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.