Building on Past Work on Pain and Fear
In September 2016, I had my shoulder replaced. The surgeons made a six-inch incision in my shoulder, cut through a muscle to reveal the shoulder capsule, cut through the capsule, and cut off the top of the humerus (upper arm bone) and replaced it with a titanium ball on a six-inch stem inserted into the bone. Then they “reamed out” (shaped with a sharp cutting tool) the part of the shoulder blade that together with the head of the humerus makes the “ball and socket” joint of the shoulder so that it matched the exact shape of the new metal ball. Then they reattached the muscle to the bone with permanent sutures that went into six holes drilled through the humerus. Then they stitched the rest of the tissue back together. Finally, they used twenty-one staples to close the big incision.
This was my third joint replacement. The first two—both knee replacements—were great “gateways” into my early distress, and discharging that distress clearly made this surgery easier. (The story of the earlier surgeries is in the October 2014 Present Time.) In the other surgeries I had used a minimum of pain medication, primarily relying on discharge to “handle” the pain. One of my goals this time was to use no pain medication and use the surgery to face the unbearable early hurts. I thought I could do it because since the second surgery I’d discharged so much on the pain and on where I had given up and taken a drug twenty-four hours after the surgery.
With my knee surgeries I’d had a spinal anesthetic, but all the surgeons I talked to about my shoulder surgery said that it required a general anesthetic. I researched it well, and in my pre-operative anesthesia visit I requested minimal anesthesia. I said that I wanted no Versed (which has an amnestic effect), no painkillers apart from what they needed to control my blood pressure, and no painkillers before they sent me to the recovery room. I said that I wanted to wake up in pain. The pre-operative anesthesiologist was very negative about it all, so I had her put my requests in my chart along with a note saying that I didn’t want her as my anesthesiologist. The anesthesiologist I got on the day of surgery agreed to all my requests.
I was administered the anesthesia in the operating room, right before surgery, and awoke quickly in the recovery room with little drowsiness. I was in a lot of pain from the time I woke up, but I knew why I was in pain, I remembered everything about my decision, and I was relaxed about it. I told the recovery nurse that I didn’t want any opioid (narcotic) painkillers and that crying would be my main means of pain control, and she was fine with it. Soon one of my buddies was allowed in, and I began discharging. The nurse was very relaxed and left us alone except for checking on me from time to time. I cried softly but intensely.
They were slow in getting me a regular room, so I was in the recovery room, crying, for four hours. My counselors took turns being with me. For most of the time the pain was about 8.5 on a scale of ten (with ten being unbearable pain for me). To my surprise, it never increased to the level I had experienced with my knee surgeries. Instead, after four hours, it started to diminish. And while it varied for the next few months, it was never unbearable. (It had felt unbearable with my knees.)
The first day after the surgery I mostly discharged on pain. I felt like I had a ball of fire in my joint, and it was easy to focus on that and discharge. I had many people with me at all times. Three people stayed the night. To my surprise, I discharged enough that day that by 10:00 p.m. I fell asleep. (After both of my previous surgeries, I hadn’t slept until the second night—the pain was too intense.) I slept for five hours. Then I woke people up, and the sessions began again.
I did so well in the hospital that they discharged me after one night. (The surgeon had told me before the surgery that this was very unlikely.)
On the second day I felt physically sick. I assumed it was from the anesthesia, so I discharged most of the day on that, as well as the pain. I had really useful sessions on very early distresses, the content of which was feeling like something was deeply wrong and I didn’t want to be there but I couldn’t change things.
Since then different parts of my shoulder anatomy have hurt, and it’s been good to work on each one. The pain level goes up and down, but it doesn’t seem to be a reliable indicator of anything except my need to discharge. I’ve kept feeling the pain by persisting with the prescribed stretches (it hasn’t made sense to put much pressure on the wound). Parts of my back and neck have hurt too. I’ve felt like I am being stabbed by knives in many places, but it has all seemed to be part of what I need to work on.
Stretches and exercises began in the recovery room and since then have continued five times a day. I discharge my way through all of the stretches, holding at the places where it hurts the most until I can relax into the stretch. The pain is intense and comes close to being unbearable. I discharge a lot if I have attention. (At this point I do most of the stretches alone, discharging when I can, and then work on the pain anytime I have a session.)
My shoulder did not respond to the stretching as well as we’d hoped, so after five weeks I went under anesthesia again for five minutes while they manipulated my arm in all directions to get more flexibility. That caused a lot more pain, so I continue to cry my way through the exercises five times a day. The shoulder is a lot more flexible than before the manipulation. I’ll see what additional motion I can gain with stretching and discharging.
Recovering from my shoulder surgery has been much more painful than recovering from my knee surgeries, and, to be honest, I am very tired of the pain and of the painful stretches five times a day. I have to discharge regularly on the early feeling that things are bad and not changing. If I don’t do that discharging, I want to stop the stretches and just live with the mobility I have attained so far. (It is much better than before the surgery, but what I really want is to have full range of motion. I picture myself swimming across a lake—something I haven’t been able to do for thirty years.)
I’m assuming that with the earlier surgeries I cleaned up much of the accumulated undischarged pain from my sixty-three years of life, including my multiple surgeries, and that with this surgery I have mostly been discharging on the pain of the surgery itself. I think the stretches force me to feel all of the pain from the cutting, sawing, drilling, and so on. And because a metal ball at the top of my humerus is rubbing against the raw “reamed and shaped” bone of my shoulder blade, I think I will have to feel and discharge all of the pain from the surgery before I am free of pain. In the knee surgeries, the cut bone surfaces were immediately covered with metal or plastic parts that were cemented into place. I think that numbed me to a lot of the pain.
Because I’ve had such a busy autumn, it’s been hard to get enough sessions to keep a good perspective. Much of the time I’ve simply forced myself through what feels like an ordeal. But my schedule gets easier in a few weeks, and I think I’ll be able to once again get more sessions and see this project as something useful for my re-emergence, as well as for my functioning.
Did I mention that I succeeded in using no narcotic painkillers? I am very pleased about that.
A month later:
After nine weeks, the excruciating (stabbing, burning) pain I’d felt when I did the stretches lifted markedly to where I could stretch and use the shoulder with just the pain of the stretch. What a relief. Now I just have to battle boredom as I continue stretching to regain my range of motion.
(Present Time 186, January 2017)