Monday, March 1, 2010

Pain Relief

(In which I take my desire to emulate the blogfather way, way too far.)

Morphine is a powerful analgesic drug that acts directly on the central nervous system to suppress pain. It is synthesised primarily from Papaver somniferum, the opium poppy, and derives its name from Morpheus - by which I mean the Greek god of dreams, not this bloke.

He's the patron saint of soporific acting at best. But thinking of Morpheus in its Italian inflection it comes naturally to me to recall also the recently un-retired Domenico Morfeo.

He was quite some player, it's too bad he could never crack a top team for long or the national side. I guess he was never fast or strong enough. Perhaps back in the Seventies, when the game required much less athleticism, things would have turned out differently for him. Still, he did score a number of highlight reel goals, as the Yanks would say. I hear he plays for Cremonese now, just down the road from my home town. They have a motto there: turron, turras, tettas, which is to say torrone, the local nougat sweet of likely Arab origins, torrazzo, the bell-tower of the cathedral, and big tits. But then of course Bologna also claims to be the city of the three tees, it's really not that original or funny.

Wait a minute, where was I? Ah, yes, morphine. It does make your mind wander, if not quite in dreamlike fashion, perhaps in the way of the loose associations that sometimes precede proper sleep or full awakening. So as I was lying there on my emergency room bed I did actually think of Domenico Morfeo and how he never seemed able to physically fend off a challenge, but I also took snippets of the always lively conversations on the other side of the curtain and turned them into as many autogenerated fragments of stories. In the process I also transformed those sounds that reached me in barely coherent form into Italian names and phrases - isn't it funny how the mind works?

If you read the typically excellent Wikipedia entry for morphine and direct your attention to the Indications section you'll find me under one of the most benign conditions for which the drug is prescribed, 'pain from kidney stones'. Understand that this affliction is defined almost entirely for the pain that it causes: it is not life-threatening, nor does it inflict permanent damage, nor it generally requires intervention other than the relief of pain. So let me speak for a minute, as a lucky chap who didn't have anything of lasting seriousness, about this pain, and let me see if I can describe it. Actually, it will have to be a gendered description.

For the men. You wake up one morning to discover that a Finnish trucker and three times Ball-Squeezing World Champion by the name of Urs has got hold between thumb and forefinger of one of your testicles - let's say the left one, for the sake of biographical accuracy - and has begun to apply pressure to it. What you should know about Urs is that the man has got nothing but time: he won the Finnish national lottery or has received a lifetime grant or something, so now he can just travel the world and be like the Kidney Stone Gnome. So he takes it slowly, beginning with little more than a pinch, and just as slowly he increases the pressure until what do you know? It's a vice-like grip. At this point you are covered in sweat and practically paralysed and hoping that something or someone will make Urs stop. This state of affairs can last anywhere from one hour to - wait for it - four weeks. I'm not kidding, I just looked it up. At some point during the proceedings Urs will be joined by his brother Bort (I hope none of this causes offence to passing Finns), whose job is to bash your lower back with a meat tenderiser. This ordinarily would make you scream but actually, and here's a kicker, you won't necessarily mind, because it's more of a dull than a sharp pain, and at least it takes your mind off what Urs is up to.

For the women. This whole thing is proof that men can't handle pain and really if it had been up to them to give birth the human race would have become extinct some time during the Bronze Age.

So anyway last week, after a series of one hour-sessions with Urs over the course of several days, I struck one that lasted the whole night so after packing our eldest for school Justine took what was left of me to the emergency room (thank you darling!). Here I was immediately attended to by nurse Donna and Dr. Andy (thanks nurse Donna! thanks Dr. Andy!) who began very earnestly the administration of some of those wonderful, wonderful drugs. Actually, the morphine didn't take at first - it brought my pulse below the safety threshold in the common side effect known as bradycardia - so Urs couldn't quite be vanquished for another couple of hours, but eventually he was, and I came out of that singular state that is the exclusive experience of pain. Relief, indeed.

It is the definition of severe pain that it demands your whole attention like that. Perhaps, more so than pleasure or enjoyment, it's pain that is the exact opposite of boredom, the thing that prevents your mind from drifting or changing the subject in any way, until that absolute pinpoint concentration too sublimates into something further, a state of feeling only, without the possibility of articulating thought. I felt during that period generally unsure of my whereabouts, or in fact of the passage of time. When questioned by the nurse, the doctor and a couple of medical students following admission, I struggled to understand them, and to form and then utter replies as simple as Yes and No, let alone anything more complicated than that, required a sort of mental run-up. So I wasn't surprised to discover afterwards that the pain chart scale used by most hospitals, including Wellington's, was originally developed by a paediatric nurse to help young burn victims who might have difficulty expressing their condition in words.

