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Wednesday, 17 March 2010

lessons from the Pain Clinic

You know what's another awkward moment?
When a grown-up man cry in front of you.

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Why did the Man cry?

He sat there, with his broad shoulders and chiseled jaw. Looking like he could rearrange someone's face with his fist without a moment of hesitation. No doubt bout that, as he used to be a sportsman. One of the 'Heavies', as they call it, those who participate in the Highland games.

He took his seat in the clinic, portraying a strong, confident image. One scowl from him and no doubt anyone would scramble out of his way. I'd looked like a small kid next to him, oh he's tall and big as well. He's so manly, I'm going to refer to him as the Man.

Yet here the Man was, in the Pain Clinic. Why would such a strong person, both physically and the way he portray himself, be here? He could easily take a punch and still manage to send the puncher flying. He looked like someone who will grit his teeth and bear the pain, not someone who come running to others for painkillers. In fact, he did not even attend the last few appointments at the clinic.

So why was he here now?

Well, the Man upped his painkillers by himself so much he almost killed his liver instead. The pain was so frustrating to him, he just wanted to get rid of it no matter what.

So the consultant had to go through his medications, trying to figure out what he had been taking and what could be changed to get on top of the pain.

And then the Man broke down. He sobbed.


The consultant gave a very good explanation of what chronic pain is all about. There are three components to it: pain, mood, and suffering. They are never mutually exclusive, one cannot separate one from each other. And everyone responds to chronic pain the same way. They get depressed, even if they do not seem like someone who would let it get to them at all.

If one only treats the pain, he'll be left with the anger, frustration, resentment at his own plight. Just stuff him with antidepressants and make him as happy as larry, he will still feel the pain. Either way, there will still be suffering.

Pain is never one-dimensional. Painkillers will not solve the problem.


This is the first time the Man ever cried in front of another guy.

"This isn't like me", the Man said. And you would believe him. "I'm not the kind that gets depressed. I just sail right through it. But underneath it I can feel it boiling, the anger, frustration."

It wasn't the pain that made the Man cry of course.

"I just wanted to do things I used to do."

"I truly understand. But put anyone in your position and he will feel the same. Tell a person in the street you will give him pain 24 hours a day, 7 days a week, 365 days a year, and he will punch you in the face. And then he will feel angry and frustrated. He won't wake up feeling great, feeling able to face another day of pain." The consultant empathises.

"You are someone who will set your goals high and do it. You will do something and ask, 'Why can't I do that?' And that is why the pain will get to you. You will not be able to do things you were able to do in the past. You will feel less of your worth, needing to 'downsize' your job to get a less physical one you can do. It's not easy. I know you felt like you lost yourself."

"What we needed to do, is to bridge the gap between expectations and reality. The pain will never go away. I'm sorry to say that it's the harsh truth."

It was the prospect of living the rest of his life with the pain and the disability it brings.

"There is no point setting unattainable goals, because you will never reach it. But start slow and work your way up. You are not going to be hurling anvils anytime soon."

"I'm not even bothered to do that now," the Man laughed.

"Yes, that will just break you. So start with throwing matchsticks. I can do it, you can do it. I know it sounds pathetic but you have to start somewhere. Then move up, a matchbox, a twig. Get to know your limits. Expand what you can do. And I'm not saying you won't be able to do some things in the future. You can still achieve those goals. It's just not what you do."

"It's how you do it," the Man agreed, wiping his tears.

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No one would deny that people with chronic diseases like cancer do suffer. But when it comes to pain, most people just brush it off. It's something you're expected to grit your teeth and pull through. It's easy to downplay the suffering of someone with chronic pain, not knowing how debilitating it can be. How much suffering it can actually cause.

Today, I learned that the pain specialist's most powerful repertoire is not his pills and injections. It's the words he spoke.

Hopefully, the consultant anaesthetist had managed to change this man's mindset in coping with chronic pain. To live with chronic pain, instead of resenting it.

And I was left with awe. He changed someone's life, before even doing anything to his pain. You know the moment when you look at someone, and you just want to be like him/her when you grow up?

I just had that moment (:

Thursday, 11 March 2010

The S word - Part I

There's always that uneasy feeling among the bystanders when suicide happened. It's a rather awkward, morbid phenomenon to encounter and most people just don't know what to do. All they can think of are questions. Why? Why? Why?

During routine anaesthetic work in the theatre, a man was rushed into the A&E downstairs after being found unconscious. Very hypothermic, unresponsive, with empty boxes of medication nearby and sheets of information on drug overdose printed off the internet. Almost went into cardiorespiratory arrest, and CPR was done all the way from being found to being resuscitated in the A&E. I followed the anaesthetist consultant down to see the poorly guy, with dozens of people already buzzing around him.

Venflons, pulse oximetry, CVP, arterial line, ETT, NG tube, gastric lavage, peritoneal lavage, urinary catheter, temp probes. Nurses, doctors, students rush about compressing his chest, ventilating his lungs, putting up fluids, drawing up drugs, taking off bloods. All the hospital staff could do to salvage what they could from this man.

Even when he must have thought there's nothing to salvage from his life anymore.

It's baffling, isn't it, why some people chose to end their lives as the solution. Of course, the hospital staff's job is to save his life and not wonder why. Eventually he stabilised, although remained unresponsive to pain. Non-reactive dilated pupils.

It was thought he could have been brain dead already, with only the machines keeping him alive. He was then arranged for a transfer to the nearest ICU in another hospital, hours away. As the emergency passed, everyone eventually left the room to resume their daily routine in other parts of the hospital, entrusting the anaesthetic team to look after him.

Just as quickly as the room was filled with activity, it suddenly became calm and peaceful, with just the monitors beeping away the patient's vitals. I went in to check on the various tubes connected to the patient, and that was when I saw something that broke my heart.

On the back of his hand, he had written with a pen.

I'm sorry

I stopped there for a minute and just stared at the writing on his hand. All I could think of is just one thing. One question.


I pulled back his eyelids and stared into the distant eyes. No response at all.