Pain

I have been thinking a lot about pain since mid-August when I woke up one morning with a knee so swollen and throbbing, I immediately thought of being in labor. It was reminiscent of that first time when my labor pains had reached a crescendo, twenty-five years ago, in that there was no way to escape the pain, no way to get comfortable. I would get on my hands and knees and rock back and forth like a tiger ready to pounce. Or lie on my back, raise both legs in the air and spread them like wings, back and forth, my mountain belly peaking hard near my belly button, as my daughter punched her way down the birth canal; a boxer headed for the ring. I would pace the cold linoleum floor of my birthing room, clutching periodically at the bedsheets and resting my forehead on the edge. There was no escaping the pain.

Giving birth would have been preferable to the problem with my knee. At the conclusion of labor, there is an end to the pain -- you receive a grand prize. Along with that bluish, wrinkled infant that finally slides out of you with a rush of star-bursting relief, you feel such an explosion of endorphins that time practically stops. All the rushing between your ears matches the rushing from between your legs, a river carrying promise of the kind of love you have never known before.

This knee pain on the other hand had no promising end. It went on and on and blossomed into something so huge it took over my universe. I was consumed with it. For over a week I writhed through sleepless nights and cringing days walking like a limping zombie, alternating icepacks and heat-packs and ibuprofen, naproxen and hydrocodone and encountering mere glimpses of dulled moments, like fissures between rocks that would close behind me just as I crossed over them.

I went to an orthopedist who drained 100 microliters of fluid from my knee, which both fascinated and repulsed me. By this time the pain had started to abate, but like a leaky faucet, it was a constant reminder that it still required fixing. I waited four days longer, wrapped my knee periodically with a tight bandage and tried to ignore it, like a child throwing a tantrum in the corner. I went back to the orthopedist, who reminded me of a track coach I once had in high school. Optimistic, excited, strangely interested in my knee. He drained more fluid and then injected my knee with cortisone. Within minutes I was agape, full of wonder. This was the magic elixir; this was what I had been praying for from the pain-reliever gods. I grasped my knee like a long-lost friend, hugging hard at our reunion, patting each other’s back. My energy soared and my brain suddenly switched gears like lifting the needle from the record you were playing over and over…for ten days my internal song had been pain pain pain oh my god stop the pain. And now it was whoop yah! Coffee? Yoga? Sleep?

I was diagnosed with pseudogout. I read up on it, but it all seemed like something I had no control over. The mysterious crystals hiding in my knee like a dragon holding its fiery breath, waiting in its cave for the next victim to saunter by the opening. And then, fire pluming, a ring of pain.

I always thought I was tough. Resilient for sure. Someone who knows how to make the best of things. Bounces back. I had a lesson to learn though. After the cortisone shot wore off, I had lost seven pounds. I was jumping around like a jackrabbit, ready to kayak on the Nehalem River, hike Falcon Point, and boogie at the local watering hole in Manzanita, where our friend’s band was playing classic rock for the night.

Two days later the pain came back, in a different location now: my upper body. It felt like a corset that bound my chest and shoulders. I could hardly breathe, and my neck would turn only to two and ten o’clock. My shoulder blades burned as if someone had pulled handles out of them and carried me on their back, up a mountain, and down again. What the hell is this? My mother was visiting with us, and I tried not to cry. She was one person I knew I could cry around, but my ten-year old self stopped short of this. Still, I whined by her easy chair as she sat knitting, like a mewing cat.

I had an appointment that had been scheduled over a year prior with a new rheumatologist. My beloved Doctor Lauren Kim had retired to take care of her own aging mother. At our last appointment together, I asked her if there were any other specialists in Scleroderma in Portland. She did not beat around the bush.

“No. I am the only one.”

I blanched.

“All of my colleagues are ‘fine’ to see, they are good doctors.” She held up both index fingers at the same time. “But, if you need a specialist, which I think you are okay now, but you might want to find one in the next ten years or so, you’ll need to look outside of Oregon.”

I felt tearful, as if my mother was flying to Micronesia on a Peace Corp mission for the next three years. I was not ready for Doctor Kim’s kindness, her expertise, the confidential way she sat on her stool and asked how I was, to leave me.

The rheumatology clinic rescheduled several times with me during 2020, for an appointment in 2021. It was understandable, as all in-person appointments had taken on new parameters during the pandemic. And I was okay. As fortune would have it, my appointment coincided with a week after the Pain (which was now a proper noun) had resurfaced in my torso. I met with Dr. Neha-Garg, mask on, and assessed her compact, bow-legged stature as she entered the room. She wore converse sneakers; jeans and a zip up pull over sweater. She looked ready for an urban hike. She turned sideways from me, typing at her standup desk the chronological events of my episodic Pain. I could see what she was typing, and I corrected her as she read out loud, dictating to herself. I wondered if this was something they taught in medical school now – transcribing as accurately as possible a patient’s recall of their medical events. It felt more interactive than other doctor’s appointments, where you remained passive while they peered at your tonsils and manhandled your joints.

“I think your pseudogout is in your neck now,” she commented, appraising me with her eyes for only the second time since she had entered the room. I warmed slightly to her.

“Let’s get you on a course of prednisone to knock it out.”

I nodded.

“Let’s see, how many days…” I watched as she did some mental calculations in her mind and surveyed the options on her screen. It seemed that prednisone had as many variations in doses available as there are food choices on the menu at Olive Garden.

“We want to not overdo it, but we also don’t want to under-do it.”

I smiled. A medical term, I am sure. Prednisone is apparently not to be meddled with. I have discovered this, as I am now on my third bout of pseudogout, back to it’s home base, my left knee, and my second round of cortisone and prednisone, and I am flying high as a kite, wide awake until 1am, rising at 5am and ready to go at my day like an ultra-marathoner. It feels so good. Is this what it’s like to have enough cortisol in your system? Have I been lagging like a thirsty old dog emerging from a long walk in the woods, all these years, with my inflammation, my autoimmune disorders, my fatigue, my PTSD, my whatever?

I am trying not to think about when the prednisone course ends, and the cortisone shot wears off, and the tempting mercurial response my body might choose again; the return to the Pain, the aching, burning, hateful Pain that takes over my life like a wildfire licking at the edge of trees at the back of my yard. I sense it waiting in the Fall gloom. A lit match, dropped to the ground, it licks at the dry leaves until the flames bounce up, jubilant, soaking into my skin, through my joints and up to my neural pathways where I yell and resist and feel overcome.

But what is the other side of this? I am no stranger to choosing certain balms to help me live sanely in the world. I’ve used alcohol for sedation from anxiety, ibuprofen for stress headaches, Epsom salt baths to separate myself from the rumpus of four noisy adolescents after long days at my computer. I have discovered something new, which counteracts that which is newly attacking me. It is a shield deflecting the poisonous arrows, a rope pulling me back from the sea, these lovely steroids.

What now? Two months, and I see a rollercoaster in my path, the sickening drop, the slow rise to the top, where the birds question why you are so close, if only momentarily.