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Ultimate Reality

I showed up at the Student Health ENT Clinic fresh from my second-year lectures about the anatomy and physiology of pain.  Since my undergraduate degree had been in psychology, I also felt that I had an edge in understanding the emotional component to pain.  Though pain was on my mind, the reason for my ENT visit was the aggravating but nearly painless problem of persistent otitis externa–swimmer’s ear.

Interns and residents, bright, knowledgeable young men and women lacking only experience, staffed the Student Health Service.  Being all of twenty-three myself, I was convinced experience was highly overrated, and happy to accept the free and convenient care.

“No problem,” the resident said.  “You just sit here and I’ll curette out that wax and debris.  You’ll feel better in no time.”

I relaxed.  He curetted.  And in ten seconds I experienced the most intense pain of my life.  I jerked away and stifled a scream.

The resident told me to stay still.  I relaxed.  Pain is a state of mind, I told myself.  Mind over matter.  I willed myself into an immobile zen-like state.

He curetted again.  I jerked away again.  We repeated the scenario multiple times.  In the end, I still had otitis externa, and now a whole new understanding of pain.  There is no mind-over-matter.  There is no zen-like state.  Pain is pain.

A few years later I took care of an old man with a compression fracture of his thoracic spine.  His fall had been minor, and osteoporosis had made him susceptible to such fractures.  The important thing, I kept telling him, was that his spinal cord was in no danger and these injures always healed with time and rest.  But it hurts bad, he told me.  So I gave him a generous prescription for narcotics before he went home from the hospital.

A few weeks later I saw him in the office.  “It hurts bad,” he said.  I asked if the pain medicine was working.

“Not taking it,” he said.  “It’s narcotics.  I don’t want to be no dope addict.”

I assured him that he would not get addicted using the medicine only while he was healing.

He looked doubtful.  “How long?” he asked.

“Six to twelve weeks,” I said.  “From the time of injury.  Another month or two.  No more.”

He gave me the same skeptical look, but this time shaded with something darker.  “I don’t know if I can take it,” he said.

“Take the pain medicines,” I told him.  “Rest.  Be patient.  You’ll be fine.”

I wasn’t worried.  In a few weeks he would be back to normal, which for him involved caring for his rural cabin where he spent his life hunting and fishing.  I had no reason to think this would not be his future.

A few weeks later, his wife called to tell me he was now in great distress.  She was afraid for him.  I got him on the phone.  “The pain’s so bad,” he said.  “I don’t think I can take it.”

I asked about the pain medicines.  He wasn’t taking them.  I reassured him and asked if he wanted to come back to the hospital.  He didn’t.  I got his wife back on the phone and told her to bring him in if it got too bad.  She told me that I didn’t know what he was like.

“He will be okay,” I told her.  “The pain is temporary.  He will heal.”

Two hours later Rescue called from the patient’s kitchen.  He had shot himself in the chest with a shotgun, aiming for the painful fracture site which was located immediately behind his heart and aorta.  He was dead within minutes.

He possibly would have been okay if he had taken his narcotics.  He possibly would have been okay if he had come back to the hospital.  He certainly would have been okay if he had been patient, if he would have–could have– given himself the time to heal.  If only he could have stepped outside of time and stepped back in a few weeks later.  But instead he was dead, a victim of the white-hot obliteration of rational thought and panic induced by uncontrolled pain.

Pain is the ultimate reality, psychiatrist Jordan Peterson stated.  None of our philosophies or religions or meditation strategies can completely take us out of our physical state in this time-space-matter continuum, and nothing drives that point home more poignantly than pain.

Often a patient with a concussion experiences something like stepping out of time for a day.  This concussion patient suffers an injury then a quick return to consciousness but with amnesia for the traumatic event and events several hours before.  He then loses the ability to retain any new information for the next twenty-four hours.  He repeatedly asks where he is, what happened to him, how long he’s been there.  After their questions are answered, almost immediately he will repeat the same questions.  It is as if time now stands still in his mind.  He remembers everything up to one moment, then nothing new.  Nearly always he will return to normal the next day.

The curious thing is that patients with this type of concussion rarely complain of pain, even if they have suffered a broken bone or worse during the traumatic event.  But the next day, when memory returns, pain returns.

Pain, therefore, seems to require us to be conscious of our place in time.

Which brings us to Jesus.

If God is God, and created the universe, one hundred billion galaxies with one hundred billion stars each, and God is all-knowing, and He exists in eternity, that is, not simply forever but outside the limits of time, then God knows of pain but does not experience it.  Yet, He made a decision to not let one species on one tiny planet circling one middling star in one middling galaxy, destroy itself, even if it cost Him some mystical transformation into flesh and time, and, yes, pain like that white-hot thought-obliterating, panic-inducing pain that would cause one to blow their heart away with a shotgun.

