It starts in the back of my head… The suboccipitals, to be exact. It’s a pressure. A tightness. A sensation as if my shoulders are permanently shrugged and no matter how hard I try, they won’t go back down. Then, predictably, comes the pain. It starts in that same spot and wraps over my head and into my forehead, as if a claw has erupted from that very tension and wrapped it’s greedy, unkept fingers around my skull. If I turn my head too fast, the room will spin. Sometimes there is nausea, other times not. But this sensation is how it always starts.
I never know how much worse it’s going to get or how long it is going to last. Sadly, this type of flare is the worst because it is almost impossible for me to concentrate. After the headache sets in, with the long and unkept, dirty nails of that claw digging into the centre of my forehead, it doesn’t take long for the fatigue to set in. And once the fatigue comes, there is no turning back.
Sometimes I’m lucky and the fatigue never comes. Sometimes I can take some painkillers and lay down and sleep away the signs. But not always. Then when the flare gets worse, the tension and pain spread down into my back, between and under my shoulder blades. The sinews projecting from the bottom of that claw grow like hungry roots, closer and closer to my core. And then it just stays. The pain feeds off everything that I need to live and be functional, yet there is no way I can sacrifice any of that energy right now.
I am a chronic pain sufferer. I have been for a long time. And, I have other symptoms, too. I’m a doctor and I know what these signs add up to… but I don’t want to accept it. There’s the classic trigger points. Sometimes it’s the painful skin that stretches the length of my lower body, making it impossible to walk through the hallways of the hospital without my scrub pants torturing me. Other times it’s my toes going numb during a long surgery case, or losing feeling in the tips of my fingers if I have to wear two pairs of gloves for too long. Then there are the days when I can’t walk properly, or sit, or lay, or pick up my daughter without my SI joints feeling like they are lined with tiny razor blades. And sometimes, it’s all of these things at once.
Gynecology is a surgical specialty with a disproportionately large number of women who suffer with chronic pain. This isn’t surprising, given that pain syndromes run together. Fibromyalgia, chronic back pain, IBS, chronic pelvic pain, painful bladder syndrome (interstitial cystitis), vulvodynia… It’s not uncommon that these occur together. Therefore, I interact with these women frequently. They are difficult patients because we can never fully help them with their symptoms, as hard as we try and as badly as we want to. They always come with stories of what their lives used to be like before the pain took them over and in telling these stories, they look defeated. I empathize deeply with these patients, yet they are a constant reminder of what I fear most. I don’t want my pain to defeat me.
Despite my logical nature, I believe that if I refuse to accept that I have a chronic pain syndrome, then it won’t be true. If it’s not true, then I will never progress to a point where my life isn’t what I have worked so hard for it to become. I stay attuned to my triggers: Stress, sugar and refined carbohydrates, lack of sleep, migraine headaches, and dehydration. I keep a journal of my symptoms and flares, and how long they last. And when I am really good and stay on top of things, they hardly come. Up until earlier this month, I hadn’t had a serious and debilitating flare for almost 18 months. I thought that maybe I had beaten it.
As I frantically prepare for my licensing exams in the spring, my stress levels have increased dramatically. As a result, the flares are happening again, and more frequently. I am scared that I won’t be able to get them back under control and that this is the spiral that will derail everything I’ve worked hard to achieve. I’m doing my best to keep up with my care in the midst of the stress, and that’s all I can do right now. Keep pushing through the pain and hope that one day the clouds will part and sunlight will kill (or at least maim) the ugly claw that is trying to suffocate my life.