King of the Mountain

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There is a patient of mine who suffers terribly from awful back pain. Every time I see her, she enumerates for me the litany of issues that she has stemming from her pain.

Lack of sleep, medication side effects, depression, inability to work, difficulty caring for herself…

Each time I see her she tells me that the pain is excruciating and unbearable. I have no doubt she is suffering. Sometimes patients exaggerate symptoms. She is not.

There is a treatment that may help her. She has never tried it before. If it doesn’t work, she can stop and she is no worse for the wear. Very low risk.

She has no other options. Pain medications did not help, she has tried every last one of them. Neither have injections. Surgery is not possible. All she has left is this.

“Doc. I know my body and I know this will not work for me.”

So each time I see her, I watch her suffering. I see her life shrinking right before my eyes. Yet she remains steadfast in her refusal to try this one thing that may help her.

I wonder why?

Has she been burned too many times? Afraid that if this last hope doesn’t work then she would face a lifetime of despair? Is she just too used to the patient role, realizing that if she gets better that she has to rejoin life again? Does she actually enjoy pain? Has it become a close friend?

Or is it about control? Is it about maintaining that one last bit of control over one’s body when it has failed to obey your wishes in every other respect? A game of chicken of sorts, a dance with pain? See who will push who first off the mountain?

I have asked her these questions. She denies them all as plausibilities. So I sent her away again today, back to her home, with no other hope. I hate that.

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28 thoughts on “King of the Mountain

  1. Could the years of chronic pain have clouded her judgement? I mean her perception of the future, or an imagining of the future, free of pain could be an ability diminished by years of chronic pain and the side effects that comes with.

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    • You have hit upon an interesting point, John! If so, how to treat that? She has refused meds for depression but maybe that is where I need to focus my energy instead of presuming that fixing the pain is the ticket for fixing her depression.

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      • And now you’re in a circle with no way out. Or at least no way I can see. I have no idea what the long term psychological effects are for this level and length of pain. If a person was cured after an extended period of chronic pain would they then, or continue to be, depressed or even have a case of PTSD thinking about the time that was lost. Is there a point of no return? I don’t know. I can’t imagine a more all consuming hell than if my own body betrayed me in such a way.

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      • It is well documented that depression occurs with chronic pain. In fact, treating depression can help improve pain. She may have reached the point of no return, if there is one. She is not a threat to herself or others per se. And certainly she has the right to refuse treatment at all costs. I just have such a hard time giving up on her.

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  2. I do not know why I would comment – you’re a doctor and already know most anything I could offer! From personal experience as a disabled person (combat veteran, 100% with PTSD and unemployable), I know that I have caught myself identifying with the disability and actually NOT wanting it to change, even when I would vehemently deny such an assertion. That’s not easy to admit, but the upside is that I recognized the ego’s “saboteur” mentality and applied myself to techniques and ideas that could help. Not many of them have made any difference, but a few did, and I’ll take any improvement in the quality of my life that I can get. Maybe she has the whole concept of “who she is” wrapped up in the condition, and that is a frightful thing to let go of because it leaves one having to start over without really knowing how. Just a thought. Peace . . .

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    • Thank you so, so much for your comment! That is actually sort of why I posted this here, to get feedback from real people. Doctors, we sit behind our desks in our ivory towers…what do we really know about human suffering except what we observe from the outside? I have wondered about the “who she is” thing. I had hoped that by asking the question it might throw her off guard enough that she might be able to open up about it. I appreciate hearing your take. Makes me think I might now be too far off, then!

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  3. I can relate to this to an extent . . . I have lingering, at times immobilizing, back pain from a car accident. I went through physical therapy, took the pills, tried the injections . . . I shrug off the suggestion if surgery because there are months I enjoy relatively pain free bliss and the possibility of something going *wrong* terrifies me. Sometimes I do think we make friends with our pain when we have exhausted, or think we have, our options.

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  4. I delayed taking a drug that has helped me enormously. I did it because there were questions that nobody seemed to be able to answer — it seemed that nobody had thought of them. (It’s an immuno-suppressant and I wanted to know how it would impact my daily life. Could I go to the grocery store, the movies, the theater, etc. Did I have to live in a bubble?) Finally I had no choice and I found out my own answers to these questions (it’s no big deal at all, and I feel terrific on the drug, awful off of it.)

    What’s my point? Is there another patient who has had this procedure that the reluctant one can talk to? I would have started my treatments a year earlier had I known someone I could talk to. There are questions a patient is reluctant to ask a doctor, or the doctor really doesn’t know. Reading about stuff doesn’t give you the full picture.

    One other thing. I can’t tell you how many times doctors have minimized the pain/difficulty/inconvenience/etc. of a treatment I have had. One surgery I had, that I may have to have again some day, was the most painful procedure I have ever had. And it hurt for 4 months because they placed a ring of plastic in my anus that bit me with each breath. It was truly excruciating. My doctor insists it was “mildly uncomfortable.” I counter that the damn procedure was invented by the Spanish Inquisition.

    She is not being uncaring — she simply hasn’t been there. There are things you simply cannot know until you have been.

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    • You are absolutely right when you say most of us have no idea of the tortures we are inflicting on others! I had a male physician tell me that a woman’s cervix has no feeling. Whatever. I can tell you after having mine pinched with forceps that there was plenty of feeling there! 😉 I wish more patients would be willing to support others. I would love, love, love to be able to hook patients up with similar issues and have them go at it. In this community, that is regarded with suspicion unless that person is already in your social circle. I love your insight. So helpful!

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      • Interestingly, I just found this:
        Treating People, Not Patients (World of DTC Marketing Blog)
        70 percent of all Americans are on at least one prescription drug, and 20 percent of all Americans are on at least five prescription drugs. And according to the CDC, approximately 9 out of every 10 Americans that are at least 60 years old say that they have taken at least one prescription drug within the last month. Are we treating patients with an Rx when they might need other forms of treatments? Blogger Richard A. Meyer explains.

        Here’s the link (as it didn’t copy): http://worldofdtcmarketing.com/treating-people-patients/cost-of-healthcare-in-the-u-s/

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  5. You’re a DO and I don’t even play a fake doc on TV…so I’m sure you’ve considered this already. Transdermal magnesium therapy for a one-two punch depression fighter and pain relief option? Inexpensive, might lift the burden of depression a bit to clear the way for better thinking, and then things like SAM-e or such? Although some people are averse to even natural therapies in a case when it has been chronic for so long. My .02 shekels and you’ll probably have some change back 😉 I’ve known a few people that this has proved very helpful for, and there is some pubmed lit on it as well.

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