So this is the miracle of Christmas: the Creator of the Universe chose to experience pain like yours so that you could experience love like His, and someday you, too, can step into eternity, outside of time and outside of pain.  And into great joy.

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Broken

 

The patient had just murdered his wife.  A single shot from his handgun had sent her straight to the morgue.  Then, with a sudden loss of basic marksmanship, he failed to kill himself.  He placed the gun in his mouth, allowed an awkward angle, fired, and the bullet lodged in the right temporal lobe of his brain, narrowly missing the structures that would have led to his immediate death.

Frankly, I lacked enthusiasm for treating him.  He wanted to die.  He deserved to die.  I wanted him judged by the standard of an eye for an eye, a tooth for a tooth, and a life for a life.  But the discipline of medicine allows no such judgements, and I found myself in the operating room removing the bullet, debriding damaged brain, and sealing the cranial cavity from potential contamination from the tract through the mouth and sinuses.  Miraculously, and somewhat to my disappointment, he survived.

And he survived well.  On day one, I changed his bandage.  On day three, he regained consciousness with no loss of vision or paralysis.  On day five, I removed his stitches.  He suffered no complications despite the high risk of infection.  Physical therapy supervised his return to normal balance and ambulation.  For two weeks he wore a patch over his right eye because he saw double, but then that symptom also went away.  By the third week he could read again.

His discharge was delayed, however, because he had no place to go except jail, and he couldn’t go there until he reached sufficient physical and mental capacity to be competent and self-reliant.  For several weeks he lingered in the hospital with a sheriff’s deputy stationed at his door.

Each day I would come to see him.  Always he was courteous and cooperative with myself and the staff, and in my mind I tried to reconcile the gentle person before me with the raging lunatic who had killed his young wife.

I asked what would happen to my patient after he was transferred to jail.  The deputy shrugged.  “It’ll be up to the judge,” he said.  “But I think probably nothing.”

“But he murdered his wife,” I said.

“Yeah, but the judge is going to see that scar on his head and send him to a psychiatrist who will say he’s not competent to stand trial, and maybe he’ll go to a state mental hospital, or maybe he’ll just go home.”

I stared at him.  He shrugged again as if to say What are ya gonna do?

The next day I found the patient reading his Bible.  I wondered if he even remembered what he had done.  So I asked.

A cloud passed over his face.  “I killed my wife,” he said.

“Do you remember why?” I asked.

“I was angry.”

His memory was intact, but sometimes patients with temporal and frontal lobe damage will be incapable of remorse.  “How do you feel about that now?” I asked.

The cloud came back.  “I feel bad,” he said.  “I loved her.”  He paused for a moment,  then continued, “I’m not that person anymore.”

In his last statement, he was entirely correct.  Due to his self-inflicted wound, his temporal lobe and frontal lobe were significantly damaged, and changes to his emotional responses and intellectual capabilities were undeniable.  He may be incapable of anger.  In a way, he was broken.  Yet the changes left no outward signs.  Even the scar became hidden as his hair grew back.

I once watched a man in Wyoming break a horse.  The horse was dangerous and useless, but expensive with good breeding and therefore worth saving if at all possible.  As a last resort the horse had been sent to the trainer from New Mexico.  Unless the horse could become trainable and safe, it would be euthanized.

The horse bucked and snorted in his stall before being released to a circular corral about forty feet in diameter.  The man stood in the middle of the corral with only a light six-foot flexible rod and let the horse run around him, seemingly oblivious to the threat of crashing hooves and sharp teeth.  He then described his own life, full of passion and rage and despair, and stated he and the horse were alike until, on the eve of his own self-destruction, he was broken and began a redeemed life.  Over the next hour he talked to us about redemption as he let the horse run, made himself vulnerable to the horse, thereby building trust, and then gave the horse the opportunity to submit.  He never touched the horse with his rod or his hand until near the end of the hour when he faced the now calm animal, stroked his muzzle, and placed a halter on his head.  Then he mounted and rode around the ring.  The horse was no longer the dangerous bucking bronco that had entered the ring.  The changes left no outward sign, but the horse was “broken.”

I know that within myself is a streak that is wild and self-serving and ultimately destructive.  It is the voice that tells me that only I know what is best for myself, that life is short and I need to get what I want now, that I need to free myself from the people and the rules that restrain me.  This voice echoes the wild spirit of the stallion, the spirit that would have led to its destruction, and I expect that it echoes the demon voices that drove my patient to murder.

We all needed that spirit to be broken before we could become whole–at least whole in the sense of fulfilling our best destiny.  In other words, we needed to be broken to be healed.

But I don’t think we can break ourselves.  My patient may have come close by trying to destroy himself.  But the horse needed a gentle trainer.  And I also have a gentle trainer; His name is Jesus.

When we are broken, we can be redeemed from the wild and self-serving spirit that leads to rage and lust and alcohol and drugs and despair, the things that hold us in back from our best selves.  The best of us are broken.