The Psychological Anatomy of Pain

 The pain in my thigh was severe, constant, banging on the ceiling of my consciousness for attention and waking me at night. Last week I rang the hospice for advice, and they were hyper-efficient, sending a nurse called Nicola the following day who spent a long two hours interviewing me and Ann, less about the pain but more about how we wanted to handle the terminal phases. To direct questions, Ann bravely said she wanted to keep me at home and I said I didn't want to be resuscitated, to which she said they could stick DNR notices round the house to make sure any ambulance people got the message. She recommended paracetamol and co-codamol, with an offer of morphine if the pain escalated. Also, at a very practical level, she contacted the oncology team at Addenbrookes to arrange a scan. The appointment came through on Friday, and late on Monday evening a had the CAT scan. The first results were through for the head the same evening, showing the atrophy of the brain I have already commented on.

The other results trickled through the next day, surprisingly showing that the cancer was stable in the lungs and liver. The nodules have not increased in size, and there are no further metastases. The scan did reveal a hitherto unknown degeneration of the spine with scoliosis (curvature), which explains why my posture is bent as a tired comma. But no metastasis was seen in the bones, particularly the upper thigh. The pain is most probably referred pain from pressure on the lumbar nerves in my back! This has changed my whole attitude to life. Hitherto I had been told I would be dead within 12 months, with September looming daily, unavoidably closer. Now it is one more stop on life's journey rather than an ultimate terminus. Now, the pain has not changed, but my whole attitude to it has. It is no longer a marker of impending doom but a sign of aged decay, typical of the pain anyone might get if they live long enough, but not fatal. Suddenly, I am not trying to supress it completely or wondering if I ought to request morphine yet. Suddenly, it is merely a nuisance to be ignored and lived through. 

View from Borley Church

When I was a medical student, it was still accepted that we used euphemisms when talking in front of patients. Cancer was 'mitotic changes' or vaguely, 'neoplasia'. Gradually this changed and transparency became key. We told patients directly to get their affairs in order or say their goodbyes. I was one of those at the forefront in bluntly hitting them with an unpalatable message, and I remember witnessing the sudden change in demeanour, the shoulders drooping, the downturned face, the heavier step as they turned to leave. Now I have experienced it directly. Now life seems worth living again, for I might yet have a year or two rather than a few shrinking months. Life is much better imagining a bright ongoing future, rather than a shortening path to a certain death. My art today is 'The View from Borley Church'. Borley is a village in Essex whose church and rectory are reputed to be the most haunted in Britain. The churchyard was cold and shadowed even in summer, but the view north was across to Suffolk, looking sunlit, warm and inviting. Thus do I feel as though I have stepped from a cold, dark place haunted with fears and death back into the sunny fields of the living. I have learned that hope is the most valuable medicine of all. We must not destroy hope, but encourage the belief that there is always one more thing we can do before the end closes about us.