The Wounded Healer

I am taking a class called "Psychosocial Oncology" and today's lecture was about palliative care. The two instructors giving the lecture were what most people would consider in medicine to have opposing jobs. One had a doctorate and was a member of the spiritual care team, the other was a physician and the director of the acute-intensive palliative care unit. Together, they helped me to redefine my notions of adult palliative care, and I was astounded by their abilities to interconnect their roles. Needless to say, I learned a lot about the process of dying, both from a medical perspective and spiritual one. 

5 things I learned today about dying:
1. 93% of palliative care patients ranked maintaining a sense of humour to the end as one of the most important things
2. 0.5% of people in Oregon choose physician assisted suicide despite it being a readily available option
3. Palliative Care physicians are often more influential and important in the life of a person who is dying than any of their "active treatment" physicians
4. Palliative Care medicine actually involves a lot of "real medicine," its not just about pain control
5. Most people who are dying have little desire to confess their sins or wrongdoings  at the end, people do not consider them to be important to them any more.


When we were discussing the importance of physicians and members of the palliative care team to let down their barriers, show their emotions and connect with patients, this quote was on the slide:

"The doctor is effective only when he himself is affected. Only the wounded physician heals." - Carl Jung

I'm not sure how I have made it almost 21 years now with out ever seeing this quote from Carl Jung. I have been beginning to doubt whether or not I can make other well if I am not entirely free of illness myself. But I now feel again that strong sense of purpose, and what I guess you could label as "my calling" to medicine. I don't believe that everything happens for a reason, but I am grateful that this quote was on the slide today, it was exactly what I needed. Perhaps me being in pain, will allow me to heal somebody that others cannot. 

I will someday be a Wounder Healer.

Pain and Sleep

I am a very high functioning young adult with chronic pain. Seriously, how many people do you know with straight A's, who volunteer 10 hours per week, and ride a bike 16 hours a week who have chronic neurological pain? (If you do actually know somebody, please let me know, I would like to meet a this person.) I somehow manage to do things that most normal people, let alone people with chronic pain, can't do. To be honest, I have no idea how I can ride a bike, but somehow I do.

When you have chronic pain, you struggle to sleep, some people struggle to fall asleep, and some struggle to stay asleep. I am a member of the later group, I usually fall asleep within seconds of hitting the pillow, but I wake up about 4 hours later. My pain gets worse when my leg is still, so when I am awake my leg is in constant motion, but when I am in a deep sleep I don't move (like a normal human) and then my pain gets worse and I wake up in a grip of pain. On occasion, I actually sleep through the night, which means I get 9 hours of sleep. I usually go to bed around 10:30 and get up around 6:30-7:30 in order to maximize the potential amount of time I might be able to sleep. This tactic works pretty well because usually out of the 9 hours I spend in bed, I am asleep for 7 of them, meaning on average I get more sleep than my peers. So, strangely, chronic pain probably makes it so I actually sleep more....weird, huh?

My idea to write this post came from this article: "Extended Sleep Reduces Pain Sensitivity" And, as the title suggests, sleeping more means less pain. So, maybe the reason I am able to do all this stuff is that I actually experience less pain than my fellow nerve pain suffers because I sleep more? It is a possibility.  And, even if you don't have chronic pain, sleeping more may help you recover faster from that flu shot, dental procedure or surgery pending in your life. In the world of cycling, those who train hard and sleep a lot are generally the fastest. So if you don't have chronic pain, and are not predicting pain, sleeping might in the very least make you a faster cyclist.

On another note, I crashed riding in the ice/snow yesterday on a corner and sprained my thumb pretty badly. It isn't broken, but I think there is some ligament damage, hopefully the doctor will give me the verdict tomorrow. The worst part is that exams start next week, and it is my dominant hand. Maybe sleep will make it hurt less?

I learned how to tape it via youTube...it worked!

Medical Extremes

I think this is my 4th  Medical Monday blog post, and thought I would write about an interesting medical contrast that I experienced today, which I feel really reflects on my own personal experience as a patient. If you are thinking I'm going to tell you about some really cool medical condition, then you should probably navigate yourself away from this page and check this out instead.

