What Hurts?

Pain is inevitable. Suffering is optional.

She Was Hot. She Had Dreams.

How will she get it back?

Jacqueline weighed two tons naked.

Round, moist rolls on the outside, crunched vertebrae with spurs and cracked discs inside.She was forty or thirty I can’t remember. I know her spine was sixty.

“I can’t even write anymore!” she said. Her face scrunched in self disgust. “I just recline in my lounge all the time with my laptop but now I hurt too much even for that.”

“No patient gown,” I thought. “We probably didn’t have one big enough. Those floral curtains she’s wearing will work the same. Here’s hoping she has underwear.”

“Who is at home with you?” I asked.

“Sly my cat.” She replied. “I was married. I got fat. He took all the friends. He sends checks.”  Becoming a hot pharmaceutical rep at 28 and nailing a doctor assuaged her grief from quitting on her wish to become a writer. “Let’s wait a little while, honey.” He said regarding children. She spent all he made. He took her all the time. It didn’t fill her so she ate. 

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I had to practically stop breathing to do the physical exam. My swimmer’s lungs were a blessing because she moved as slow as an asphalt truck and radiated the same heat.

Momentarily distracted I remembered, “She’s over the 350 lb. maximum capacity of my operating table.” Then I caught myself, “What are you thinking?! Do NOT operate. This is a no-operation situation. Remember, help the ones you can and don’t hurt the rest.”

While checking spine alignment I lifted a flank panus on her right and part of a squashed sandwich fell to the floor with a splud. Broken glossy skin steamed decay from the folds. Reflexively the back of my tongue pushed up to block off nasopharynx airways. My nostrils pulled in. I could not stop the tendrils of aroma from reaching up my Olfactory nerve into the heart of my Amygdala then defibrillate my Hippocampus. Cerebral valves opened and squeezed a gusher of memories.

Africa. Malawi. The Leprosarium. Cleaning wounds all day. Red dust. Sweet nauseating air of fetid flesh. The spectral shadow in all huts. Each had been cast out of their family, tribe, village long before death would come. Each now depended on the small vegetable garden and the ones that could hoe or make crafts to sell. The ones that made new friendships lived. The others didn’t. All smiled for the missionaries who thought they could empathize.

In his book, Pain: The Gift Nobody Wants, Dr. Paul Brand tells how having lost protective nerves, “lepers” cannot avoid injuries. Scratches and cuts become infected without warning. Since pain is essential for healing as well, the wounds appeared to eat them alive. Without nociceptive messages the victim could not be convinced of the new injury.

I once worked in a Leprosarium in Africa. Now I work in the “Obese-arium” that is the USA. Jacqueline’s flank ulcer tweaked my mind to a lateral connection. Like the people I saw with leprosy, the people I see with obesity are often cast out of their family, marriage, and village long before death. Their spines get crushed prematurely and they miss the warning signs. The injuries pile on because they cannot be convinced of the old injury.

WHAT THIS BLOG IS ABOUT

In this blog I share some of the anecdotes and pearls I’ve gleaned from over 70,000 cases. Names and details changed for privacy.  There are three parts to each post:

1. What people tell me vs. the real issue.

2. A comment on the neuroscience of the case.

3. Observations and philosophy on pain and suffering. 

Jacqueline told my staff the appointment was for her back pain. She couldn’t even sit in her recliner and write anymore. The focal back pain was easier to treat than the bigger issue. She really felt disoriented by missing out on being a mom and writer. She broadcast the image of a hot party girl and got the guy that loves fun girls, not writing mothers. Giving up on writing and collapsing under her weight squeezed out hope.

Research suggests that the Ventral Anterior Insula is the pacemaker of disgust. When the sandwich fell out, both Jacqueline’s and my Insula jumped with a scream. Other neural networks were immediately recruited including, visions, smells, and vagal tone.

Insula
Pacemaker of disgust
Once the neurotransmitters are fired it’s hard to hide. Rachel Hurz, PhD, explains in her book, The Scent of Desire, that disgust includes empathy for oneself at having to observe something repulsive. Well-honed habits and philosophy can steal one to regain empathy for others. Empathy makes community.

Believing we’re trapped is killing us. Feeling alone and trapped is making us obese. Fear of rejection and forgiveness is making us isolated from community. Check your thoughts with someone.

Oh, ya. You’re reading this.

“Jacqueline needs to keep writing,” I thought. “How about blogging?!”

 

 

Vance Z. Johnson, M.D., is the medical director of the University Spine Institute.

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