The only real experience followed a fall down a mountainside one afternoon in the wilderness of Crete and finding, when I came to rest, that I had dislocated the proximal interphalangeal joints of the middle and ring fingers of my right hand.
Considerably fortified by the lunch-time bottle of wine I decided with no hesitation to reduce the dislocations myself. The procedure is simple in the extreme: I had reduced several in my Casualty days. It's just a matter of pulling and bending. Isn't it?
So without allowing any time for thought, I grabbed the end of the middle finger, pulled heartily, straightened it up, and with a suitable 'thunk' the joint went back into its anatomical position.
But the ensuing pain was so unexpected that I was sick on the spot, I almost passed out, and I learnt what 'shock' was really like. 'Deep' pain; something inside rather than superficial cuts and bruises. And there was no cup of tea, as in: 'the patient was treated for shock' at hand.
And yet I was still faced with the ring finger whose forlorn terminal phalanges still pointed due east. It is surprising what one can do when the need arises. Even knowing what it was going to be like, I recall absolutely no hesitation before reducing this finger too.
So when I awoke after my laryngo-pharyngo-thyroid-oesophagectomy etc. one of my first thoughts was '...why isn't something hurting here?' With a one foot long transverse upper abdominal scar, and a scar more than halfway round the root of the neck I was surprised to find myself relatively comfortable.
Until I coughed...
The pain from a diaphragm abused by having the stomach mobilised and dragged up through it to be cobbled on to the remains of the oro-pharynx is nothing less than spectacular. It is as if the whole torso is about to split asunder; as if not just the odd swab but a whole clip of artery forceps had been left inside tearing at every nerve-ending available. I swore never, ever to cough again.
Physiotherapists however have a different agenda. "We have ways of making you cough..." (like squirting saline down the tracheostomy...) And even bolstered up by heroic doses of opioids, the agony of each cough was, shall we say, memorable. But I managed to clear the evidence of basal pneumonia eventually, and as with all assaults upon the human frame, day by day I slowly but surely managed to heal the shattered muscles and torn nerve-endings.
But most interestingly - a fact well-known to the producers of various magic chemicals - I find I cannot remember the actual sensation of pain. There seems to be no mechanism in the brain that can recall what it was like. We can remember that 'it hurt', but not what the feeling was like.
Mother nature does well...
"The Pain Team" however, in my opinion, did not do so well. I was provided with a syringe driver with a continuous trickle of morphine, and a hand-held button to give an extra dose if needed. Whether it was the guilty conscience of being a medical man and wondering about the thoughts of addiction, the ensuing analgesia was never enough to allow a respectable cough, and barely enough to enable much in the way of movement in bed. I was interested to find I never appreciated any euphoric effect at all from the morphine. It was one of the things I had been interested in experiencing. But whatever the dose was, it didn't do much in the way of analgesia either.
Then came the change to morphine solution through the jejunostomy tube, with regular 6 hourly doses augmented by '...any further necessary doses on demand.' However, natural reticence and the difficulty of finding two senior members of the nursing staff unoccupied at the same time to check the dose made this less than satisfactory.
Curiously enough, I found the effects of the combination of Paracetamol and old-fashioned Dihydrocodeine much more effective than the morphine. A rather odd disappointment.
By a fortnight I could stand upright reasonably comfortably, and even make feeble attempts at coughing without hugging my sides and doubling up. Again, I was surprised to find large belts of morphine solution directly into the jejunum delivered no 'buzz' at all. What do they put in the stuff these days? What I needed was a pint of decent ale...
When at last the time arrived to go home, emotions ran high. I had friends amongst the staff: people who had seen a human being at his very lowest, and seen him clamber back up the ladder of humanity. It was almost as if I felt reluctant to leave.
So my goode wyfe and I toasted them in a little pub round the corner with halves of cool, and very black, only slightly fizzy nectar with a white collar on top. It did more for my morale than all the poppies in China...
Dr Alan G. Gray