ended up with a few who had diseases. The ill people had a lower pain tolerance than the control group, while the injured group had a higher pain tolerance. He wrote:

"I suspect people with injuries like mine learn to associate pain with hope for a good outcome -- and this link between suffering and hope eliminates some of the fear inherent in painful experiences. On the other hand, the two chronically ill individuals who took part in our pain study could not make any connection between their pain and a hope for improvement ... in the absence of any positive association, pain must have felt more frightening and more intense for them."

Ariely acknowledges the accidental inclusion of ill people wasn't statistically significant, but his theory makes sense to me, particularly after this latest foray into pain. The day after surgery when my nerve block wore off, I could feel the plate and screws in my bone burning and throbbing like Anakin Skywalker after Obi Wan gets the high ground. It did indeed help to know the pain meant the plate existed, and the plate would ensure my bones healed correctly so I can run again without fear and without ankle arthritis. I just kept picturing that as I breathed through the burn and counted down the minutes until I could slam more Oxy.

In my outings on crutches, I've noticed people reacting to me in a way they haven't since I was pregnant. I have a theory now (and I'm sure I'm not the first) that people are the nicest to people with obvious short-term injuries or medical conditions, such as pregnancy, crutches or casts. Less so than they are to people with long-term injuries, like walkers or wheelchairs or canes. And illness, forget about it. Nobody wants to be in the same room with someone ill: Even if it's not catching, we're afraid we'll catch it. Some part of it.

Maybe the fear part.

It makes sense, I suppose. We don't like to think about our own mortality or how we would feel if it were us in the wheelchair instead. Crutches or a cast denote temporary conditions, ones we think we could probably live with, and that the otherwise healthy-looking person sporting them seems like us.

It's easy to root for someone on crutches.

Sitting in the waiting room of my orthopedic surgeon, I saw a lot of wheelchairs, walkers, canes and amputations as well as crutches and casts. The people with various conditions of injury also wore different expressions. The wheelchair-and-walker crowd for the most part seemed more serene, or at least resigned*. The cast-and-crutches gang was like me: really fucking pissed off to be there and not bouncing around like normal, sometimes crying as I did in the waiting room after my first visit when I learned I would need surgery and months of crutches.

I'm not sure what to do with any of these observations. I may very well become terminally ill at some point in my life. I mean, we're all terminal. My sister asked why I read these weird books, but I know why I do. I want to become resilient. I want to be the Zen guy in every movie about an airline crash on a desert island who is shockingly oblivious to the situation even as the hero runs around freaking out over his lost car keys. I want to be the calm one when they are both in the exact same situation, which the hero never seems to realize as he's trying to get the Zen guy to please freak the fuck out, already, thank you?

For someone with anxiety disorder to aspire to be the Zen guy in the airplane crash is some form of the Special Olympics, I'm sure, but hey, if they can do it, so can I.

 

 

I should note that long-term injury isn't a death sentence. In fact, it's something else Ariely talks about in his book: hedonic adaptation, which basically states humans have a base level of happiness they tend to return to no matter what happens to them, including wheelchairs.

 

Guest Post: FARMWORKER & the Story of Undocumented Agricultural Workers from Diana Prichard

(Editor's Note: Thanks for taking time to check out this guest post from my farming friend Diana Prichard of Righteous Bacon. I've known Diana for many years now, and I've always been impressed by her dedication to farming and agriculture and her moral compass. I know I recently enjoyed Making a Murderer on Netflix and believe documentaries are one of the easiest ways to educate a lot of people in a little bit of time about complicated issues like the American judicial system or how we get our food. Immigration is not a pet cause of mine, but I fully support the part all immigrants play in the success of small businesses and small farms. Beyond dollars and cents, I personally believe America should open its arms to immigrants and refugees.)

From "The New Colossus," a sonnet by American poet Emma Lazarus, which is mounted on the base of the Statue of Liberty:

Not like the brazen giant of Greek fame,

With conquering limbs astride from land to land;

Here at our sea-washed, sunset gates shall stand

A mighty woman with a torch, whose flame

Is the imprisoned lightning, and her name

Mother of Exiles. From her beacon-hand

Glows world-wide welcome; her mild eyes command

The air-bridged harbor that twin cities frame.

"Keep, ancient lands, your storied pomp!" cries she

With silent lips. "Give me your tired, your poor,

Your huddled masses yearning to breathe free,

The wretched refuse of your teeming shore.

Send these, the homeless, tempest-tost to me,

I lift my lamp beside the golden door!"

I distinctly remember the first time it really hit me what was at stake in making a documentary about undocumented farmworkers. I had just finished filming and photographing the wedding of the couple featured in the documentary and was following the bride, groom and a caravan of their friends and family from the church to the reception location. I found myself wondering why in the world they were driving so slowly—just a mile per hour under the speed limit, but about ten miles too slow for my usual speed demon style. I knew where we were headed and planned to stop off on the way there anyway so I merged out into the passing lane and started to accelerate around the car carrying the bride and groom when it hit me like a ton of bricks: that even the slight risk of driving a few miles per hour over the speed limit was a distinct privilege. That they were driving “so slow” because, while if I got pulled over I’d have an unfortunate speeding fine to pay, if they got pulled over it could be the end of their lives as they know them. What would be a routine traffic stop for me could turn one of the happiest days of their lives into a living nightmare and tear their family thousands of miles apart from one another. 

