Struggling against the almighty tides of eventuality

Update: I’ve set up my own blog for pain purposes.

In the past, I’ve written extensively on the subject of chronic pain, and opioid therapy to treat that pain. In those writings, I’ve mentioned as an aside that these things apply to me, being that I am a chronic pain patient. What I haven’t done is write extensively on my specific pain, my specific treatment, and how my pain changes my life. There are reasons for this.

The main reason is because–until recently–I didn’t want to believe that my pain affected my life at large. I didn’t want to believe that this can not only affect my life, but it in fact dictates the majority of my day. I wanted to believe that I could take medications and ignore it and continue on the path I’ve chosen without modifying anything. To my disdain, this is painfully untrue.

In high school, I participated in running sports like Cross Country and the long distance division of Track & Field. I ran 6-8 miles every night, and I was in fantastic shape. I continued to run after high school until I was around 19. At this age I started having a dull ache at my tailbone. It was intermittent and mild, so I’d take over-the-counter (OTC) analgesics like acetaminophen, ibuprofen, and naproxen. As time passed and my age grew, so did my pain. The pain spread to my entire lower back and started taking over my life. By the time I was 21 OTC analgesics weren’t working anymore, and I had no health insurance. After being turned away at free clinics under suspicion of drug-seeking, I started going to an ER on a regular basis. They’d occasionally give me a shot of hydromorphone or prescriptions for a few day’s worth of muscle relaxants and opioid analgesics, but 90% of the time they’d also turn me away under suspicion of drug-seeking. At this point, the pain was nearly constant and unbearable. The clinic the ER sent me to for follow-up had a lazy doctor who never treated anything but crotch-rot and runny noses. He sent me to Physical Therapy, and a litany of other specialists within the charity hospital. I had x-rays and MRIs and no one ever saw anything. So, again, I was ignored for what was presumed to be drug-seeking behavior. Then, the aforementioned clinic was aquired by new management, and with this came a new doctor. I gave him a shot, and gave him my history, and he decided to give me a chance. I went through two-week trials of every NSAID you can think of, until he finally agreed to give me opioid analgesics, under the condition that I would continue to try to figure out what was wrong with me, and that he would stop prescribing them when I did. Around the time I turned 22 I moved 900 miles from that clinic, to Baltimore.

In Baltimore I spent about a year making my way through an orthopedist, rheumatologist, gastroenterologist, and a cardiologist. The original orthopedist discontinued the opioids and gave me injections, which worked at first but quickly faded. He gave me a few month’s worth of opioids and referred me to a pain management doctor. This doctor diagnosed me with lateral facet joint hypertrophy, or more plainly, a severe form of arthritis in the joints of my spinal vertebrae. He continued the opioids and gave me a multitude of injections, which didn’t help much. I was still miserable despite the narcotics and one day I broke down crying and he decided to pull out all the stops and put me on some real opioid therapy. I started taking extended release morphine along with the hydrocodone I was already receiving. In the time since I’ve been on methadone, and now transdermal fentanyl fills the role of my 24/7 medication, and the hydrocodone has been replaced with oxycodone. I also have adjuvant medications like muscle relaxants and sedative/hypnotics. All in all, it took nearly four years to get my pain under control.

Now that I see a good doctor–who does his best to help me manage my pain–I thought my fight might be over. It took day after day of good days and bad days before it dawned on me that I only won a small battle, and while I’ll spend the rest of my life at war, I’ll never win. I’ll continue to have good days where the pain is balled up into a corner of my mind, and I’ll continue to have bad days where I’m balled up into a corner of my bed. I’ve always known this, but only recently has it really fully elucidated itself: I will be in gut-wrenching pain for the rest of my life.

Knowing that, it begins to dawn on me that I will be unable to live the life I want to live. A given activity may be restricted or even impossible for me to endure. Walks in the park are now a test of my pain threshold rather than a harmless stroll. Going out with my girlfriend to places like malls is now not only mind-blowingly boring, but back-breakingly painful (one might think this is a good thing, but any time together is good time together). Not only are these things difficult now, but my condition is degenerative; it will continue to get worse every single day, as will my pain. While a walk through the mall may seem hard now, walking at all may be an arduous task in the not-too-distant future.

So where do I go from there? Will I become legally disabled and unable to work? What of my plan to go to medical school? What of all the hard work I’ve already put into school? Medical disability programs in this country are pitiful, and a mere pittance compared to my current income, let alone the future income I could achieve with a medical license. Being a physician is physical work, and carries the longest hours of any profession. I’m not implying that I couldn’t get a degree, but what am I to do with it if my physical limitations continue unabated? Will I be seeing patients or will I be relegated to boring research?

