Terminal Pain (Paige Zhang)

“It feels like someone is sticking a knife into me. Like, right into the very core, you know what I mean? It’s fucking unbearable.”

The medical student scurries to copy down the words, nodding emphatically with Joe’s description of his chronic back pain. He wonders if she even scribbles down “fucking unbearable” into her neat little notebook.

The day before his scheduled surgery, Joe was visited by a small medical class from the local University. The older man in the group asked if a first-year medical student could interview Joe to practice their interviewing skills. The students all smiled pleasantly at him. “Sure, why not.” He could use the distraction, keeping his mind from being torn apart in his head.

The student was nice enough, naively cheerful and very eager to please but pleasant and comfortable enough to converse with. Joe did his best to answer her questions, or at least give her something that she could write in that notebook she was furiously scribbling into.

“On a scale from 1-10, with 1 being fine and 10 being the most unbearable pain, how badly would you rate your pain?”

Joe struggles in his bed, too weak to move but determined to sit as straight as he can. It’s an unreasonable question; he can’t reduce his pain to a mere number, barely even a word.

He shrugs. “It’s been bad. It’s gotten real bad, unbearable. There are days that it’s been beyond the worst pain imaginable. It’s been real bad for more than days, where it just doesn’t stop, and you think that it never will.”

“I’m sorry to hear that.”

“Yeah, I am too. Chronic pain is a bitch. It pushes you to change, but it keeps you tied to the same. It’s from you and from outside of you. I don’t know how to explain it.” The medical student smiles reassuringly, as if she understands. Joe knows she can’t, how could anyone? This is his pain, his story, and his own tragedy to bear.

“Does anything make the pain better?”

Joe’s eyes take on a faraway gaze, and the medical student pauses to let him take his time in responding. Finally, he laughs sharply, his voice tinged with bitterness. His face transforms into a raw plateau, broken and open. “Well, a couple of times, I tried to kill myself.”

The snow was mottled and dirty against the somber backdrop of a stormy day. There was a soft howl to the wind carrying across the brushes of sleet and dirt, muting the vibrancy of the tall trees and wheat hills with murky snow. Joe sat in the car, distant from this landscape and the rest of this world. His fingers slowly turned off the exhaust. The car shuddered into silence. He was finally ready.

He had thought about it for years, shortly after the pain began following that fateful car accident 6 years ago. At first he only thought about it when he was in the pits, when things were really bad. Those were the times he felt like he lost it all after he and Laurie fought. There were the many nights of endless bottles and collapsing in some alleyway with his only hot breath on his stained clothes to keep him warm until he picked himself up the next morning to head home once more, aimlessly.

He dreamed of hurting himself, and grew fixated with finding his ‘terminal pain’ – the final shot to escape the persistent pain that tortured him. These dark episodes would ebb with bouts of sobriety, of begging Laurie to stay or of spurts of determination to work past it. However, the pain always remained and always escalated into bouts of fury and desperation. Lately, it had been coming all at once. Even the alcohol failed to help as Joe couldn’t wipe away his haunting fear that the debilitating pain would return, as it always did.

He had almost ended things two times before. There was that time he casually decided to go to the hardware store and came home with a thick, long cord. He had thought for a long time about what he would say if the cashier asked him what it was for, but she hadn’t. She just handed it back to him, “$18.34 please”. When he got back to his empty house, Joe swung the rope over the exposed partition of his ceiling, and sat on the chair for a long period of time, thinking very seriously about standing up and tying that knot. He smoked a cigarette, wrote one-sentence goodbyes to his children, and took one last swig of whiskey. But, as the time ticked by, he couldn’t bring himself to do it – to allow himself to live out that sudden fall, feel the unnatural jerk of his head, and face the unknown.

The second time, he had taken his father’s old Colt revolver from the back of the closet. The cold metal felt heavy in his hands. The pistol was old, and from a time when men believed that they had to be prepared at any time to protect their families. Joe’s father never had a chance to use it, but maybe now Joe could use some of those rusty bullets for their intended purpose. It would be fast, and it would all be over. But once again, Joe could only sit and think, giving reluctant gravity to the life he was about to end, and how he desperately wished it wasn’t this way. Once again, he was saved by fear: fear of the sensation of a bullet roaring through his brain, fear of not being able to escape after all.

On this cold winter morning, Joe was sure he was at the end. It was would be easy enough, and he had given it so much planning that he had rationalized the fear away. Take the pills and let the sleep take over, dreaming of Laurie and the kids: happiness, relief…

A bottle of his favourite scotch sat in the passenger seat. Journey played on the stereo, a scratchy rendition of the same tune that had played at their wedding. 1 pill, 2, 5, a handful, the whole bottle….that final fading image of the darkness descending upon the snowy landscape, his eyelids growing heavy, a soft memory of another winter’s morning at the hospital and seeing the twins for the first time, Laurie’s face covered in soft tears…

As Joe drifted into unconsciousness, he didn’t notice the flash of a police siren as a cop car pulled in behind him. He was unaware than the local farmer had called the police when he saw a car trespassing on his land. The cops found a middle-aged man who was barely breathing and unconscious, his skin colder than the air. The car was heavy with the stench of alcohol, and there was an empty pill bottle on the dashboard. They immediately called the ambulance, and somewhere in the local hospital, Joe was aroused from his deep slumber, resurrected and brought back from the dead. His mind blurred with impressions of the faint buzz of police sirens blaring, blinding hospital lights, the indistinct sensation of instruments being stabbed into his body… but the only next true thing that Joe could remember was waking up to that familiar pain. Once more, it consumed him.

A miracle, they all congratulated as he was revived. Joe just laid there in quiet, bitter disappointment.

by Paige Zhang

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One thought on “Terminal Pain (Paige Zhang)

  1. Paige – this is a beautifully written piece about an aspect of medicine that still too often shunted to one side. It also speaks to the disparities between what medicine desires to achieve and the type of life that the patient ultimately wants. Sadly, so many gaps still remain in mental health care, in part because these diseases are not tangible and the fixes require persistence and sometimes disappointment. Thanks for the story – it’s a great reminder.

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