Wednesday, February 8, 2012

The Power of Kindness in Recovery from Trauma and the Post Abuse Pain

I thought that after walking around with white tonsils for about six months (growing everything I encountered in nursing school in my throat) and having endured a childhood wherein I walked around with some kind of upper respiratory infection (URI) most all of the time, I figured that I knew a great deal about throat pain. Finally, after suffering so long, and concerned that I wouldn't be able to work in my chosen profession of nursing due chronic URIs, just before I would graduate from the first phase of nursing school which qualified me to take boards to become an RN, my doctors finally agreed that I should have a tonsillectomy. I knew that the surgery was much more dangerous as an adult, as much as I was one at the age of 19. But at that point, I thought I was an expert in throat pain.

I no longer remember what the preoperative process was like, now 26 years ago, only that I was angry that they only gave me an oral Valium as a pre-op drug.  I wanted to have the experience of an IM injection while I was on the receiving end of the surgery experience. I will not forget waking up however, and the experience changed my outlook as a nurse.

I'd gone into surgery with a painful throat infection that was not responding to treatment.   Both tonsils were still covered in a white blood cell rich coating with the left tonsil so swollen that it filled nearly the whole cavity in the back of my throat and pushed up against the right tonsil. I had a fever, and I loaded up on Tylenol to break it so that they wouldn't postpone the surgery.   I felt terrible, but I looked forward to having only a surgical wound instead of the constant tender soreness of a sick tonsil for months on end. I anticipated good things, as a surgical cut always heals faster than a tear (which his how I envisioned my tonsil). The girl in the bed next to me, about my same age, had what the surgeon described as “embedded” tonsils which he planned to have to dig out, and mine were ripe and dangling for the plucking.  All good signs, right?

I don't think that anything could have prepared me for the experience of awakening in the recovery room. I know how I struggled with my clinical workload in school, but my nurse never spoke a word to me -- not once. And I found that I couldn't speak.  I remember black, and strange clinical sounding noises,  feeling incredibly cold, all background window dressing for the BLINDING, tearing, screaming, dry throat pain to which I awakened. I'd suffered broken bones, too, and I thought I had some understanding of pain.  But I'd never felt anything like this hot, burning, blinding pain in which I felt like I was floating.

I opened my eyes. White ceiling. I tried to look at the room, and I couldn't see, not without lifting my head a little. Oh my GOD, HELP ME! It felt like my throat was tearing as I tried to lift my head to see where I was. Some woman with jet black hair in a pixie cut appeared over top of me and made eye contact with me pretty quickly after I'd tried to move to see what the room was like. Without speaking, she plunked a cup of ice chips in my hand, but I laid there, feeling as frozen as they were. I must have been in the Post Anesthesia Care and Recovery Unit, but I was never repositioned in a way that allowed me to see where I was. I only could see the ceiling the whole time, feeling as though I was floating in pain with just my head above it, allowing me to draw air. I was completely wrong in my pre-op idea of what the pain would be like. I thought I'd experienced every kind of throat pain, and I imaged that it would be different-better. It was different-worse, beyond anything I'd imagined before.

The floating in pain feeling was very a difficult and disorienting experience, especially as I was unable to move to see the room without making things feel worse. Everything I could see, save that quick glimpse of that woman's face was white. Even that cup of ice was white, and my hand was buried in the sheet. This is surgery?

Suddenly, I saw the face of my surgeon looking down at me with a scrunched forehead of concern. He was grey haired, and he wore green scrubs with a green scrub material hat that was tightly wrapped against his forehead. He said, “You've been asleep for awhile, and you're in recovery now. The surgery went well.” And as he tightened his forehead a little more and leaned into my field of vision a bit more to make better eye contact, he put his firm, strong hand of assurance on mine saying, “I know that it really hurts. You don't have to talk.” I must have had an expression that tried to convey a million different things, as I certainly felt that way. This experience became an unexpected and vivid memory associated with that trauma of the unexpected pain, and I'm reliving it as I write. This surprises me a bit – how powerful it feels for me, even now, even knowing that it was a part of my healing.

I cannot really explain what happened to me in that moment when he touched me, but I suddenly became a fixed point in space instead of a floating object in a field of white and black pain. It was a flood of awareness of contrasts. He was as warm as I was cold. He was as strong as I was weak. And I felt like I was a sucking mass of pain, and when he touched me so firmly with such strong confidence and reassurance, I felt like he poured a fountain of strength into me which re-fixed me in time and space. I knew where I was, and someone knew and cared about my pain. I would not be left without help. It was such a dramatic change for me in that moment, I wondered if I'd drawn all of the strength out of him because I was in such need of it and took so much encouragement from his touch. I thought that this might have been what happened to the woman with the issue of blood when she touched the hem of Jesus garment, or the tassel on His Talit, whichever it was.