This afternoon I spent time in the emergency department of our city's children's hospital as part of the Pediatric Emergency Medicine Research Team, but prior to that I spent the morning volunteering in the palliative/respite care area of the very same hospital. I went from an area that was focused on ensuring that kids who have terminal illness have the best times of their lives while they still can, to an area that was focused on getting kids in and out of the department as fast as possible.

The energy between the two places was extremely different, and while you may not expect this, the doctors, nurses and parents who are taking care of kids in respite care (none of the kids currently under palliative care are actively dying) were way more cheerful, happy, fun loving and honestly just more kid friendly. People were focused on enjoying life, and making sure the kids laughed more than they cried. But in emerg, it is the exact opposite. Nobody is focused on making a kid smile, rather just figuring out what is wrong with them, treating them and moving on to the next patient. We expect that when we set foot in an ER, a doctor will asses us, treat us with modern medicine and then send us home cured of what ever aliment brought us to the door.

As I stood and waited for the bus to take me back to school today (by waiting I mean pacing, I'm a pacer) I began to think about these comparisons and how I have started to shift my own expectations of what medicine can do for me. I'm palliative, not in the dying sense, but in the sense that there is basically nothing anybody can do that will "fix" me, only make the pain a little less intense. Yet, I still expect that a doctor will be able to "fix" me, on the outside I portray that what I am looking for is a diagnosis and curative treatment. But deep down, I'm not. There isn't a cure, there isn't away to fix the pain I have all night and all day. The only thing I require from medicine now is for it to help me live the best life that I can, for it to help me give everyday %110. 

"Do not let the pain make you hate"

I wish I had the strength to follow these simple rules.

"Do not let the pain make you hate." This is a really hard thing to do, for me, its more a physical pain that makes me hate, but I know that is not the case for everybody. I hate that I have to deal with things that everybody else deals with, and deal with the pain. My life would be so much easier if I could just sleep through the night, not spend most of the day feeling nauseous from the pain and not spend huge amounts of time faking to the world that nothing is wrong. I hate that I can't do anything about these things, and I hate that the pain makes me hate things.

I don't know why I have this idea in my head, but I feel like if I ever get into med school that my worries will just disappear. I have no idea why I think this will happen, because likely my worries will triple once in med school. Maybe its because my goal of trying to get into medical school has been the only thing that makes me keep on going despite the pain. What will happen if I don't get in? Well, I think my pain will make me hate the world even more than I already do.

I need to go see my family doctor about sleeping pills....I hate asking for drugs (and there we go again with my pain making me hate things).

Never the answer?

I always here people say to or about a friend, a loved one or somebody that they don't even know that "Suicide is never the answer." (Before you get your spandex shorts in a knot, this post isn't going to be about me contemplating suicide...in fact it is not about me at all.) When people say things like this I find that it makes me almost irate, not because I think suicide is a good option, but because people who say that is not an answer to your problem clearly have no idea what that person is going through.

Today's post is about how a boy, living in my city, thought it was the only option. This boy's story can be read here and his name is Dom. Dom had chronic pain that started when he was 14, and it progressed to the point where it was so badly controlled, that by the time he was 18 he decided that his only option to end the pain was suicide. And now I bet you are thinking that: "No, there must have been a better option, there must have been treatments....there must have been something other than suicide that would ease his pain!" Well, my friends, as somebody who has chronic pain, you are eventually told that there is nothing more that can be done to help you, other than physical and emotional therapy. See, Dom was a teenager, and chronic pain is something that people, let alone other teenagers, can rarely comprehend. They don't understand why you can't just get out of bed and go to that party on Friday night or why you can't go shopping after school. Unless you have chronic pain, you cannot understand what it is like (even if you are a doctor, or a medical student or a personally know somebody with the disease).

Dom made the decision to end the pain because our medical and social system failed him. The only thing that kept me out of the depths of isolation and depression when it all first started for me was that I had teachers who had chronic pain, the fact I was at a boarding school where I was constantly surrounded by people making isolation impossible, I had a doctor who tried absolutely everything to help me and I had my bike. I was lucky to be where I was at the time...luck, pure luck, and without it, I don't know where I would be. Dom was completely imprisoned by pain, without doctors to fight for him or friends to pull him out of the depths of blinding pain. If you where him, would you be okay with having your mom spoon feed you for the rest of your life? Would you be okay with asking you sister to help you put on your socks at 18 years old? I wouldn't.