It’s not that I’d gone into this project callously. We had many meetings and discussions before I ever began filming and I’d spent hours considering what security steps I would need to take in order to protect their identities until we were ready to reveal them. I knew in my mind, but that was the first time it really hit me in soul. Since then, there have been countless moments like that one. Fleeting seconds where I get just a glimpse of what it’s like to be productive, valued members of this American society, but also undocumented, and every single one is heart-wrenching. 

The story of immigration powering agriculture in the United States is long. In the 1920s Hispanic farmworkers were already migrating north to work in California’s green fields of lettuce and cabbage. Today, 77% of farmworkers in the U.S. are foreign born. Most of them are Hispanic, and most remain undocumented in the U.S. These people are economic contributors to our society and valued community members where they live and work, and they are at an ever-increasing risk of deportation—both now and as our next president is elected and takes office with immigration at the forefront of the national dialogue. The dairy industry alone estimates that loss of even half of Hispanic farmworkers in the sector would result in a 33% increase in milk prices. In the fruit and vegetable sectors we have already seen what immigration crackdowns do—when immigrant laborers have been run out of states like Georgia for fear of deportation under stricter laws the crops have rotted in the fields, because there is no one else willing to do the work. 

As the inflammatory rhetoric around immigration heats up this election cycle, I fear that some of our most vulnerable immigrants are getting lost in the noise. Through 'Farmworker,' a documentary and companion publication by the same name, I’m trying to change that, bring awareness to their contributions to our affordable food supply, give them a voice — too often they are portrayed as helpless in the media, but they’re capable people and deserve a spot at the table when we talk about immigration policy — and ultimately affect the national dialogue on immigration, cultivating an awareness of what we all have at stake if they are forced out. Farmworker isn’t just about farmers or even just about immigration; it’s about food, and if you eat, it’s about you. 

Beyond what I’ve learned about what it’s like to live undocumented in the U.S. these past few months, I’ve also learned what it takes to make a documentary. I’ve already spent thousands dollars and countless hours of my time—both of which I consider a good investment, because I believe deeply in the worthiness of this project—but neither of those things has brought me close enough to really doing these people justice so now, I’m crowd-funding. The truth is, I’m a farmer myself. We don’t employ immigrant workers. We don’t actually employ anyone outside our family, because our farm is tiny. But I’m still fairly well connected inside the ag industry. I probably could have gone to them for funding. This is a really important topic for farmers of all types and operations of all sizes. But I didn’t want to be tied to any industry for the message. I want to be able to tell it without bias and for our readers and viewers to know that what went into this is only heart, soul and hard work, no spin. That’s why I’m asking you for help. 

I need to raise $30,000

in 30 days

. It seems like an insurmountable feat, but I’m keeping the faith in the power of our online community strong. I know we can do great things; I’ve seen it happen before. 

Donate.

This

is

a crowd fund, and ultimately what I need to complete this project is money and I cannot express how much contributions of any size are appreciated. Backing this project financially—whether with $10, $100 or $1000 dollars—helps us do justice for people who are literally risking their lives to have a voice in a country where every citizen should already have one. And this crowd fund is all or nothing, which means if we don’t meet our $30,000 goal, we don’t get any of the pledges. Which brings me to the next item.

Spread the word.

 If 3,000 people give $10, we meet our goal. That seems like a lot of people, but if we put our networks together, it’s probably just a small fraction of the people we know. But we have to reach out to many, many times than number to get enough donations first. If you have a social media account on any platform, please consider telling your followers about this. And if you know family, friends or other contacts who might care about this issue, too, please consider reaching out to them directly to encourage them to back this project, too. Emails always reach people and encourage action better than Facebook posts and tweets, but I’m not picky. I’ll take both. 

EMBED CODE FOR VIDEO:

Farmworker: How Immigration Feeds America from Diana Prichard on Vimeo.

LINK TO CAMPAIGN: bit.ly/farmworker

Politics
Tips for Crutches

I had never used crutches before I broke my leg, and I've learned a lot. I'm on quite a bit of Oxycodone at the moment, but I wanted to write this before I forgot the desperation someone might be feeling if they stumble upon this. Feel free to share!

Three weeks ago, I broke my fibula (smaller bone in calf) and got crutches. On Wednesday, I had surgery to get a plate and some pins, maybe a screw, really not sure. Here are my tips for crutches and broken legs when your pain is low and when your pain is high.

