Measures of Pain and Joy

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fiction

Thomas Mampalam

Measures of Pain and Joy

 

 

Magdalena Henriquez glanced at the shelves of thick books stacked in the cabinet beside the neurosurgeon’s desk. She could distinguish a few of the larger titles. Brain Tumors, Neurological Critical Care, and Vascular Neurosurgery were three of the prominent texts. Her chronic pain was probably not worth the neurosurgeon’s time, she thought. The dark wooden shelves seemed to creak with the weight of the neatly ordered volumes.
   She pondered the neurosurgeon’s question: “What’s your pain on a scale of zero to ten?” Dr. Sid Narayan faced her from his mahogany desk. Behind him, partially opened window blinds framed a filtered view of low green hills and the ash-colored bay. A morning mist hung over the water.
   Ten was the torment of a tragic hero, Magdalena thought. The pain was mythological. You were the thief of fire and an eagle tore at your internal organs with beak and talons. Ten was the suffering of the Savior at Golgotha. Only a drama queen would compare their suffering to Prometheus chained to a boulder or Jesus scourged, then nailed to the cross.
   Zero was not happiness, but the calm after long meditation in a quiet, dim room. You focused on that stillness and thought of nothing else. One was the tingling from a file of ants crossing your hand on a hot summer day, barely a distraction. You lay on the grass and gazed past the drifting, translucent clouds to the pale blue sky.
   Two was a distended stomach after three slices of pizza and a tall soda—more discomfort than pain. With three, a rose thorn pricked your hand as you watered planter boxes in the garden, just a nuisance. Lowering your face to a cluster of flowers, you inhaled.
   “Ten would be like a broken bone or maybe like childbirth,” Dr. Narayan offered. He noticed wincing at the word childbirth.
   Just a few seconds passed, but Magdalena knew she should answer soon; she did not want to appear evasive. She also knew that the neurosurgeon had a waiting room full of patients with more serious problems than her neck pain. Brain tumors that caused eyeballs to pop out. Blood vessels about to burst. Bone spurs sticking into spinal cords. Dealing with these misfortunes you clutched the chair arms and worried about how long you had to live or whether you would be paralyzed.
   “Ten would be the worst pain you could imagine,” Dr. Narayan continued.
   She wanted to get the number right. With nine, a pit bull clamped jaws onto your leg, the inquisitor heated a serrated blade to slash across your back, electric shocks coursed down your spine. You thought of nothing but the stabbing pain.
   “But you don’t have to be screaming or crying for pain to be a ten,” he added. “Everyone responds differently.”
   Four was the tender swelling after a sting from bees that hovered at the yellow and dark red roses in the planter boxes. A doctor would wonder why you were in the office for pain less than four. Eight was the pointed tip of tiger claws or shark jaws. Orange sparks detonated in your mind. For five, a granite boulder you could barely budge balanced on your chest. Your heart beat against the jagged rock. Suffering began here.
   She wanted Dr. Narayan to take her pain seriously but not to think she was exaggerating. The number should be above five but modestly under nine.
   With seven, you shivered and walked circles in the slush of an icy lake. The pain really focused your attention as you struggled against the bitter chill, barely keeping your head above water. Magdalena hovered beneath this number like those bees at the roses. Her thoughts did a waggle dance. She was close.
   “What would six be like?”
   Dr. Narayan was not surprised, every clinic morning produced a character. Most patients blurted out the first number that came to mind, but this one made some sort of complex mental calculation. All she had to do was pick a simple whole number. Fractions or irrational numbers were not involved. She spoke perfect English and the intake form indicated she was a teacher at a special needs high school in Oakland, so language was not the problem.
   “Maybe this would help.” From the desk drawer Dr. Narayan pulled out a chart where line drawings of faces showed increasing levels of pain.
   Magdalena saw a series of circles with dots for eyes and curves for smiles or frowns. Zero was a smiley face and ten, a crying face. She then scrutinized Dr. Narayan to make sure he was not mocking her, but saw no sarcasm in his dark brown eyes— even though the chart seemed clearly made for children or brain-damaged adults. His calm tone reassured her.
   “Six is the one with the frown but no tears,” he said.
   “Six seems right,” she said. ”I feel like a snake squeezes my neck. But I can still breathe and talk.”
   She thinks best in analogies or metaphors, not numbers or pictures, Dr. Narayan concluded. “There is no right or wrong answer, there is no blood test or device to measure pain. A number is just a simple way to record your pain. You don’t have to pick a number.”
   Magdalena looked confused and again looked closely at the chart. “Six,” she said emphatically. “The number is six.”
   “Good pick,” Dr. Narayan said, maybe with some impatience, but, he hoped, not sarcasm.
   In the neurological examination Magdalena showed full strength in the major muscle groups and her reflexes were normal as the doctor tapped her elbows and knees with the red rubber tip of the tomahawk shaped hammer. He showed her the MRI scan images of the cervical spine on the desktop computer screen. He counted down the vertebrae and the smooth back edges of the intervening discs. Between the sixth and seventh vertebrae, he saw a small bulge that did not press on the spinal cord or nerves. She was fifty years old; at her age a minor disc bulge was a common degenerative finding.
   “The good news is that you don’t need surgery,” Dr. Narayan said.
   So that was it, she thought. He was washing his hands of her just as he washed his hands after removing an old surgical dressing.
