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May 1, 2016 | by  | in Features |
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The three lives of pain

Madeleine shares her story of experiencing and enduring extreme bodily pain. The piece describes the details of a car crash which may be triggering to some people.

 

On the 18th of December I was in a high-speed car accident at the T intersection where state highway four meets state highway three near Te Kuiti. I was asleep in the passenger seat until impact. The car I was in pulled out into the intersection when it shouldn’t have, and a car coming from our right hit us at 100 kilometers per hour.

There’s this trope that “there’s nothing that prepares you” for that type of experience, and it’s true. The language for, and the acknowledgement of, pain and suffering in our culture are totally absent. Prior to that afternoon I had no idea how many types of pain there are. I mean, I still don’t, there are people who have experienced far greater and radically different pains than those that I have known.

The silence around suffering denies guidance for those in pain, and in some ways denies their reality. Putting words to unknowable experiences demystifies them, so here’s my understanding of the pain of dying, the pain of surviving, and the pain of living.

 

 

The pain of dying

We spun from the road after the car hit us. I awoke on impact and my vision was flooded with inflated airbags. I was trying to figure out if what was happening was real or if it was some bizarre event I was constructing in my head. The car skidded to a halt on a gravel patch to the side of the road.

I couldn’t breathe. It wasn’t that sort of gasping, as though you’re breathing through a straw type of breathlessness. It was as though there was a great weight on my lungs, making it impossible for them to inflate. As though they were entirely flat within my chest, limp without purpose. This was the first point at which I thought I was going to die.

I didn’t have the tools to face dying at all. I don’t have the tools to understand that I was that close to death now. There’s no guidance for that. When something you’re used to seeing only from a great distance is that supremely close to you, it appears completely alien.

Death interrupts the way we comprehend our own identities and existence so fundamentally that our understanding of dying is completely externalized. Death appears too big, too absolute in its opposition to existence, to be comprehensible in individual and personal terms. It’s much easier to tuck death neatly away in the realm of the ‘they’—far removed from where it may touch ‘you’ or ‘I’. Through this othering, it is possible to sanitize the personal within death and reduce death to some unknowable and generalizable concept, far away and completely out of touch with your own reality.

Death is simultaneously universal and acutely individual. The circumstances of your own death will be unlike those of any other, and how you experience your death will be known only to you. The pain of dying lies in an intense awareness of what you’re about to lose. Fear and sadness spring directly from what has meant the most to you throughout your life; the people who you are lucky to have loved, those who have loved you in return, and all those thousands of small things that are woven together to create who you are. There is nothing more individual than this awareness.

In dying, there’s this bizarre liminal state where simultaneously you’re the most acutely aware of your existence that you’ve ever been, but you can also physically feel that you’re fading from existence as a self and starting to exist as a story. All the unique details of your own life and personhood confront the enormity of unknowable death. What you have known so closely and so deeply comes to meet what you have pushed away from the possibility of knowing. You can imagine the irreconcilable nature of this. There’s a glaring awareness of the closeness of your existence, while you also find yourself pushing that personhood into the same far away category that you had neatly tucked death into leading up to this.

This inbetween state that you’re left in, without the social codes to make sense of death in terms of yourself, fosters dualities: between trying to remain rational while overwhelmed with emotions, becoming incredibly dependent while maintaining an essential autonomy, rejecting that this is the end though accepting that it’s very much a possibility. It’s impossible to understand how your identity and your values fit within this scenario, and how it will guide you through it.

It’s bizarre that considering the universality and inevitability of death, that there remains this enormous dissonance between self and conception of death. Finiteness doesn’t have to be considered in this way, and putting a narrative to the individual experience of dying demystifies and centralizes the reality.

 

The pain of surviving

I was on the side of the road for about an hour experiencing incredibly intense pains in my abdomen and lower back without pain relief. Eventually, I was airlifted to Waikato Hospital. There wasn’t a moment during this time where I was unconscious. Before that afternoon I didn’t know that pain like that existed.  

I was given multiple scans, asked a barrage of questions, hooked up with painkillers and eventually left to wait. At this point I was still in intense pain but was getting regular doses of fentanyl, an opioid painkiller 80 times the strength of morphine. Fentanyl fogs up your thinking and somewhat blocks your memory, but I was still completely lucid.

A surgeon came into the ward to give me the results from the CT scan they had performed when I had first arrived. He told me that I had fractured my L1 vertebrae and had severe ruptures in my colon with possible trauma to my pancreas. I honestly had no idea how to interpret this information so I asked him, “I’m not going to die though, right?” He only told me, “these are very serious injuries.”