High Pain

1. When I first broke my leg, I was only in high pain for two days before I could stop taking Hydrocodone and just hit normal Advil. This surgery has been a game-changer. I am still in high pain, though I'm hoping it will start to ease this weekend. If you are in high pain, pay very close attention to taking your meds on time. I was shocked that 10 mg of Oxycodone was not enough, but I called the pharmacist and my doc and they all said it was fine to also take Tylenol or Advil. I'm not exceeding the max dose per day of either so I will need to sub in some Advil for Tylenol today. If you're in high pain, don't move. Keep the leg up way high, drink water, ice the back of your knee if you can't feel it through a splint or cast and sleep. You're just sucking resources right now. You can make up for it later.

Low Pain

1. Be in decent shape to begin with. I'm no Olympic athlete, but I could raise myself from sitting to standing on one leg before I hurt myself. HUGE. As we get older, stuff starts to go. Don't neglect your muscle strength. You never know when you'll go ass over elephant and need to be able to balance on one leg for 20 minutes.

2. Don't use your armpits. My doc told me there are a lot of nerves in there. Set the crutches so you can fit 3-4 fingers between your armpit and the top of the crutch and put your weight on your hands as you swing out. Use your core/abs to swing yourself forward.

3. When planting your crutches on a new surface, give them a little half-turn to make sure it isn't slick.

4. Indoor stairs are best taken on your ass like a toddler dragging your crutches along with you, up or down. Much, much safer.

5. Outdoor steps are crutches first. Going down is easy. Going up can require a big old one-legged hop. If you can get someone heavier than you to give you an arm to pull on, even better.

6. Get a child-sized backpack. Put your meds, tissues, any normal medications you take, grippy slippers or socks, lotion, chapstick, extra glasses, purell and your wallet in there. Don't go anywhere without it. If you need to carry most things from room to room, you can stick them in your backpack. I've even transported drinks by first carrying the glass to the recliner in my backpack then going back for the drink container, pouring it, and taking the juice back to the fridge in my backpack.

7. Use your surfaces. My kitchen countertops wrap from the stove to a breakfast bar. I slide plates and cups from one end to the other and can make meals that way.

8. Embrace a low center of gravity. In a haze of fury the day I found out I definitely had to have surgery, I cleaned three bathrooms and my library wood floor by putting cleaning supplies in my backpack and crab walking around spraying and wiping. Crab walking is also great for getting dressed, putting away laundry and folding blankets.

9. If you go shopping with family, use the store Rascal. I was getting weird looks until I stuck my crutches in the basket. Those things are easy to use but they top out at the speed of a lazy lap dog, so don't bother thinking this will go quickly.

10. Keep in mind you can do almost anything on crutches if you think through the task, use your backpack, take rest breaks and remember there are legless people the world over who rock their lives like a boss.

11. Exercise. I got a chair workout video and already had a floor barre video. I was doing them daily until surgery and will get back to them when I can. When I asked my doc about them, he encouraged me to do them as long as I put no weight on the broken leg. He also said keeping my legs as strong as possible will make physical therapy go much smoother. At first I worried about losing cardio fitness and I'm sure I will, but walking on crutches is HARD. When I feel good and can go along on errands, I feel
like I've run three miles after crutching for the same amount of time.

12. Shower stool. Shower stool. Shower stool. You're at your greatest risk when wet and soapy. Don't be a hero. Also only shower if you're in low pain, because it actually requires a ton of energy with a broken leg. Which is why I haven't showered since my surgery. High hopes for tomorrow. This is the longest I've gone w/out a shower in my adult life, ugh!

Anything I missed?

Health and the Gloriou...
Unintended Bling

It's been 17 days since I broke my right leg, and the healing clock starts over on Wednesday. That's the day they are going to put a plate and some pins in there!

I'm really trying not to think about this surgery too much because I don't like the idea of having things screwed into my bones, even if it does mean they'll heal properly and I'll be able to run again ... someday. Right now that day feels very, very far away, my friends. Right now even being able to leave the house by myself in a car feels unattainable ever again, though that's dramatic and I know it. Still, one of the fun things about being an adult is being able to get the hell away from other human beings if you want to because no one is the boss of you. Except ice. And snow. And crutches. And an aircast on your driving leg.

I spent the weekend vacillating between pity parties and rocketing myself around big-box stores on my crutches just because large, wide walkways are something I don't have in my house and they feel decadent. I never thought I would beg to be taken to Target just for fun without giving birth to another baby. It turns out if you want to recreate that longing for freedom breastfeeding induces, all you have to do is break your driving leg. Who knew?

I've decided to take a hiatus from working on THE BIRTHRIGHT OF PARKER CLEAVES until after the good drugs wear off from my surgery. It's been nearly a month since I took a Library Tuesday, and I fully intend to demand someone drive me there for an hour coming up soon so I can continue to write. I was getting close to being done adding new scenes and ready to go for another scrub pass before my broken leg and my daughter's school break blew the doors off my best-laid plans.

Today, though, that, too, feels so far away. I know in the grand scheme of things this will pass so quickly, but six more weeks on crutches before I can even dream of putting weight on my right foot seems like a really long row to hoe at the moment.