So don't judge somebody when they decide that taking their own life is the only solution, because for them it just might be. For me, I had decided to find my own solution, to spend my life in the lab trying to fix this problem. I still have hope, Dom didn't. I can tell you that even if you believe people who commit suicide go to hell (which I absolutely don't), hell might just be better than having every inch of your body be on fire all the time.

Just think about it for a moment, what would you honestly do in Dom's situation?

Wiriting About Pain

I had to chose a topic for my Health and Society unit research paper. I thought about the whole shabang of health related issues (okay, I didn't think about all of them because that would take FOREVER), and I ended up settling on what I know best, Chronic Pain. I started off wanting to focus on the young adult population, but there is far more research on the adolescent population. And lets face it people, there is no point making an assignment harder than it should be, sometimes you just have to start writing and go where the sea of journal articles takes you.

It is interesting writing on a topic focused on a population that only two short years ago I belonged to. I didn't have chronic pain until my last year of high school, and it was brutal. As I wind my way through the research articles, there is one idea that keeps on coming up, adaptation to pain. People who have lower perceived quality of life and higher scores on depression scales are focusing their lives around ending the pain, rather than living with it. I can attest that focusing completely on the pain and finding new ways to get rid of it consumes your every thought. The pain starts to literally rule your life, and that's how it was when it first started for me. For the first two months, I avoided wearing shoes (I wore flips flops in December and January, and yes, I live in Canada) I rarely went out for our team group rides and I was less involved with my school life. Then one day I woke up and decided that enough was enough, that no matter how much it hurt I wasn't going to stop doing something. Even though my pain levels increased, I was happier.

They call this adaptive behavior. Rather than avoiding the pain, you adapt your life and actions to include the pain. Its like your annoying little brother that follows you around all day, you can't get rid of him, so you have to do things that also include him.

I always wondered why the pain doesn't seem to get under my skin (that often), and it's because I somehow learned to adapt to the pain. I will probably never give up on new ways to try and get rid of the pain, but in the mean time, I know how to live with it.

I found this book conveniently on display in the library today, so naturally I signed it out. Its odd holding a textbook about yourself...

Thoughts

Everyday there are certain things that I think about on an almost clock like cycle: eating, homework/school, ways to regrow nerves, eating, biking, eating, and homework. You would think that my mind would be constantly focused and consumed by the pain I am in every minute of every day, but its not, I rarely think about the pain. Yes, I perceive agonizing pain every waking and sometimes sleeping minute of my life, but I don't actively think about it. I find that odd, that I am somehow able to block out my ability to reason why I am in pain. I figured it was because I have just come to terms with the fact that my leg will feel like its being cut open by a scalpel forever, but I don't think that is true. Lately I have been thinking about one thing more than I have been thinking about food (which might explain the weight loss),  amputation.

I know my options for treatment are running out, and I don't want to spend the rest of my life in pain knowing that there might have been a solution to end my pain, even if it means hacking off my leg. Every time I think about it, (which has been a lot seeing as it have now surpassed my thoughts about food) I weigh the positives with the negatives. They always end up cancelling each other out, leaving me at a net score of zero. Then I forget about for a few hours, and then come back to it trying to approach the idea at some sort of new angle, trying to add in pros and cons to maybe tip the scales. So far, I end up with a score of 5 for hacking and 5 for keeping, which is a tie.

Unfortunately, we don't have shootouts in decision making.

The Circle of Life

As some of you may or may not know, my Grandpa passed away two weeks ago. He had an amazing life, did amazing things for people and ultimately left the world a better place.

Today was his "Celebration of Life," which is basically just a happier version a funeral and sans burial.  My brother and I both spoke, and neither of us cried! We both even managed to make a few people chuckle and few people cry. It was a really great service, and the pastor at my Grandparent's church is simply amazing. It was a bit exhausting though....having to constantly meet people and have them tell me how wonderful he was all day...it was constant reminder that he is gone. I will miss him, but I am trying to remember that this is a time to rejoice in the difference he made in the lives of others rather than a time of mourning.

Yesterday, (Friday) I went to Vancouver to see my surgeon, Dr. B, again for a follow up. He was a bit puzzled by the fact that it is still swollen to the point where you can leave a thumb imprint in my ankle (it literally stays there for 5 minutes...its kinda freaky) and the fact that I have throbbing pain...but overall pleased that my nerve pain is better. He said that it could be possible that the nerve is growing into my bone....great. He is sending a e-mail to Dr. S Mackinnon in St. Louis who first preformed the procedure to see if she knows what might be going on...she is also pretty much my hero.