Loss of who you are in intense bodily pain is absolute. The pain is so demanding, so exhausting, that its presence overrides everything else. Intense bodily pain demands to be felt so deeply that it supersedes the world around you, and the self within you. Memories slip away, notions of identity and value are severed, and relational situatedness shatters. Those rich, layered narratives of memories, knowledge, and experience that surround and protect your identity fall away. There is no possible way to create meaning simultaneously in those moments. That is what loss of self feels like.

Intense bodily pain isolates you completely. You are cut off from reality in the world and left without language, replaced with at best an occasional capacity to cry out. You are the most alone that it is possible to be, but the self you are left with is completely unfamiliar. Intense bodily pain cuts you off so radically from reality that once it disappears you are forced to begin to forget it in order to reclaim yourself as real, instead of the unreal self that existed within that pain.

Even having felt it, it’s so hard to know that this pain is real; that this loss of who you are within it, is real. Establishing what happens when you undergo intense bodily pain as a truth, when it has no public existence is so difficult—it’s exhausting. You don’t get the luxury of legitimation through external validation that you might with other private experiences. Instead you end up endlessly questioning what it meant, what exactly was happening to you within it. It is near impossible to have any kind of confidence in the truth of this pain, when you have never seen it around you in any form. There is no public element for intense bodily pain, and nor can there be. It can only be felt.

 

The pain of living

I underwent two surgeries. The first was exploratory to better assess what was going on in my abdomen. The trauma to my bowel was much worse than initially expected; it was severed at both ends and ruptured throughout. Parts were removed and the rest was sewn up. The second dealt with the fracture in my back. Two metal rods and six pins were put in to stabilize the fractured vertebrae. I spent eleven days in hospital, the first three in the critical care unit and the remaining eight in the general surgery ward.

I have been in pain since December. I’ve suffered daily debilitating fatigue, three infections including a particularly excruciating viral one, and the loss of a number of opportunities. Since being discharged from Waikato I have had countless follow ups with orthopedic surgeons, concussion specialists, psychologists, occupational therapists, nurses, and GPs, as well as a multiple trips to after hours and ED. I spent a month recovering in Nelson before moving back to Wellington to start to reclaim a self-sufficient life.

In desperation to create distance from the loss of identity and personhood within intense bodily pain, you try to deny a new normal. It seems as though the fastest path away from the loss of self leads to that same identity that you knew before pain.

This is not the case. There’s a reshaping that occurs to incorporate the enormity of experiencing intense bodily pain, and near death. Ongoing pain can’t be ignored, it becomes interwoven with who you are. Pain becomes a part of your identity. Eventually, you are forced to confront the fear around the implications that a pained self will have, and you let go of the loss of familiar ways of being. When you’re experiencing pain on a daily basis it’s impossible to keep it separate from your conception of self.

The articulation of this new personhood is often as woefully inadequate as the articulation of the pain that onset it. In explaining it, you face an underlying assumption that pain can be undone. As though if you can apply feelings that negate pain, maybe pleasure or happiness, then it will disappear completely.

Others tend to assume that the pathway to recovery is paved with feelings that undo pain. It’s supposed to slowly lead you back to your pre-pained identity. The lack of language for articulating that this simply isn’t the case can be interpreted as a lack of pain itself. This interpretation not only becomes a denial of suffering, but a denial of who you are as a pained person. This can be a shattering experience.

Performing the expected role of the ‘good patient’ who does not speak candidly about death or suffering and who expects to follow a path leading directly back to the pre-pained self is impossible. Misunderstandings and denial of pain are felt as others turning away from something so fundamentally shaping your experience that you feel your new existence is denied.

Where pain can be self-destroying, care from others can be self-creating. Others can strengthen the re-building of identities that incorporate ongoing pain. Others legitimize and encourage what this new identity is experiencing and what it is to become. The people around you have the capacity to validate and create the truths that self-construction is built on. Through human care this self is brought back into reality.  

I’m going to be in pain for a while. I’m going to know the nature of intense bodily pain. I’m going to carry with me this weird understanding of what it’s like to be that close to death. I don’t expect you to understand it, because I know that you won’t be able to. I know as well that others will experience pain, that is in every way as legitimate as mine, that I will never be able to understand.

There’s no real resolution here, and nor should there be. To make steps towards understanding these massive, identity destroying and identity shaping experiences, we have to give words to suffering. While it’s impossible to create a sense of reality in a vacuum, it is possible to shed light on a dark part of human existence by bringing it into the public realm. There’s no greater truth than that.

 

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