In a Moment

The room is cold.  Every operating room is cold, but this room, while it has warm wood paneling and a mix of soft and bright LED lights, this room is especially cold for all of its attempts at warmth.  The anesthesiologist is holding my hands, and I wonder how her hands are so warm while mine are so terribly cold.  There is another nurse holding my feet, her hands resting gently just below my ankles.  Her hands are warm too.

I feel something cold entering the veins on the back of my right hand and I wait for the regular drowsy brain thickening to start.  I can hear the compressor click on for the oxygen that is tubed up my nose, and the air that floods my nostrils and throat is cold and a little metallic and just a bit sweet.  I try to take deep breaths, partly to calm myself, and partly because I know that a lot of oxygen in my bloodstream will help facilitate the anesthetic.

This is not my first surgery.

I’m still waiting for the anesthetic to hit and I’m starting to wonder why nobody is asking me to count down from ten (my record is four – I’m a boss at fighting anesthetic) and another nurse, not the one at my feet, is swabbing my bare lower back with a ridiculously cold sponge.  I’m pretty sure that warming the antibacterial soap they use to clean a site would not negatively impact its antibacterial qualities, but I’ve yet to find a surgical center that does.  I’ve been to five different surgical centers in the region in the last four years.  Sometimes for the same problem, sometimes something different.

It’s amazing how much can go wrong in our bodies.

My doctor/surgeon steps beside and starts probing my back with his gloved fingers.  The anesthesia still hasn’t kicked it, and I’m starting to get nervous.  Last time I was half gone when they started with the needles, and even though it hurt, it hurt as though through a fog, a dim and almost shapeless hurt, vague and sharp at the same time.  I was never more than half gone last time, but half gone was enough.  This time my brain is sharp and even as another hit of cold infuses the veins of my right hand, I am approaching the realization that there will be no real anesthesia this time.  I try to prepare myself because I intellectually know what is coming, and my reliance on some sort of anesthesia had prevented me from doing the kind of preparation I would have otherwise taken for something I suspected was going to hurt a great deal.

I’m too late though.

The first needle enters with a sharp stab in my lower back.  My muscles contract involuntarily and I let out a little cry.  The surgeon withdraws the needle with a sigh.

“You’re going to have to hold still” he says.  There is a little compassion in his voice – he knows how much I’ve been hurting these last several months, but at the same time, he knows I just wasted several minutes of valuable surgical time.  The radiologist has to re-adjust the x-ray to get the ganglion that my surgeon is hunting back on the screen.

I hold still as I can this time.  I know the needle is coming, and my left fist is full of bedsheet while I try to get control of my breathing.  I’ve had pain of one sort or another for over a decade.  Twice, no, thrice it was from car accidents that were not my fault.  Once from a motorcycle accident that was.  Then there was pain from all the fights – fight after fight – and all the training for fights, until my anger had run dry and my need to hurt myself had dissipated.  And there was the pain from testing my limits.  I have always tested my limits – how far and how long could I run, how many rounds in the ring could I stay conscious, how much weight could I lift, how quickly could I ascent the rock-face.  Long ago I realized that the limit we perceive and the limit we experience are vastly different.  The first kicks in way before we even get close to the second.  All of which is to say, I know how to handle pain.  I know how to hold still when it hurts.  I even know how to relax through it – to lean into the pain until it becomes something that I can control, like my breathing or, to a degree, my heart rate.

The needle goes in smoothly.  I don’t flinch and I feel the ganglion light on fire as the syringe delivers its payload of lidocaine.  My surgeon withdraws the needle, says something supportive and moves to the next site.  This time he hits the ganglion on the first attempt.  I don’t even twitch, even though I can feel every fiber and tissue scream as the needle pierces its way to the front edges of my spine.  Again the burning as the lidocaine hits the nerve, and the relieving sensation as the needle withdraws.  I think to myself, as long as I keep breathing and keep calm, I can do this.  I can stand this – I’ve had worse.  I’m secretly pleased that my heart-rate is only a few beats over my normal resting rate.  I’m in control.  I can do this.

I was wrong.

The needle begins its penetration to the next nerve and my whole body seizes in pain.  I can’t tell if I’ve screamed or not, but my heart rate has accelerated to a brisk jog, and the burning in my back persists even though I know my surgeon has removed the needle.

“The nerves are really irritated and sensitive in this region” he says.  NO SHIT, I think.  I’ve been in pain for over a year.  Sometimes it burns and aches so bad that I can’t stop the tears, that I can’t continue to stand, that I seriously consider the merits of suicide.  He’s trying to push a 5 inch hypodermic needle into the second most painful spot on my body.  The most painful is along the same vertebrae, but on the right side, and I have a brief moment of panic.

