Not All Pain Is Bad

On May 6th, while many were dealing with Cinco de Mayo hangovers, I was having a conversation with a doctor over the results of some recent tests. As soon as I answered the phone, I knew this call was going to be a bit different. Instead of the standard “Everything looks fine” speech, I was instead asked:

“Are you somewhere where you can talk?”

I knew immediately what she was about to say: cancer had caught up with me. With my family history, I knew I would come face to face with cancer at some point. I just hadn't planned on it being at forty. And this began an odyssey of near constant doctor appointments, consultations, and testing. Ultimately, it was determined that my type of cancer was slow growing, in the fairly early stages, and surgical removal would be the best option. While the days and weeks didn't feel quick when it was happening, looking back, I am amazed at the speed with which everything progressed. Barely three weeks out from the diagnosis and I had a surgery date of May 21.

The surgery would be a twofold process. The first step would be a large and deep total excision of the malignancy and the surrounding tissue. The second would be a process called a "sentinel lymph node biopsy": a surgery that would remove one or more lymph nodes to ensure the cancer had not spread. In discussions with the surgeons, it became clear that the first part would be the worse.

The goal was to remove every last bit of the cancer. The excision and removal was going to be quite hefty; a circle roughly 4 centimeters in diameter and well into the muscle and surrounding tissue. A plastic surgeon would then follow immediately behind to reconstruct the area and close the gaping hole that would be created. The finished result, the plastic surgeon said, would “look like a shark bite.” Both surgeons assured me that such a large excision was the only way to be sure.  I dubbed it the "Ground Zero Approach" and had an immediate movie flash.






Despite how it looked, the surgery went well. The recovery however, was difficult and, at times, exceedingly painful, despite the assistance of some hardcore painkillers. One of the worst days was about a ten or so days after the surgery, when the external stitches were removed. The surgery site was almost at the elbow of my right arm. My arm had been nearly immobile since the surgery and this was going to be the first time I had really moved it. After removing the external stitches (and assuring me my arm was held together by internal stitches), the surgeon asked me to fully straighten my arm. To say doing this was agony would be an understatement. What surged through my arm and body was a pain so excruciating I almost lost consciousness.

The day after someone implanted a tennis ball in my arm.

As the pain receded and my wits returned, the surgeon delivered a one-two combo of news. The good news: despite the pain, everything seemed fine he said, and was healing nicely. The bad news: the surgery had wreaked havoc on my forearm and elbow; “traumatized” were his exact words. The muscles had become atrophied, connective tissue constricted, and nerves and other soft tissues would need time to heal and regrow. In short, every movement from the elbow down was going to cause intense pain. Despite this, I was now under strict orders to slowly move and stretch my arm every day.

“It’s going to hurt,” he said, “but you have got to keep doing it.” This was the only way for the muscle to rebuild and the connective tissues to regain their former flexibility. The tissues would grow back and eventually re-pattern themselves back into something more functional. Without moving, stretching, and enduring the pain, the arm would lose much of its former strength and range of motion. Following doctor’s orders and dubbing my arm “Frankenarm”, I started moving it, slowly and gingerly, still convinced something was wrong. It shouldn't hurt this much, I kept thinking. But it did. Worse, I was told this level of pain was normal.

During this recovery, I thought a lot about pain and discomfort. My mother and I have often had conversations about how much tougher people were in the past. I’m glad I’m in the 21st century; I would have never survived 150, even 100 years ago. At a time when doctors with tiny cameras can see nearly every part of our bodies, inside and out, it’s hard to imagine that people once bled, purged and puked themselves to near death with the idea of getting to better health. It’s only in the last 100 or so years that people have had relatively easy access to a doctor. Prior to that, if you broke a leg you limped for the rest of your life. Broken rib? You’re probably going to have pain anytime you breathe from that point on. Don’t like the sagging body parts? Tough, live with it. Hypochondriacs didn't stand a chance.

Even if a doctor could be found, most performed procedures without any anesthetic beyond whiskey or laudanum. Sick in the 1800’s? Kicked by a horse? Too bad, you were probably out of luck. And out of time. A doctor then was a bit of double edged sword. In a letter to his family in 1849 a California miner wrote, “Have now paid all my gold to the Doctors and they leave me worse in health.” The doctors of that era seemed to believe that a person could not get well without a sufficient amount of pain being suffered first. And, to some extent, they might have been right. 

This was new territory for me. I’d never experienced the level of pain, constriction, and loss of function I was now going through. The whole process seemed counter intuitive: it hurts to move, but the only way stop the hurt is to keep moving. I thought of a saying: “When you are going through Hell, the only thing you can do is keep going.” Against all instincts, I forced myself to keep moving and stretching Frankenarm.

Even with the pain and my concerns, over time, I started to notice something. To be accurate, I started to notice what I wasn't noticing. The pain. What had once been agony gave way to mere torture. Torture slowly became excruciating. And even excruciating was eventually downgraded to discomfort. The pain had, in fact, eased. The doctor was right; both Frankenarm and my hand began to get better and slowly started to feel relatively normal. Looking back, it all happened in a remarkably short period of time.

Of course, removing the tennis ball probably helped.

As an adult, I've known that not all pain is bad. However, as bad as this pain was, left to my own devices, I probably would have babied my arm to the point of irreparable damage. Though Frankenarm still isn't quite what it used to be, it is almost back to normal. This ongoing ordeal reminded me of a very simple truth. Sometimes, we need the input and advice of others to help us know whether what we’re feeling is "good" pain or "bad" pain. Sometimes we’re simply too close to the pain, emotional or physical, to be able to make an intelligent decision. And this is true not just for our bodies, but our lives. We’re usually smart enough or experienced enough to get by in most situations. But sometimes, we’re not good enough to do it alone. We need to be open to advice and different ways of thinking. We need a little guidance and assurance that not all pain is bad.