Dr. B saw that I was studying for the MCAT (I was working through the 1001 MCAT physics questions before my appointment), laughed and said that he can't remember anything from the MCAT because he blocked it from his memory. So...I guess it is that bad...

Racing the Tour de Bowness Crit on Monday morning, wish me luck! (Not crashing would be nice, but this course has some pretty nasty pavement and a hill section.)

Side note: I gave an elderly homeless man on Robson St in down town Vancouver (it is the shopping street of the city) $50. I don't really know why, but I even went back and re-crossed the street to give it to him. I haven't really ever felt compelled to give somebody that much money before for no apparent reason, but I just felt like I really needed to. Maybe it was my Grandpa talking...I don't know.

Peace like a river

Gone? Never?

I don't think I have CRPS...at least I hope I don't, but my pain never really seems to go away. I had one month of relief the first month after the surgery...but while my nerve pain is less (but slowly creeping back) it has been replaced by this deep awful throbbing pain.

Does pain for people like us really ever go away, or is it just something that is going to be a part of my life until I die? I know nobody can answer this question, but I wish they could. I really wish they could.

On a happy note, this is my first post from my new Dell XPS 14! Yeah, I know what you are thinking...why didn't I  buy a Mac? Well, you see consumers of the world, Apple has one of the worst CSR policies on earth. Not too long ago there was a fire at one of their factories in China and people literally burned to death because there were bars on the windows and they couldn't get out. My concious won't let me buy an Apple product...they may be cool, but so is my new Dell...which also happen to come in enviro-friendly bamboo packaging. Way to go Dell!!

Peace like a river.

The Swell

I haven't posted in a while because I have been super busy with that thing called work and that other thing called the MCAT, neither of which I fully enjoy. I have been spending a fair amount of time on my bike and the weather is beginning to look a bit more like summer...which is nice because I had clean my bike 4 times a week there for a while.

I bet you are wondering about my good ol' leg eh? Well, truth be told, so I am and so are my doctors. My whole leg below the knee is swollen and spongy like (yuck) with some nice vascular changes (aka my veins are popping out) and a heck of a lot of pain. Now, I know what you are thinking...I should probably stop riding my bike right? Wrong. Cycling doesn't make the pain any worse or any better, but it keeps the muscle spasms in check and keeps me from going insane, so really I don't see any good reason to stop riding.

I have another appointment with my family doc this week...I have pretty much seen him or his locum every week for the past month. There is something not right about what is going on, after the neuroma resection 2 years ago (almost exactly) I knew something wasn't right and everybody just kept telling me it was fine. Then I almost had a below the knee amputation...I don't want to repeat that, this time I am not settling for "don't worry."

On a completely different note, I almost had a heart attack today (not really, but my heart rate went to about 205). I was out for a ride on my usual 65km route, I was just starting up a bit of a hill when all of a sudden this giant thing ran out of the forest 20 feet in front of me, across the road and into the forest on the other side. That is the first time in a while that I have seen a bear whilst out on my bike. It scared me a lot because it wasn't very big, meaning that mama bear might be around waiting to pounce and I was going up hill with a head wind having only spandex for protection. I live in a rural area (obviously) and bears aren't exactly a new phenomena (I'm really not afraid of them) but today seeing that bear with nobody but lil' me around made me realize how vulnerable I really am on my bike.

Pro tip of the day: Bring bear spray when riding in the BC Rockies.

Summer?

Its not even close to being summer weather here in the Canadian Rockies. It has been raining for the past 2 weeks straight and there are flood warning across the Southern BC/Alberta Rockies. It also snowed in Canmore today for the Iron Maiden XC race, fortunately, I was not racing, but from the pictures, its looked pretty nasty.

All this rain is keeping me from riding outside, which at this point is probably a good thing. My ankle pain has been increasing lately, not nerve pain, but a deep throbbing pain. It is still pretty swollen, and I feel like it should be looking  bit better by now, it has been 6 weeks since the surgery. I tried to get into see my GP...but you know how it is in Canada with the doctor shortage and all. I don't think an appointment in 3 weeks is really going to help me too much.