“You’re going to have to control the flinch reflex.” he says.  “Like you did on the other ones.”  I try to get control of my breathing as he starts probing around my spine again.  I’m almost ready when I feel the needle prick.  My back muscles flinch and he withdraws.  It takes a few moments to re-align the x-ray and I try to get control of my reflexes.  It takes me five or six more tries before I successfully resist the flinch reflex.  I’m super proud of myself as he starts the injection along the left side, starting with the less painful vertebrae.  This time I don’t even twitch when the needle enters.  I’m a pro – experienced at pain, and in full control of myself, my life, my choices, my world.

And then I am not.

He starts to slide the needle against the S1 vertebrae, and the hyper-inflamed nerves lead the muscles in a total mutiny of my hubristic “control”.  I flinch so hard that I can feel the needle tearing tissue in my back as the muscles drag it away from my spine.  The radiologist re-adjusts the x-ray and my surgeon tries again.  Again I seize.  Again I feel the tear.  He lectures me a bit, and through clenched teeth I say I’m trying.  But the pain – this is not a pain I can meditate through or breath through or relax through.  This is fight or flight.  This is the pain that trumps everything.  It is primal, and the flinch is hardwired into a part of my brain that I have no control over.

Again and again my surgeon attempts to get the needle into my back deep enough to hit the offending ganglion nerve.  Again and again I seize and tear the needle away from its target.  I’m starting to grow fatigued from the pain and strain when I feel the nerves in my right leg fire and my foot begins to thrash about.  Now I know why there was a nurse at my feet.

She pins my foot so quickly that I barely have a chance to hurt myself.  My surgeon withdraws the needle again.

“It hit my leg” I say through clenched teeth.

“Yeah, I thought so.” he says, and tries to slide the needle in again.  The nerves in my right hip and leg are still afire from the violation, and the muscles in my back are seizing so hard that I barely notice the cold rush into the veins of my right hand.  The oxygen tank compressor has been off for a while, and I wish it would click on, that something would happen that, for a moment, could take my mind off of what is happening.

I’m doing this for a job.

The thought hits me like a stone.  I’m doing this to my body so that I can continue to work a job in a cubicle – a job that has long since ceased to be satisfying, a job for a boss who has become mercurial on his good days, a job where all it feels like I do is fix other people’s mistakes – and make my own in the process.  I’m doing this for a job that is not what I’m meant to do – that is not my dream, that is not my goal, that is not my final destination.

And I realize that I am insane.

I’ve lost track of how many times the surgeon has tried to get the needle into place along that last vertebrae joint.  Twenty?  Maybe thirty?  More than thirty.  My entire list of adult life choices is passing before me – everything from my first job, to my failed marriage, to my undergrad, to my current position and I’m judging like the chief justice of the Supreme Court.  How many failures?  How many times have I tolerated situations that were really unhealthy for me?  How many times have I allowed people to mistreat me?  How many times will he need before he gets this needle in?  And what in my life is worth this kind of pain?

Not a hell of a lot – definitely not my job.  Probably not my house.  I’ve already given up my lifestyle.

I’d endure this for a friend.  For my immediate family.  For a lover (that I really don’t have) or for someone who has the potential to really make this world a better place.

And then it hits me.  Would I endure this pain for me?

Would I do this to improve my own life?  Would I tolerate this if I knew it would give me something beneficial in the end?  I’m terrified and disappointed that I never asked this question.  And year and change of doctor appointments and debilitating pain and all the different drugs in the world, and I’ve never actually confirmed that I am worth this.  I always thought I was doing it for the job, but the reality is that I should be doing it for me.

I feel the needle enter, and the muscles don’t seize.  It hurts so bad that I’m crying, my knuckles are white, and even my right hand is clenched so hard that the IV is protruding from the vein.  My surgeon keeps pressing and gets the needle as close as he can to the over-stimulated ganglion.  I feel the chemical burn of the lidocaine as it hits the nerve, and then nothing.

The nurses close my surgical gown over my back and set a warm blanket over my body.  They wheel the gurney into the room and I move myself from the table to the bed.  I lay my legs straight and it takes me a moment to realize that I can do so.  Normally I can’t.  But I hurt.  Oh how I hurt.

And this is only a test.  I get to decide if I pass or not, and the next grade… it makes this look like a cake walk.

I decided I passed, but I would be lying if I said I had no trepidation for the next stage.  And everywhere, in every sentence and every question and every email and meeting and conference call and document needing review there lingers this life changing decision.

Is it worth it?

I don’t know.  But I hope so.