The faces of pain used on the charts at Wellington Hospital. In the chart proper they sit on a numerical scale from one to ten with descriptors ranging from "no pain" to "the worst possible pain".

Besides their benign nature, kidney stones are unique also in that they provide you with exquisitely concrete evidence of the source of the pain. Eventually you'll end up with something like this, a little rock made in about 80% of the cases of calcium oxalate (the image opens in a new page due to the ewww! factor - fair warning). This inorganic compound forms by precipitation in the kidneys in needle-shaped crystals (gee, thanks), is highly poisonous and is produced in nature amongst other things by the dieffenbachia. That's weird, right? Even weirder than the human body manufacturing morphine on its own. I mean, I had never really given much thought to animals and plants producing minerals before, but of course it happens all the time, and it reminds me again of the art of Brendon Wilkinson and of the recent sketchy reflections on this blog about human geography and geology.

Take dolomite, the rock whose origins are a mystery to science but likely involve the sedimentation of different kinds of organic matter, and that was found once to have formed inside the kidneys of a Dalmatian dog. Yet there are whole mountain ranges of the stuff. Here's a photo of my dad climbing the Dolomites, ca. 1958. For some reason it boggles my mind that he was fifteen years younger than my current age at the time.

Wait, don't tell me, I'm letting my mind wander again, aren't I? Oh well, just one last look at those beautiful poppies then,

and I'm off to look after myself for a few days.


Emanuele Ziglioli said...

The worst is over! hope you recover soon

Deborah said...

The stones. They are gone?

I was wincing and moaning slightly at various points in that post. My deep sympathy, and my best wishes for a speedy recovery.

Samuel said...

Ouch! Hope you're feeling much better shortly.

Di said...

Oh dear god, I can't believe you left me holding my nose, trying not to laugh through it because I want to be sympathetic, I totally get the pain factor but you are hilarious but I know the dastardly side-effects of morphine.

I'm glad 'it' came out but even typing that made me do that hollow-bellied laughter. Get well soon and yes, buy Justine flowers because she is goddess who loves you and got you there.

But please, never make me laugh like that ... when all I want to do is sympathy!

stephen said...

Glad to hear that you're ok!

My ex-wife and mother of my child has passed a stone and she says stones and childbirth are absolutely comparable in degree of pain. Although it is better in that no one expects you to be all happy and proud afterwards and treat it as an affirming womanly experience.

wv: flusped, past tense of flusp (v), to be on the verge of saying FOR FUCKS SAKE but managing not to.

Giovanni said...

wv: flusped, past tense of flusp (v), to be on the verge of saying FOR FUCKS SAKE but managing not to.

One of the nurses complimented me on my lack of swearing but hey, you can't swear if you can't talk I say.

Although it is better in that no one expects you to be all happy and proud afterwards and treat it as an affirming womanly experience.

What you get at the end of it is also less likely to ruin you financially.

(Also, @Deborah: yes, the stones, they are gone. Yippee.)

Anonymous said...

Been there, done that
Happened to me (out of the blue) a couple of months ago
I describe the pain as having a rat gnaw his way out of your back
You just can't switch it off
Loved the morphine although it took a double dose to do the trick, unfortunatly my body doesn't like morphine , vomiting
Mind you last time it was with 5 broken ribs which is not nice

The good news is that after extensive testing there has been nothing since
I just get to drink a little more
I sincerly hope you have the same result
Raymond Francis

Giovanni said...

I was saying to a friend that we should form a veterans' association. That way we can meet and drink lots of water together.

Philip said...

Blimey. If only my toothache had resulted in something this interesting. I don't suppose I'd be looking forward to the next one with happy anticipation (there are limits even to blogothusiasm), but I might at least feel that my non-boredom had not been altogether in vain.

Word Verification: nonarit, Latin for he, she or it did not say "yes" in a Somerset accent.

Danielle said...

Philistinism alert: I knew about DolEmite (the blaxploitation movie) before I knew about dolOmite (either the rock or the mountain range).

I am extremely impressed that you maintained Regular Blogging Frequency under such circumstances.

Giovanni said...

Well, yes, I am fond of my RBF. Consider that the post practically wrote itself though.

Taramoc said...

Glad to see you are ok, and equally impressed on the fact that you keep blogging no matter what.

When it comes to pain, I have to report my experience on breaking two legs (thankfully in separate occasions) and a wicked hear infection.

The infection wins hands down. I remember taking these pills every four hours that were supposed to stop the pain, but would work only for half an hour, leaving me with three and a half of howling. Once I tried to take one after two hours out of desperation, and my wife told me that I started to sound like HAL with half of his memory banks removed. I didn't dare to experiment like that again.

