Staying ahead of the pain

I lean against the wall with my left shoulder pinching the tubes between my arm and the wall, pushing them forward and holding them steady. My right hand, clumsy as ever, holds the hose that's connected to the little cooler. With one hand I push the ends of the hose toward the tubes dangling from my left arm. As the two nozzles connect with a quiet click, I feel the ice water begin to circulate in the pad strapped to my shoulder. The cool relief cuts through the queasiness from the percocet even though it doesn't do much about the top-of-my-head-is-detached-and-floating-away feeling that sounds like it should be enjoyable but really isn't.
Over the last 48 hours I've been learning about pain in all its myriad forms, and what it means to "stay ahead of it." When I first came out of surgery I was hooked up to the ice machine which I couldn't feel anyway, because of the nerve block which had deadened my arm. I was acutely aware of the ice pad digging into my left side, which was not blocked, and the IV in my right wrist, which felt like it was digging and grinding into my arm every time I moved. But mostly all I wanted to do was doze off. My left arm felt like another person's arm, warm but completely limp. I willed myself to wiggle my fingers - nothing. I watched the nurse stroke and wiggle my fingers. "Can you feel this?" I can imagine what it would feel like, but no, I couldn't feel a thing.


The shoulder surgeon told me that I'd had a 360-degree tear of the labrum and he had to use SEVEN anchors! to reattach it to the glenoid (shoulder socket). I heard the buzz in the recovery room when people talked about my shoulder: "SEVEN anchors!" always with the !! and always with SEVEN in caps. I had no idea what it meant but it sounded serious.


The doctor prescribed percocet and naprosyn, telling me to take 1 to 2 tablets of the percocet every 4-6 hours as needed for the pain. When the nerve block wears off later today, he said, your arm will come back from the fingertips first. When you start to feel some tingling in your elbow, he warned, you will want to take 1-2 percocet because that's your 10-minute warning that your shoulder will start to hurt.


But I don't want to be totally zonked on painkillers, I said. If I feel ok, can't I wait until I actually feel some pain? (After all, I reasoned to myself, I've been through three shoulder dislocations already, and one of my coworkers who's been through both told me that a shoulder dislocation hurts worse than childbirth. By that measure, I've already birthed 3 babies without anesthesia. It hurt like hell, but arthroscopic surgery can't be that much worse, can it?)


Dr. K said, very gravely, you should take the percocet. Don't wait 'til it starts to hurt. You want to stay ahead of the pain.



After a couple hours of grogginess in the recovery room, P-Daddy took me home. As soon as we got home, though, he got called back to the hospital. For those of you who don't know - if you sever a finger or a hand in the greater NYC metro area, and need it reattached, P-Daddy is the guy you need to see. If you hurt your hand or break your arm any other way, if you are below 42nd St., chances are P-Daddy will probably hear about it. This was about the worst - a VIP (family member of a fellow orthopedic surgeon) had severed a finger and they had just shown up at the ER. Although P-Daddy would have stayed if I asked him to, I couldn't in good conscience do that. Besides, I felt pretty good and I had pain meds and all I needed to do was rest anyway. Around 3:30 pm, my elbow started tingling and P-Daddy gave me a percocet right before he left. I slept for several hours and my friend Jane brought dinner. I was pretty much pain free and we laughed about my limp arm. I finally had feeling in the fingers and could wiggle them a little, and my elbow was still a litle tingly but not much more. But I was relieved that I could still carry on a conversation even if I felt a little woozy from the painkillers, and the little ache I was feeling in my shoulder was totally manageable. At 8:30 pm, just before Jane left, P-Daddy called to tell me he was going to be several more hours. Looking at the clock, I figured I might as well take another percocet now. One every 5 hours was not a bad pace to start, and it would probably tide me over until P-Daddy got home. I reached for the pills and wedged the bottle in my sling against my limp arm so I could take the cap off with the other hand. Here, let me get that for you, you gimp, Jane said, laughing, and took the cap off and shook out a pill in a swift, two-handed move that I'd taken for granted all my life, anytime I reached for a bottle of Advil or vitamins. Thanks for contributing to my drug use, I said.


10 pm - with the help of our neighbor (Zola's mom) we walked Biggie in the sleet and came back for a play session in the lobby with Zola. Our neighbors all remarked on how lucid I seemed on the pain pills. Yeah, It's really not too bad, I said. Much better than I'd expected.


At 11:30 P-Daddy called to say they'd just finished in the OR and he was coming home. About 10 minutes later the pain caught up to me.


In retrospect, the nerve block probably didn't fully wear off until then. Before that, it was just toying with me and my macho, I-don't-need-drugs mentality. It started with a little niggling ache deep in my shoulder. It was a little early to take another percocet if I was trying to keep to the 1 every 5 hours schedule, but I could take up to 2 every 6, so maybe I could do with another pill.


I got the pill bottle and tried to open the child-proof cap by steadying it on the counter with my barely functional left thumb and forefinger while pressing down with the right. No go. The niggling pain started to throb a little. I tried using my hip and more of my left hand to wedge the bottle against the edge of the counter, turning with the right. I had images of the bottle and cap flying through the air, pills spilling everywhere and the puppy gobbling them up. When I tried to brace my left arm to give some resistance, all I got was a torquing, fiery pain shooting up my arm and deep into my shoulder. I think I whimpered.


Stopping to catch my breath, the pain shifted shape again and settled in. I thought I could feel every one of the SEVEN anchors drilled into my bone. I thought about other one-handed ways to open the bottle, including using tools. Given my complete ineptitude with my right hand, I stood a better chance of injuring myself than getting the bottle open. P-Daddy was on his way home, so all I needed to do was survive a few more minutes of the pain.


If I could only lie flat on my back and not move, maybe the pain could be manageable. Biggie lay in his crate, watching me sympathetically. I would have to meditate my way through this. I eased myself onto the bed, whimpering with the effort and hating myself for whimpering. The pain changed yet again, burning and throbbing and coming in waves. I braced my feet on the bookcase next to the bed and tensed my legs with each wave of pain, as I compared every aspect of the current pain with the double dislocations from my skiing fall and the pain of easing my body into the Sled of Shame and feeling every bump in the mountain as we slid down to the clinic. The pain from the dislocations was worse, but this time I was alone, with no adrenalin and no snow to numb my shoulder.


Seconds passed like minutes, and I finally gave in and started crying. Oddly, it felt a little better. I raged at my powerlessness, lying on the bed in excruciating pain. The tears flowed down the side of my face, and I hated that childproof cap with all of my energy. I was angry at P-Daddy's patient for cutting his finger off, angry at P-Daddy for leaving me alone, and really angry at always having to be the brave one. Here I was, incapacitated by a child-proof cap and all alone barely 12 hours after surgery, and my husband is off taking care of someone else. I railed at being alone. All our friends had said, You must be so lucky to have P-Daddy 'in the business' and there to take care of you. Look at me now! I wanted to scream. This is the picture of the doctor's wife, whose husband is taking care of someone else while I am a blubbering, incoherent mess!


I managed a short call to P-Daddy, who was only blocks away. You have to come NOW! I sobbed. I can't stand it anymore, I really can't, I can't, I can't do this, I really can't handle it, please you have to make it stop, I can't get the pills open. I can't stand this pain...


When P-Daddy burst in the door and ran across the apartment to give me two pills and I grabbed a bottle of water to gulp them down, my last thought was, this is what drug addiction must look like - wild hair, tears of pain mixed with tears of relief, to be so desperate for the pills that nothing else matters.