When I was 23, I did what I had done so many mornings: I woke up and stumbled off to make coffee. Except that morning was different. That was the morning I fell down a flight of stairs, landed on my spine as I slid down each step, eventually lost my job as a result, and spent countless hours in and out of doctors and hospitals, culminating in a back surgery where I was cautioned that a possible outcome of a poor surgery would be paralysis. Such side effects are rare, and my surgery was fairly successful. Until recently, I had managed my back issues because I was able to foresee my triggers and react accordingly. Lately, however, my back pain has been managing me.
Pain is a mostly invisible phenomenon—all neatly bundled away inside your nerves and your brain. Pain is only easy for another person to recognize at its extreme: when another person goes rigid, clenches the jaw, gasps audibly, cusses, grabs a body part, or suddenly has some kind of horrific accident that can only mean terrible, terrible pain. Unlike this kind of excruciating pain, every-day pain is almost completely invisible. A common cold, on the other hand, is easy to notice. Your friend has a telltale red nose and is clutching a box of Kleenex; she may be coughing and sneezing excessively. Nor is it hard to miss when an acquaintance breaks a bone. Because I “seem” fine, people assume that I am fine. I am not fine.
At my most recent doctor’s appointment, I was asked if I were ever pain free. I sat (in pain) on the bed and thought hard about the question. I know that I’ve been without pain. I remember when it wasn’t a daily part of my life. I just can’t remember any time since August where I haven’t had pain. Everything I have done since then has been done with some degree of pain. Some days are good days; I barely notice the pain, and I’m perfectly functional. Other days, it’s hard for me to focus on much else.
This pain I have lived with is mostly invisible. Even on bad days, it’s invisible to others in the grocery store when I have to ask my husband to push the cart for me because I can’t anymore. Or if I am shopping without him and I end up with a bum cart that pulls to the left, it is no longer a mere nuisance. This bum cart is an ordeal as I exert constant pressure to steer the cart straight; every movement, every step, sets my back ablaze as my nerves scream their protests. On such days, I can’t even help put groceries away. Bending over to unload the groceries, to open the bin to stash vegetables, to lift the half gallon from the floor or counter to the fridge is just not possible. I am filled with rage at myself, at my back, for betraying me as I watch my husband both unload the car and put away all the groceries without a hint of complaint while I stand idly and uselessly by.
Sometimes my pain will look like annoyance instead. My poor dog Alke has begged every day for the last week and a half for a walk in the morning—one of our favorite morning activities together after my husband has left for work—and I’ve had to reject Alke’s plaintive eyes each morning. You see, the last time I walked him, he pulled too much. He’s normally so good on his walks; we worked so hard with him to not pull and to walk nicely beside us. But whenever he catches a whiff of anything worthy of investigation, if he so much as dips his nose to smell the grass, the pressure on my lower back intensifies, and I yank on his leash in frustration, say “NO” loudly—such a small infraction, to smell a clump of grass—and try desperately to keep it together until I can get back home as with each step and each small tug, I feel my back become angrier and angrier. Instead, I throw Frisbees for my dog, toss his ball, and give him endless cuddle sessions, but he still lets me know each morning that he’s ready for his walk now, please.
Since my pain is in my lower back, it very literally affects everything I do. Sometimes my attention wanders in meetings because I don’t want to have to be that person in a meeting who has to stand and walk around. Even then, sometimes I’ll stand, and I’ll be distracted by the pain in my back. If I’m having a bad pain day, I can’t tie my shoes without pain. I can’t sneeze without pain. I can’t lie down without pain. Even on good days, I can’t go on a road trip or get on a plane without knowing by the end that I will be in significantly more pain than when I had started the journey.
I have tried so many different strategies to alleviate the pain over the years and particularly since August. For starters, I’m incredibly conscientious and responsive to new triggers of pain. I have, for example, given up the dead-lift from my weights routine after it caused too many problems. I have a new standing desk at home and at work. I’ve tried prescription strength pain medication and muscle relaxers, and I was cautioned by my doctor that if I used the heating pad much more I could give myself permanent burns on my back. I’ve spent a ridiculous sum of money on physical therapy, and I’m beginning to try massage therapy too. Most recently, I had a cortisone injection into my back under sedation. Some of these things help, temporarily anyway, but I live in this constant state where I wonder what will set my back off next, if I can push the grocery cart this weekend, when I can walk my dog again, whether I will be able to lift my maybe-one-day child into the air as she coos in delight with her fingers stretching toward the sun.
This dark side, this despair-filled bleak vision of the future, may seem melodramatic, but it lurks as a constant pessimistic phantom when I feel the every-day ache, like a dull spearhead is embedded in place of my spine even now as I sit to write this. Sometimes this despair feels more like a dire premonition of inevitable calamity on days when I can only clench my teeth together tightly as I walk—just walk—through the grocery store as my husband pushes the cart ever so slowly beside me.
I am also always mindful of the fact that my pain used to be significantly worse than it is now. Before my first surgery brought significant relief, the pain would seize me in fits that left me incapable of either moving or speaking, as if every nerve in my body were radiating waves of lightning instead of relaying information. During one trip to another doctor’s office, I reached a breaking point. I was under so much strain from dealing with the spasms of pain, but I was also too stressed to handle the agony of another failed cortisone shot. As my blood pressure rose to unnatural levels and I felt my anxiety spiral out of control, I asked what my other options were besides the shot because I just couldn’t subject myself to another one. The doctor wheeled on me—my 23-year-old self, in so much pain I couldn’t work anymore, couldn’t drive my stick shift any more (I can never own a manual transmission again) and absolutely terrified. He raised his voice in frustration and replied that I could lie in bed 24 hours a day and never move again and that I could have a catheter and people to feed me and that he was positive that I would be fully healed after 6-8 weeks of such a lifestyle. He narrowed his gaze and asked rhetorically, “but you wouldn’t like to live like that would you?”
I managed to tell him no and to leave his office with as much dignity as I could muster through my tears, but I think of what he said that day far too often. I think of it anytime I lay in bed, desperate to roll into a more comfortable position and wondering how hard I must grit my teeth to endure the change, whether it’s worth the pain to roll over to try to sleep a little better.
I fear that I will lose my ability to walk—let alone carry a backpack of supplies over alpine meadows and arduous mountain passes—as some days I do struggle to walk. Instead of a normal gait or pace, I lumber around like an elephant, swaying and unable to twist or turn with any kind of flexibility or natural motion. Other days, I walk so slowly that I am frustrated with my snail-like pace. These are the bad, extreme days, of course, but I am only 31 years old. What will my mobility be in ten, thirty, or fifty years? What will I have to sacrifice to the demands of my back? How will I manage when I cannot join my husband on backpacking trips? Would I be bedridden from the pain if we were to have a child? These questions and many others haunt me in my dark moments of weakness and doubt. The real agony of living with chronic pain is not the pain itself, its irregular ebbs and flows of intensity, but with the terrible crushing fear of a future that is limited, shaped, and filled by that pain.