Statement of Record

Pain and Coping

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Pain and Coping

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by Christine Henneberg

Recently an old knee injury from my twenties flared up. The knee aches every time I walk down the few steps into the garage. In bed at night, I can feel it throbbing; it distracts me from the book I’m reading. I blame it on the fact that the pool is closed and I haven’t been swimming. Instead I’ve been walking a lot—almost exclusively with the double stroller. I even went running a few times, for the first time in years. And I’ve been doing a lot of home exercise videos when I wake up at 4:30 in the morning, unable to fall back asleep. All of these things must have taken a toll on my already shredded cartilage. 

My best friend, who also has a baby and a toddler at home, has been having pain in her lower back and hip ever since President’s Day. Yesterday it got so bad that she called her doctor, and learned (over a video visit, without anyone to physically touch her and ask Is this where it hurts?) that she “probably has a herniated disk.” She texted me: Now I just have to find out if this muscle relaxer the doctor prescribed is okay to take while breastfeeding.

I have been thinking about pain—both chronic and acute—as it relates to stress and isolation, and specifically the current “crisis.” I’ve observed that my abortion patients have been having more pain during the procedure, even though I’m giving the same doses of moderate sedation that I always use (Fentanyl 100 mcg + Midazolam 2 mg). This combination is typically effective for most patients, but lately the medicines seem to hardly touch them. To the point that it seems like a pattern. There’s always been variability. In the past, on any given day, I might joke to the nurse that we got a “bad batch” of Fentanyl, because no one seems quite as relaxed and comfortable as I would like. And then other days, everyone seems perfectly calm, almost serene, with exactly the same medicines. But there haven’t been any days like that since the beginning of the Coronavirus pandemic. I just keep hearing patients cry and tell me it hurts, watching their hands clutching the sides of the table while I work as fast as I can, trying to finish. 

I have also noticed another pattern, which is an increasing tendency for women to apologize during and after their procedures. This might be directly related to the observation that they seem to be feeling more pain, because one of the things patients apologize for (and this has always been true) is crying or moving around on the table, or in some other way involuntarily expressing discomfort or sadness during the procedure. But lately, especially the past two weeks, it has been remarkable.

A few patients come to mind. 

The first woman was barely pregnant, maybe five weeks. I told her there was a chance her pregnancy would be too small for my instruments to reach, or that even if I did get it out, it might be too small for me to see, and I might need her to come back in a few days for some blood work, “to make sure your pregnancy hormone level is going down.” I made a downward sloping line in the air with my hand as I said this, as I always do when talking to women with such early pregnancies. 

This obviously made her anxious. She explained that she was a sheriff’s deputy, and she worked “weird hours” at the county jail. She wouldn’t be able to return for a blood draw for at least a week. I told her that wasn’t ideal, but would probably be okay. But she kept asking how likely I thought it was that she would need that second appointment. I couldn’t give her a definite answer. I could see that what she was nervous about was the idea of not being done today, of walking out of here possibly still pregnant. 

“I will do my very best to make sure you’re done today,” I said. “I promise.”

She was tall, with big shoulders and long legs. She looked like a woman who could hold her own among police officers and inmates. She wore no makeup. Her blonde hair was pulled back in a tight ponytail like a softball player. It was almost hard for me to imagine that she was pregnant. I suppose this was because it was hard to picture her surrendering her body, making herself available and vulnerable to a man, which (a limitation of my own imagination and experience) is the only way I have of conceptualizing penile, penetrative intercourse. 

She asked me about the para-cervical block. “Is it a shot?”

“It’s an injection,” I said. “Of lidocaine.”

“But is there a needle involved.”

Yes, I admitted, there was a needle.

“Oh Jesus.” 

When I gave the first injection, she jumped. Her bottom lifted higher off the table than any woman I’ve ever seen. She begged me not to give the second dose, so I didn’t. “It’s not absolutely necessary,” I said. 

She didn’t have an easy time with the rest of the procedure, either. I kept having to remind her to hold still. At one point I stood up to talk to her, reassure her, coax her back down on the table, closer to me. She was biting her knuckles; she had half her hand in her mouth. Around it she whispered, “Shit. Okay. I’m sorry.”

“It’s okay,” I said. “It’s hard.”

Afterwards in the lab, I could see that I had definitely gotten the entire pregnancy. It was tiny, but it was complete. I went back into the room. She was still pressing her eyes and lips together. I was happy to tell her the good news, thinking she would be relieved and grateful. But she just nodded, almost imperceptibly, and said. “God, that was painful. And I screamed like a bitch. I’m sorry.”

“You were brave,” I said. “It was really hard.”

“Shit,” she whispered. “Shit. I’m sorry.”

