Everybody deals with pain differently, but is it down to pain thresholds or simply a lack of complaining, asks PAT DONLON
I’VE BEEN musing lately about pain thresholds and wondering if tolerance to pain is something you develop or are born with. The reason for this particular musing was a recent injury when on my way to the bathroom in the middle of the night. I fell, smashing and dislocating my shoulder and fracturing the upper humerus in four different places. I slipped in and out of consciousness and then nursed my arm back to bed where I lay and thought about what to do next.
At 4.30 in the morning in south Dublin, the only choice would have been St Vincent’s, a good hospital, but one where the emergency department is overstretched with the distinct possibility of days lying on a trolley. A much better option would be to put up with the pain, let sleeping husbands lie and wait until the Beacon emergency department opened in the morning, which is what I did.
One thing which did happen was that it jolted my memory of another night of silent pain. I was four years old, had slipped on the terrazzo floor of our kitchen and broken my leg. Nothing too dramatic in the scheme of things or so it seemed. But from the outset it was to be an arduous process: the ambulance called at several hospitals before finally finding a bed in the Children’s Hospital in Harcourt Street.
Hospitals were different in those days and parents were kept very much at arm’s length, with only two weekly visiting days. It was my first time away from home and I was terrified. I was brought straight to theatre full of masked people, bright lights and then had the gas mask thrust on my face – a sensation of smothering that I will never forget.
My leg was set by a young doctor and I remember him with gratitude because he came to see me afterwards and was kind. I know now that perhaps it was guilt as the leg had to be broken and reset with yet another visit to theatre and more gas masks and the smell of ether.
I don’t know why it was not set in plaster but instead was placed resting on an iron block covered with some cloths. During the night, the cloths slipped and the bar started to cut through my leg. All I knew was that I was in pain and so like any four year old I cried. A nurse arrived and slapped me: “Now just you stop that. Every time you cry you’ll get another slap.” I was so shocked I stopped crying and didn’t utter another sound.
The following morning, the day staff came to make the bed. Throwing back the covers they discovered a pool of blood and a very large gaping slash on the back of my leg where the iron bar had cut through to the bone.
Nothing was said to my parents and I was terrified to say anything to them. If I told them, surely the nurses would come and slap me even more. That was not the only time I was slapped during my stay: another night I vomited in my sleep and was awakened by a nurse shaking and slapping me as she shouted, “Why did you do that?”
This was two years after the end of the second World War, so food was scant and mostly inedible, served in chipped enamel mugs and dishes. Towards the end of my stay I was moved to the “jam” ward where instead of bread and margarine we got bread with jam. But by then my parents had had enough and fearing even worse things might happen they found a kindly German GP who offered to take responsibility for my care, so I was signed out against the hospital’s wishes.
Back home I had to learn to stand and walk again, clinging on to the wall, and I limped for years: even today I have a large scar on the back of my leg, a reminder if one was needed of that night of pain.
But from that time on, I seemed to be able to bear pain without complaining. Some years ago following an emergency coronary bypass, my GP said to me, “If you were a man you would have come into my office, banged my desk and screamed about your pain. Instead you muttered something about a bit of pain in your chest – you’re only 52, I might have missed it.” But, he didn’t and I lived to tell the tale.
While lying in bed waiting for dawn I had time to plan how to deal with the next few hours. When my husband woke up I explained my dilemma and calmed him down (he has a tendency to the dramatic). The drive to the Beacon was none too pleasant with every pothole and bump in the road jolting my arm and shoulder.
We were second in the queue and in no time I was taken into the treatment area. They were cautious about pain relief initially, not wanting to mask any symptoms. However, following initial X-rays when it was obvious that I had wrenched the arm from its socket, cracked and splintered the humerus, pain relief was given intravenously. I was given a shoulder immobiliser and sent for a CT scan.
By 1.30pm I had had X-rays, scans and analgesics and was down in the orthopaedic unit waiting to be reviewed by one of the consultants. He showed me the X-rays and scans and, for the first time, I realised the extent of the damage. He recommended that a plate be inserted to hold the lot together and I was admitted some time later.
Everyone I encountered was very honest about what lay ahead for me. The doctor admitting me said, “the pain is bad now, but you need to know it will get worse”.
He then outlined the path ahead for me post-operation. In order to restore mobility, I would have weeks and possibly months of physiotherapy, and it would be painful. It was and, seven weeks, later it still is.
There have been rewards on the way – being able to drive again, brushing my teeth and using two hands to shampoo my hair. Things which before this I took for granted. But I have a long way to go and I still have to resort to painkillers most days in order to be able to do the physiotherapy.
I think I feel the same level of pain as most, only somewhere deep in my psyche I don’t believe I have the right to complain too loudly. Sometimes it helps, but I have to admit that there are times when I wish I could just scream and shout and let it all out.