The degeneration could be curbed by strong back muscles, but in order to get stronger I have to exercise, and that is quite difficult when mere walking is a test of pure will. I don’t believe any amount of medication in the world can change this. My medication barely allows me to function in the world. I’m lucky when I get out of bed and get back into it without some horrifying pain in-between, let alone adding purposeful physical exertion into every day. Perhaps if I take a morphine shower afterwards.

As things are I take quite a bit of strong, dangerous medication and it barely manages an uneventful day. I frequently employ the aid of a cane. If I so much as play with my little nieces or wrestle around with my girlfriend, I pay for it dearly. I used to think that bill would stop coming, but I really do realize now that bill controls my life. It controls what I can and can’t do. I can think “don’t let this control me, don’t let this be who I am,” and yet it is anyway. My pain is my life, and my life is pain.

Well it’s a sad picture, the final blow hits you
Somebody else gets what you wanted again
You know it’s all the same, another time and place
Repeating history, and you’re getting sick of it
But I believe in whatever you do
And I’ll do anything to see it through

Because these things will change, can you feel it now?
These walls that they put up to hold us back will fall down
It’s a revolution, the time will come for us to finally win
We’ll sing hallelujah, we’ll sing hallelujah

So we’ve been outnumbered, raided and now cornered
It’s hard to fight when the fight ain’t fair
We’re getting stronger now, from things they never found
They might be bigger but we’re faster and never scared
You can walk away, say we don’t need this
But there’s something in your eyes says we can beat this

‘Cause these things will change, can you feel it now?
These walls that they put up to hold us back will fall down
It’s a revolution, the time will come for us to finally win
We’ll sing hallelujah, we’ll sing hallelujah

Tonight we standed on our knees
To fight for what we worked for all these years
And the battle was long, it’s the fight of our lives
But we’ll stand up champions tonight

It was the night things changed, can you see it now?
These walls that they put up to hold us back fell down
It’s a revolution, throw your hands up ’cause we never gave in
We’ll sing hallelujah, we’ll sing hallelujah

Been feeling down lately. Wait, what am I talking about? I’ve been down for a long time. Every now and then I’ll get into a little episode of depression, just like most of us humans. It’s normally inexplicable, and equally harmless. Most times homoeostasis is returned within mere days, but I’m starting to think I may actually have a depression problem.

At first, I thought it was just a bout of homesickness. I don’t particularly care for my life at the moment. So far I’ve managed to convince myself it’s merely a transition–I must simply “hang in there” as it were, while my beloved girlfriend completes nursing school, which will allow us to move anywhere we please–or so the theory goes. The problem with this is I can only convince myself for so long. The cold hard truth is that there is a big difference between plans and reality, and reality has never seemed to have much of a predisposition for conforming to my plans–in fact, it seems to almost have its own plan for my life. I would prefer it left it to me. I find that reality is almost always wrong.

My friends from back home ask me what I’m doing in Baltimore, and when I tell them I work for an engineering company that has me write computer software for the government they’re pretty impressed–if only I were also. I’ve been doing this for a long time, and I’m no longer particularly interested in it. In fact, when I coded as a hobby I vowed I would never rely on it for a paycheck, simply because I cannot maintain an interest in some arbitrary project. I have the “open source itch,” as it’s come to be known. That is, I have an urge to code particular things I’m interested in, and not something that a project manager tells me to code. Fortunately I’m not in that situation–I get to code however I want, with whatever method, style, or language I prefer–but I still don’t get to pick what I code. When I first started this job I ran at full speed; I completed two major projects in the first three months, one of which had been in limbo for nearly three years. I am good at what I do, I just don’t like what I do.

So what do I want to do? Due to various encounters–positive and negative–with the healthcare profession, I would very much like to attend medical school and work as a pain management physician. I don’t know if I’m smart enough, and I don’t think I’m young enough. If I wait until my girlfriend has finished nursing school I will be–at the minimum–three years shy of thirty before I can even start pre-med. I just can’t convince myself this is a realistic thing to do, especially seeing as how we have plans to start a family around that time.

I dreadfully find that I have fallen into the exact same predicament most members of our society do–one that I promised myself I would never be trapped into: not achieving my dreams. Most of us have something happen in their early twenties, and you think “oh, I’ll just wait a year until I can figure this out,” or “I’ll just take a few years to get this right,” and then you turn around and it’s been five, seven, ten years. I’ve spent a mere twenty-three years on this planet–four of them taken away by intractable pain that isn’t stopping anytime soon–and already I feel the pressure of time slowly pushing me farther and farther from my dreams.

I see my friends saving money, buying houses, having families; I see me stuck, as if running in a dream: never quite able to catch what you’re chasing. No matter how hard and fast you run, it only gets farther anyway. I’m very afraid that I’ll become like so many blue-collar families–like my own parents: spending their entire lives attempting to ensure a better one for their children. That’s simply not what my life was made for. It was made for greater things than these.