Not sure if it stacks close to the kidney stone, but I sure hope not to find out.

WV: rotoccle: way of cooking an egg by taping it to the end of one of the rotor blades of a helicopter and activating it for 30 seconds.

Peter Ashby said...

I hear you, about Urs. It takes me back to the time I had epididymitis. There I was industriously injecting dna into mouse eggs and Urs came along and STOOD gradually and implacably on my left ball. I was in such pain that dropping my trousers in front of the only doctor (female) I could see at short notice was no problem. I didn't get morphine just antibiotics.

Oh and humans don't make morphine, that is the wrong way around. Morphine just happens happily to fit the same receptors that our own molecule does. Since animals came before flowering plants that makes morphine an analogue. I have no idea what it does for the poppy, its probably a pesticide, for us animals.

Group I am also addicted, to my own endorphins. These days it takes me about 30 mins of running to feel it as a sort of third wind. It works so well that the slight niggle on your heel for the last 10miles turns out when you get your sock off to be a broken blister the size of a 50c piece. Which hurts like crazy once you have cooled down, showered and lost the happy juice.

Wise runners recognise the signs even while blissed out.

I'm different on morphine. My wife says it makes me crabby.

Keri h said...

O Giovanni!
And, another O!
I know about pseudogout, and osteoarthritis: I've broken my pubic inferior & ischial rames, and 3 metatarsii. A rib.
Have neck vertebrae that were early damaged and are now eroded, and sometimes leave me stranded on my beautiful bed (where-near I keep all necessary comforts. Voltarren mainly. Some heavy stuff from my medical friends. Almost never needed. Never opiates.)
When I broke my right arm v. late last year, I knew the pain tricks (how to keep your mind focused on other things entirely.) They work - but *never with jaw abcesses* and *never* with kidney/gall stones/fullblown gout/spinal abcesses -or childbirth....
Why 'never opiates'?
I know - in some strange instinctual way -that they will kill me. When I was offered morphine to have my Colles fracture disimpacted, I said, I can handle this. And could.

Heal very well Giovanni! And - look forward to seeing you me te whanau south this year?

rob said...

Ouch ouch ouch.
Urs is a very bad man. I hope someone removes HIS testicles while he's watching, and tosses them nonchalantly (as a vet once did with one of our donkey's testes while we watched) to their grateful terrier.
The nastiness of the experience has another effect though: doesn't it suddenly feel miraculously, blissfully grand to be at ease, once again, in one's body? What we take for granted and hardly notice is thrown into stark relief. And my goodness, the relief is like a blessing.

Giovanni said...

They work - but *never with jaw abcesses* and *never* with kidney/gall stones/fullblown gout/spinal abcesses -or childbirth....

It’s funny you should say that because at one point seeing where the pain was I distinctly remember thinking “what I need here is an epidural”. But I guess morphine is faster. And of course you can’t give opiates stronger than petidine, if that, during labour.

(Since I introduced the silly comparison between childbirth and kidney stones in the post, one could mention also that the pain of labour has a function, whereas the pain of kidney stones at best is there to tell you to “go curl up somewhere”, and to add to the weirdness you feel it in a different place from where the stones are actually passing. I think there are wiring issues there that somebody ought to fix.)

Heal very well Giovanni! And - look forward to seeing you me te whanau south this year?

We’d love to, and steadily working towards that I assure you!

The nastiness of the experience has another effect though: doesn't it suddenly feel miraculously, blissfully grand to be at ease, once again, in one's body?

The after-effects of the morphine I think might have messed with that transition, I didn’t necessarily feel like that wonderful body was mine. I do get exactly the feeling you describe the morning after a migraine though (even though the migraines I get aren’t even very painful).

harvestbird said...

There was a classroom poster of all the birds and their names,
mostly in English. The most
dangerous birds (to you) at the

top, the least were at the bottom.

I read it to avoid the other
readings (water safety,
fire safety, burning children and
drowning girls) and read it again.

I watched the wall and read it again.

Hot August night, under covers in
someone else's room, someone else's town
I could hear the sound of my own groaning.
After a while the birds came into focus:

beak, wings, breast, bearers of pain.

This is the New Zealand Falcon
and behind it, this, this is the Kakapo.
Sharp motion followed by dull ache.
The adults at the door in the dark.

I don't remember what happened after that

to me or to the pain; it must have stopped.
We were miles from the city hospital.
The beating of the wings,
the scuffling of the claws.

I was ashamed of the metaphor

and of the pain. (Fire, water, learn.) The birds retreated to the wall, the poster superseded.
The lesson never got repeated.

harvestbird said...

The formatting on this one is a bit borked*. The correct version can be viewed here.

*old poetical expression.