Getting the Light Just Right

 Keith Humphreys presents the following dillema in pain management:

"Every public health official I talk to at the city, county, state and federal levels knows how serious prescription drug misuse and overdose are, yet is also struggling to find ways to limit the damage without causing harm to people in pain. If you can thread that needle perfectly, the world will beat a path to your door."

It's a really sketchy call.  Let me share some of my personal experience.

I've had moderate chronic neck pain since I was in a near-fatal surfboard accident in 1989.  As the onset of the pain was slow - taking maybe 6-8 years to fully present, I watched my quality of life slowly deteriorate.  Depression thus became a growing concern; suicide gradually came into focus as a sort of emergency escape hatch.  The pain was essentially non-stop, worst at night, when sleep was difficult.  Formerly a very athletic skateboarder, my life activities ground to a near halt; more than light/moderate activity risked intense spasms that could last days.

I attempted suicide a couple of months after the birth of my first daughter.  Hard to fathom such a cruel act in retrospect, at the time it seemed perfectly logical.  I was the primary caregiver (my wife taught classes during the day) and the baby was colicky.  I was able to imagine my wife remarrying and finding a better life for her and my daughter with someone who was able to give them what I felt I could not.

I had been taking anti-depressants and over-the-counter tylenol/advil for years.  I had a few sleeping pills I'd stashed from my time spent in a medical environment earlier in my career.  Yet none prescribed.  Anyway, what I took was some combination of those.  I remember regretting it almost instantly.  As the baby cried downstairs, I went to the toilet and tried to induce vomiting.  But it was too late.  I lost consciousness in a matter of minutes.

I found out later that my wife came home from work to find me blue on the couch.  She called the ambulance and had to wait for it to arrive, with me dying by her side.  They pumped my stomach and in two days I regained consciousness.  I spent the next week in the psych ward.  But it was largely unnecessary.  I knew as soon as I woke up what I had done.  It was as if something terrible had rushed out of me, and something beautiful had rushed in.  The pain was still there, it has never left.  But so was my wife, my daughter, my family, my friends, my art, my dreams.  Keeping my mood up is often a daily battle.  But it's never been so hard since.  The suicide, like some taunting devil in the closet, has been banished far, far away.

I now take a doubled dose of anti-depressants and a sleeping pill.  On really bad days I'll take a Xanax.  The doctors I've seen over the years have all been very nervous about treating my pain with opioids.  And for the most part I agree - I try to live without as many "crutches" as possible.  It is partly just a matter of psychology.  The less I worry about my pain, the less I, well, worry about my pain.

But sometimes you can't escape, and it can overwhelm you like a ton of bricks.  A formerly beautiful day full of golden promise can become a wretched bog of shit to slog through.  What a difference a "mood" makes.

I wonder if my pain could have been managed better, I might never have reached the depths of depression that nearly robbed my family of me.  But that's a counter factual too impossible to know.  And yet, there is a correlation between suffering and depression, between pain and suicide.  There is a logic to the thought that the only way to stop the pain is to end your life.  But it is a logic that misses a couple of key things.  One of them is medical treatment.  And the other is the extraordinary power of the mind to transcend physical suffering.

However, that power is not inexhaustible, and all it takes is a few life events to pile up and you have a powder keg of stressors that can break even the most strong-willed patient.  It occurs to me that in this time I was without medical insurance.  Ironically, this was because I had a pre-existing, chronic condition, and could not find coverage.  It may have been no use.  But a better system of pain management, possibly a routine series of visits with a physician every few months, might have helped.  Ultimately, in many ways I got lucky.  These cases can be tricky for the health care system to deal with.  But I find it hard to come to the conclusion that less care would ever be better.  Especially for those who need it most.