Also, this whole MCAT studying thing is really starting to get to me. I don't want to study anymore, but this is after all one of the most important tests of my life. Its seems stupid that there is an aptitude test for medicine, just because you know how to answer an obscure question doesn't make you a great doctor. If it did, then we wouldn't have any crappy doctors in N. America...Stupid MCAT, I just want to be a doctor!

Surgery, Smurgery

My surgery is done, and I am alive!

On Friday afternoon, I arrived at the hospital at 11 am and by 12:45 I was in the block room with a lovely anesthetist who did the popiteal block (a nerve block that is done behind the knee to freeze both the sural and peroneal nerves, thus numbing everything below the knee) on my leg before the surgery. She was incredibly nice, actually talked to me like a human being and reassured me that I will get into a medical school in Canada because (and these are her words) I am reasonably smart, I will probably do reasonably well on the MCATs, I can talk to people and I have a good story. Its always nice to get a reassuring pep talk from a doctor. After she did the block on my leg, she let me see the ultrasound of where tibial nerve divides into the the sural and peroneal nerves...which was pretty amazing! I love learning things when I go into the hospital, its like getting a sticker after a shot when you are a kid. This anesthetists even called me this morning to see how I was doing (unfortunately it was at 7 am and my phone was off) and left a message with her phone number to call her if I have any questions or concerns. Who does that? She is awesome! Is there a new doctor that I want to be like? Yup, I think so!

Anyway, after the block I was wheeled to the OR, where a resident anesthetists took over. I asked him which kind of intubation he was going to use, and he showed me the two different kinds and explained why he was going to use the tracheal one. It was cool, to finally be able to ask questions and have them answered like I was an intelligent adult, and not just a silly patient.

I threw up a bit after the anesthetic when I woke up in recovery, but it was all settled with some Maxeran.

After that I dressed myself (which according the the nurse was quite impressive) and was out of there by 5:30! The surgeon recommend (or agreed to my suggestion) that we start driving home right after the surgery in order to milk the nerve block for all its worth. So we made it to Kamloops and stayed overnight there. I expected to wake up at 1 am in severe pain from the block wearing off, but I didn't. In fact, when I woke up at 5:30 am I still couldn't feel my foot or move it in anyway...such an odd feeling trying to wiggle your toes but nothing happens. Seeing as it was still numb, we hit the road and I didn't start to have any pain until 2.5hrs from home! That anesthetist did a darn good block! It wore off completely sometime last night, so now I'm in pain.

The doctor gave me Oxycodone (whoohoo) but I am slightly allergic to it, so I have to take benadryll which makes me even more sleepy. Oxycodone doesn't work so well for nerve pain, but it does make it so I don't care that I'm in pain...

The surgeon said that both the proximal end of the nerve (the one that was implanted in my muscle) and the distal end (the end near my foot that is only an axon not attached to a cell body) both had sprouts growing off it. So he removed those from the proximal end, crushed the nerve and put it into a 5mm drill hole in my fibula. The distal end is another story. Not only did it have sprouts growing off of it, but it also had grown an entirely new branch...this is pretty much impossible according to what we know about neurophysiology. The distal end was not attached to anything (the proximal end is still fully intact with a cell body somewhere in my spinal cord), so the distal end would not be receiving any nutrition or regulation from the cell body, yet it still managed to grow an entirely new branch. I apparently have an unbelievable ability to regenerate nerves (which is unfortunate in my case), so lets hope I can translate that biological ability into the ability to do so in a lab!

Alright, time to go back into an oxycodone stupor. Sorry for all the spelling mistakes...its not me, its the drugs.

Summer Job

One phone call totally made my day today. I was offered a data entry job at Teck Coal this summer! The best part is that it is at one of the offices in town, and I can do it on crutches. It is absolutely fantastic, I'm not too sure how much it pays, but I am sure it is well over minimum wage (but to be honest I don't care how much it pays, I just need a job that doesn't involve the use of my legs).

My week started off absolutely awful, Monday and Tuesday were probably the worst days of my life, and seeing as I live in constant pain, that is saying something, but today made up for that.

Wish me luck tomorrow on my first race of the season!