   “What’s the bad news?”
   “The bad news is that I don’t have a good treatment for your pain.”
   “Are you saying that the pain is in my head?” She scrunched up her nose as if making another weighty deliberation, maybe this time assigning a number ranking to Dr. Narayan for his error in judgment.
   “No. You have pain but you don’t need surgery for it.”
   “Are you saying that I just have to live with this pain for the rest of my life?”
   “We have to manage the pain without surgery. I could get one of my colleagues to give you an epidural injection. Would you like to try that?”
   There was no surgery in it for him. Magdalena wondered if he was trying to palm her off to another doctor. Consultations were only worthwhile if they led to surgery.
   “Sure. I’ll try anything if you think it might help.”
   One month later, Magdalena returned to the office. Again, she sat across from the doctor; behind his head the unchanging gray water of the bay. The injection had not helped. Her pain level was still at a six, a snake squeezing her neck.
   Dr. Narayan decided to take another tack. “Is there anything else you want to tell me about your pain?” he asked. “Maybe I missed something.”
   Magdalena leaned back in her chair, briefly raising her eyebrows. The silence between them seemed long, compelling her to speak.
   “Last month was the five-year anniversary of when my son went to heaven.”
   “Your son died five years ago. How old was he?”
   “Twenty-five.”
   “How did he die?”
   “God called him.”
   Dr. Narayan was not sure if he should push further to make the source of her pain explicit.
   “Was it suicide?” Hoping to understand her pain, he wanted to glimpse its source.
   She nodded. He said nothing. The how was not important.
   She told Dr. Narayan about being at the hair stylist a few blocks from her son’s studio. She had missed his call on the cell phone. She heard an ambulance siren but that distant wail was not unusual in their neighborhood.
   They sat in more silence and then the doctor said, “I don’t have words to help you with that pain. I can only sympathize, I have grown children, too.” Magdalena had seen pictures of the neurosurgeon’s family in the waiting room. The walls were filled with beautiful framed scenes of marriages, babies, and idyllic vacations to Hawaii and Asia.
   “But you think it is all related, that the pain is mostly in my head.”
   “Grief can manifest as bodily pain. But helping you with that kind of grief is beyond the scope of my practice—you were sent here to see if I recommended surgery on your spine.”
   “Have you ever experienced pain like I have?” Magdalena knew that even if she walled herself off in a stone tower like a monk, she could never escape it. Only when she was dead and buried would her pain die.
   “No. But I do not have to have personal experience with such pain in order to do the right thing by you.”
   “What is the right thing?” An end to my suffering, she thought.
   “You don’t need surgery. The pain you suffer for your son needs another kind of attention.” He frowned. “Your primary physician could refer you for counseling.” It was as if they were in separate rooms. The doctor might have talked longer to Magdalena, but felt he did have to get through the clinic. A craniotomy for resection of a large midline meningioma was scheduled for the afternoon. The residents could start the case but he had to attend for the removal of the tumor off the sagittal venous sinus.
   “Your numbers don’t describe my pain,” Magdalena said. If her son had committed a mortal sin, then the afterlife would bring her no relief.
   “I think I understand,” said Dr. Narayan. In her world, Magdalena’s pain could not be described by a simple integer, but was the product of complex formulae with exponents, radical signs, and limits to infinity. There were asterisks and footnotes with arrows asking for forgiveness, mercy, and deliverance from evil but even with pages of such scrawling, symbols could not contain her pain. Narayan wished that with some magical algebra, he could transform the pain scale into an inverted sequence of joy. Instead of the worst pain imaginable, ten would designate an unattainable bliss, the nirvana of union with God.
   “I have not had a moment of happiness since my son died,“ Magdalena said.
   “Maybe if you focus on the good memories, then you can find peace.”
   “A memory of happiness is not the same as happiness,” Magdalena said.
   For a moment, Narayan glimpsed discrete joyful images that corresponded to higher integers on the imaginary scale for joy: his wedding to Kamala, the birth of his daughter, Radha, reading to his granddaughter, Maya, in the evenings, the sound of her laughter a silver bell as she splashed in the waves at the seashore or picked strawberries to share from a planter box in the garden. The lower integers were memories of tastes and smells: a dark chocolate, a fruity zinfandel, the fragrance of a dark rose.
   “I wish I could have been more helpful to you,” Dr. Narayan said.
   He walked her to the waiting room. He told his secretary that since Magdalena did not require surgery, she would follow up with her primary care physician.
   Turning, Magdalena saw his dark brown eyes and then the soft brown eyes of her son. She envisaged the Savior crowned with thorns and wrapped in a purple robe, his face smeared with tears, sweat, and blood, but made beautiful through endurance. The Savior’s sorrowful eyes told her he shared each person’s suffering even if silently.
   “Thank you for asking if there was anything else,” she said.
   “I wish the best for your future, “Dr. Narayan said. “I will call your primary care physician about referring you for counseling.”
   As he walked back to his office he thought that office conversations barely touched the particular quality of each patient’s pain. Only a few could be cured and for many the best he could do was avoid worsening their misery. He had to let go and move on to the next case. He really could not measure pain, let alone joy.