Not until then did I find the strength to break out of my frozen state of body and mind to manage to feel over with my left hand to get to that cup the black haired woman plunked into my right hand, all without telling me I could or should eat those ice chips or where I was.  No one spoke to me again until the that nurse who had given me that Valium tablet in my room hours earlier asked me to slide back over into my bed. No one asked about my pain or offered pain medicine to me until the night nurse made her rounds at about 2 AM. And she insisted that I take it after I tried to say that I didn't need it. I didn't want to swallow, and thought I'd tough out the pain.  I'd made it this far, right?

When I look back on that experience from my perspective now, I knew that I was doing perfectly fine. My breathing was perfect and my throat didn't bleed. (Unlike children, adults face a serious hemorrhage risk after a tonsillectomy.) But even considering that I would graduate from nursing school in about six weeks, until my surgeon showed me so much kindness, validating how I felt and that he knew and had compassion... I feel that without that experience of him touching my arm with confidence, I probably wouldn't have lived.  That's how I felt emotionally.   I know that I would have, but that is not how it felt at the time. I made it a point thereafter to acknowledge my patients' experience of pain and always made an effort to greet and reorient them after surgery. And remembering the power of my surgeon's strong hand, I made sure to always do the same with some touch of reassurance, usually by firmly touching their hand with my own reassurance.

Making Good Use of Pain

In some way, I hope that is what I am doing through this blog and specifically through this subject matter concerning Post Traumatic Stress. There is a terrible disorienting feeling of floating in pain about it and the question in your mind that “This surely should not hurt this much.” I think that for those with the most earnest hearts who are willing to open up their hands and hearts to what God is trying to teach them, it hurts beyond a person's ability to fathom. I hope that what I write here will be a point to fix people who are floating in the disorientation of unanticipated pain back into time and space, just like my surgeon's hand was on mine that day so many years ago. I hope that through what people read here, that the material will flood people with the message of hope, that though it hurts, it is both a part of being sick and a part of the healing that takes place. And as my experience taught me important lessons about how to be a better nurse, I hope that people will heal to go on to learn their own greater sense of kindness with others in distress.

I would go on for the next two weeks in intense and constant pain, finding it difficult. I didn't want to eat, and I drank only when I had to drink. The fatigue was terrible. My throat burned like fire from the pain medicine. Out of concern that I wasn't eating and to give me something with more substance, my mother thought pear nectar would be good, but it felt like I was swallowing sand or ground glass. I'd realize in a day or two that, during surgery, they'd put the breathing tube into me through the left nostril, and that sinus hurt and drained like mad which aggravated my throat. What another added little bonus from which to recover, as I suffered with frequent sinus infections, too. I think that the burning persisted for three weeks, and I'd wrongly anticipated that the surgical wound would limit that type of pain to only three days or so. It ripped and tore when I tried to open my mouth, especially when the surgeon wanted to examine me before I left the hospital. It ripped and tore and burned in the doctor's office, three weeks after the surgery and for a long time thereafter. I remember how painful a yawn was, for a whole month, and I dreaded any kind of involuntary thing like a yawn or a sneeze or a gag. It took so long to heal from that inflammation and soreness and burning and tearing because the tissue didn't want to stretch.

What did happen with the URIs I used to get? Not quite twenty years later, I would have surgery again on my sinuses for chronic infection. They didn't have the technology at the time of my tonsil surgery to do fiberoptic scoping and scraping to both open my and repair my sinuses which were a mess on CT scan. I think of this as analogous to my spiritual abuse experience. My tonsils were not the primary source of the problem: my sinuses were the source of infection that kept my tonsils busy. (The sinus issue comes from a different, underlying immune problem, too.)

In the same sense in a strange analogy, my church experiences (like my throat infections) were only a place to where I transferred the problems that I suffered in my family of origin (which were more like my sinuses).  The immune system problems that caused the sinus infections were more like my false ideas about reality, and the toxic shame I carried.  They were the deeper source.  Likewise, not all people but many will realize that after they leave a spiritually abusive church, they discover that they  have a different root source where their deeper pain and  abuse first began. Be prepared to look deeper into your heart, as God may be using spiritual abuse as an instrument to work on a deeper roots of pain in your heart and mind.

I get mail from people from time to time that had really hard experiences of spiritual abuse. They often will say things that remind me of my recovery from surgery -- that it shouldn't hurt this much. Religion should be about soothing pain, not creating pain, and pain that lasts a long time.  I offer this analogy to them.  It hurts, and it may have roots that run deep to reveal deeper sources.  Don't be afraid of them.  Let God work them together for good for your healing.  Squeeze every bit of usefulness out of the pain and learn all that you can from them.  Let it have its perfect work.

To those who downplay the significance of spiritual abuse and find the thought reform perspective  inaccurate or unhelpful, I hope that you will carry away the message that you don't necessarily have to appreciate the whole package.  But please take away with you the message that kindness to someone in the throws of pain and the hard work of recovery will help them tremendously. Be kind to them – be kind to your friends and your family (and perhaps yourself) even if you don't understand the process.   That kindness can go a very long way.