What it is like to live in pain -part 2 (the positives)

It has taken me longer than I though it would to write this, but midterms seriously suck! I just finished a week from the underworld...but now its reading week so I can catch up on organic chemistry which I haven't even looked at since I wrote the last post.

With pain comes a lot of crappy stuff, but if I look deep into how it has affected my life, there are some positive things.

1. It has made me a more empathetic person. When I see a picture of somebody with terrible burns, or injuries or a disease all I can think about is how much pain they must be in. Most people's first reaction is the 'ewwww' reaction, when I see the picture it makes me nauseous not because it doesn't look pleasant but because it is like I can almost feel their pain. It makes me want to do nothing but help the person in the picture, to help ease their pain.

2. I have always wanted to be a doctor, from wanting to be a surgeon, to an oncologist, to working with Doctors Without Boarders, but now I want to research peripheral nerve injury and nerve regeneration. Living with pain and nerve trauma has made me realize how badly I don't want anybody to have to go through what I am going through, I want to find a way to regenerate peripheral nerves so that people can be liberated from both disability and pain. I don't think I have ever been more passionate about doing something before. I have even decided what school I want to my MD/Phd at and what school I want to do my masters at and what doctors I want to work under. My own pain has made me realize that as much as I wish I could wake up pain free, I want others to have that chance even more.

3. God. While pain may make me doubt the existence of God sometimes, or make me angry with him, it also brings me closer. Sometimes when the pain is unbearable, God is the only comfort I have. Chronic pain has made me a more spiritual person, even if it also makes me hate God sometimes.

4. I'm disabled. That would for the most part be seen as a negative, except for the fact that it has allowed me to take a step out of the able bodied world and into the world of the disabled. (I hate the word disabled, for we are not 'less' able than anybody else.) I discovered that is not people who are disabled, but it is the world that makes them so. It has changed my whole view on how I see people. I  no longer see somebody in a wheelchair as disabled or somebody with a mental handy cap as less intelligent, I see them as somebody trying to make their way through a world that was designed by and for people with nothing more than a little stress to deal with in their lives.

5. I don't worry as much about the little things anymore, grades are still what I worry about the most, but I don't get all stressed out when I am late for something or when something doesn't go as planned. I know now that life doesn't go according to plan, and just because it doesn't, it doesn't mean that it isn't turning out how it should.

6. I am a lot more willing to let life take me where it wants to, and I have stopped resisting the tide. This is something that I have learned directly through dealing with pain. When you resist pain, it makes it worse, it lasts longer and it feels like you are in a battle for your life. When you let the intense bouts of pain run their course, and just breath through it and think of other things like riding a bike it makes it a lot better. Pain has taught me to stop resisting life's path, and to let life take me where ever it wants to go.

7. I have met people that I would have never met without being in pain. I have met wonderful doctors who have inspired me, and other people dealing with either pain, illnesses or a disability who have showed me that I am ABLE to anything regardless of the obstacles that are put in my way.

8. I actually became a better cyclist. Cycling does cause more pain, but it also helps me deal with the pain. If I have a rough day, or a terrible night, getting on my bike is the only thing that helps. The more you ride, the faster you get, so the more pain am in, the faster I get.

9. Pain has made me a more determined person. When I was in grade 10, I was in my physics class room one lunch hour trying to build a rather tricky circuit. I just couldn't do it. I gave up and kind of flung the half built circuit across the lab bench. I was not aware that my teacher had been observing the whole time, but then he said "That's not like you to give up." I will never forget that moment, because I looked at him, I didn't say anything, and I picked up the circuit and I kept trying. Eventually I got it, and from that day on I have never given up on anything. Chronic pain is probably the biggest challenge of my life, but is just like the circuit. Sometimes I feel like throwing in the towel, but I  know that if I don't give up eventually I will overcome the challenge.

10. I don't have a number 10. I can't have a number 10 because my journey through life isn't over yet, in fact, some would say it is just beginning. Having chronic pain has changed me in a lot of ways, many of them bad and many of them good, and it will continue to shape me and my life. I can't have a number 10 because I haven't beaten the pain yet.

What it is like to live in pain -part 1 (the negatives)

This is a post that I should have done a  long time ago, but I have time right now (because o-chem drained my brain from all mental capacity for the day), what is like to have chronic pain when you are 19?