The second woman I’m thinking of was a former heroin and meth abuser, now in a methadone program. In retrospect, I should have offered her a double dose of fentanyl right from the beginning. She was wincing and writhing even when I placed the speculum. I did give her a second dose soon after that, but it was too late—or maybe nothing would have helped her. By the end she was sobbing, these big, groaning sobs that reminded me of a child crying out for her mother. I often think about addiction and pain as being related to our most childlike state, the part inside each of us that has no real way to cope at all, can only cry out helplessly and wait to be held and comforted by someone—or something—entirely external to us. Possibly (this is just my unformed but, I think, empathic idea), abandonment and abuse are related to this also. Where does a person turn whose experience, as a child, was of loneliness, fear, even suffering at the hands of the adults who were supposed to comfort them? 

This woman embodied that childlike helplessness. The way she sobbed, her mouth wide open, all her white teeth showing, tears and mucus streaming from her eyes and nose. In between sobs she said over and over, “I’m sorry! I’m sorry! I’m sorry!” 

I thought: She isn’t even here in this room right now. I am the immediate cause of her pain. But the pain has become its own force. It has lifted her up and carried her somewhere else, far away, where far worse things are being done to her.  “I’m sorry! I’m sorry! I’m sorry!”

My patients, who are screened at the door for Coronavirus symptoms—no one with a cough, fever, or sore throat is allowed inside for an abortion—all seem to have developed some strange underlying affliction, something that started at exactly the same time as the Novel Coronavirus pandemic.

Even stranger: I have come down with this affliction, too.

When the world stopped and the paid (read: male) economy ground to a halt, a weight fell upon us, the women. Specifically, the mothers. For me, the weight has fallen on my knee. I feel it lifting and carrying two 25-lb bodies all day, and pushing the double stroller anytime I want to leave the house—because I cannot leave the house without taking my two children with me. For my friend, the weight fell on her back. She’s spent much of the past three weeks horizontal, lying on a heating pad on the floor, while her children sit and stand beside her, their little arms outstretched.

For my patients, the weight has fallen on a place that is both embodied and disembodied. It is located inside their uteruses but also, bizarrely and unfairly, somewhere else, somewhere untouchable.

As this virus was swirling in its invisible droplets around the globe, clinging to tongues and nose hairs and corneas, lurking on airplane trays and car doors and in the fingernail crevices of nursing home aides, men continued to insert their penises into women’s vaginas, as they have always done. Now these women are my patients, as they have always been. And the burden falls on them, as it always has, and always will.

And the men in their Big White Buildings—in the halls of the Capitol and the benches of the high courts and the pulpits of mega-churches—have the audacity to call abortion “non-essential” healthcare.

The third woman was young, seventeen, and had a technically very difficult procedure. She was 14 weeks and 5 days, with a tight and tortuous cervix. The calvarium was way up at the fundus and I could tell it was going to be hard to get it out. She was very anxious and nauseated. About halfway through the dilation we had to stop for a long time so she could throw up. That’s always terrible. Whenever that happens, I agonize about whether to take the speculum out or leave it in. I never know how long her vomiting will last. I don’t want to have to remove and reinsert the speculum, and re-grasp the cervix with the tenaculum, etc. if I don’t have to. But in this case I should have removed it. She just kept puking. Each time, the force of it lifted her hips off the table, her feet still wide in the stirrups, her vaginal walls clamping around the speculum, which stuck out of her body like a weapon. In between heaves, she would spit weakly into the emesis bag and mumble, “I’m sorry. I’m sorry.”

Afterwards in the recovery room, she looked somewhat better. I was relieved, as I always am in those cases, to see her dressed and reclined in the armchair, her eyes closed, a heating pad over her belly. Her mother, who under normal circumstances would have been allowed to sit at her side during the procedure, was waiting in the parking lot, an unlikely but possible vector of infection barred from inside the clinic doors. 

I touched her knee and her eyes opened. 

“How are you? How’s your pain?” 

“Better, thanks.” She grimaced, not a look of physical pain, but of apology. “I’m sorry. I feel like I was a bad patient.”

“No. Don’t. You weren’t,” I said. “It’s hard.”

“Yeah,” she said. “But. I just couldn’t. . . I feel like I was all over the place.”

Why do women apologize when we feel pain? A simple answer is that our pain means someone else must care for us, so we cannot do the work of caring for others. But why should isolation enhance our pain and our compulsion to apologize for it? I do not have an answer. With my drugs, my words, my swift and gentle touch, I am trying desperately to treat this affliction—until the Coronavirus pandemic is over, or, as we are beginning to talk about more and more these days, until we can all learn to live with it. A chilling thought, as I touched this young woman’s cheek, still damp with sweat, over the edge of her mask.

I told her she’d done beautifully, and that she was strong and brave. But I could tell nothing I said would make a difference. She was living in a story where she had failed: failed by getting pregnant, by needing to come in for an abortion—Now! Of all times! When everyone else was able to stay comfortably and safely at home!—and then by not even being able to gracefully and stoically handle the pain that she so surely deserved. I imagined these were her thoughts. I felt certain of it. I’ve seen enough women go through this. I’ve heard enough of them talk, under the effects of drugs that, even if ineffective against the pain, make them forget what they’ve said, forget that anyone was there to listen. 

About the author

Christine Henneberg is a writer and a practicing physician in California. Her essays have been published in The New York Times, Slate, HuffPost, and multiple medical journals.

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