Well, first of all, it seems like nobody in the world understands what is like. My friends joke around that I am 'lucky' to have extra time on exams because of my condition, I would say that you are lucky you don't get extra time. People say things like "I would give anything to have an extra hour for this exam" or "I would trade anything to get an extension on that paper." Would you really if you knew what it was like? You can't truly understand unless you feel it or experience it yourself, and that is something I have learned along the way and come to accept.

I'm going to list the top ten ways in which chronic pain affects my life, this is the only way I know how to tell you what it is like to be me for day.

1. I'm exhausted all the time, and not because I stayed up too late or went out last night kind of exhaustion, but the kind that leaves you in a fog, that makes a pen feel like it weighs 10 lbs. So when people complain that they are tired because they stayed out until the wee hours of the morning or because the only left themselves 8 hours to complete an assignment, it makes me want to show them what it is like to never actually sleep. 3 hours, 4 if I am lucky is all the sleep I get. Imagine trying to sleep when it feels like you leg is being ripped open all the time.

2. I need time to be by myself. No matter how well you know somebody with chronic pain, they will put on a mask to make it seem like everything is okay and that you are just as normal as everybody else. Taking time to just be with myself means that I don't need to fake to the world that I am alright. Usually this time consists of riding my bike, or going for a walk or watching a TV show with a cup of tea. Just me and my thoughts, no school work, no people, no texting.  If you ask me hang out and I say know it is probably a combination of number 1 and the fact I just don't want to have to be a fake.

3. This is a bit of an expansion on number 2, but since this whole pain thing started, I feel like I am faking to the world. You can't show weaknesses to the world because people will think you are unstable and emotional mess. Well, guess what, I am, all the time, but you don't know that because I hide it. If I didn't, you would probably never want to talk to me, or be around me. Who wants to hang out with a person who spontaneously breaks into to tears? If you knew what my leg feels like, you would be impressed that I am not constantly in tears. So if you see me and it looks like I might sort of be crying, or just was crying, its probably because I was/am.

4. Training and racing against people who don't have constant searing pain all the time is difficult. By the time they reach their pain threshold (or what they think is their pain threshold) they are experiencing a much lower level of pain that I was experiencing at the start line. You can only imagine then how much pain I am in by that point.

5. School is not the same for me as it is for somebody who is not in pain. I don't have ADD or ADHD, but I might as well have. I can't focus for more than 15 minutes because the pain is so intense that I need to take a step back from what I am doing and focus on shutting out the pain. So for every 15 minutes of productivity I have 5 minutes of non-productivity. You can imagine what it is like trying to write an exam or study, its physically exhausting after an hour let alone two hours.

6. Drugs. You would assume that I have an arsenal of drugs at my disposal and that if you pay me enough I will give you a shot of Ketamine. Wrong. I only take one drug at the moment and it is called Lamotragen, which was originally created to treat epilepsy. I take a very low dose because any higher and I get a rash that has some pretty serious consequences. That is it. This is also currently my problem. If I go to see a doctor while I am here at school who has no prior knowledge of my life and medical history and only has to go by what I tell them, they won't give me anything stronger that something like Tramacet. Tramacet is about the equivalent of Tylenol 3...not super effective. If I ask for drugs, people assume I am junky. It sucks.

7. Pain affects your relationships because it is not something that you can really control or that other people can really understand. Other than people with chronic pain or who have experienced chronic pain, nobody has the ability to understand what it is like to literally have never ending pain. IT DOESN'T EVER END. Not even when you are asleep. People try to understand this, but they can't, so they pull away from me because that is the only way they know how to cope with it. I would run away too, but the thing is, its really hard to run away from yourself.

8. My future is not predictable, not that anybody's really is, but I can't get the thought out of my mind that I will never be able to become a doctor no matter how hard I try because I will always be dealing with pain. If the surgery works, then great, but the prognosis is not about 50/50. Have you ever had that feeling that no matter how hard you study, you just can't get a good grade? That is the frustration that is my life.

9. It makes me doubt the existence of God. I believe in God, but I don't want to believe in one that does things like this to people. This feeling comes and goes for me, it is very dependent on what has happened in my day. (Discussed further in part 2.)

10. With all the pain, it has  taught me a lot. It has taught me to appreciate the good moments and to understand that bad situations or circumstances usually aren't all that bad.

More to come with part 2, the positives.