By Richard M. Cohen
The New York Times
The sharp pain in my right knee has shot me over the falls. I have a new respect for the camel that invented the cumulative burden.
Pain associated with multiple sclerosis — the upper back jolts in cervical disks, joint pain and endless muscle knots and spasms — are a part of life, filed away under "Routine."
Grinding intestinal pain has receded to the muted timpani of the dull ache, a few years into post-colon-cancer, after-the-ileostomyitis. The grimace is fixed, built onto my face.
This is not the searing pain of the severely injured and dying.
My pain seems trivial in a world with so much suffering. There is another level of hurt, however, a category of relentless, cutting discomfort that does not go away. It prods and nags and insists on reminding a suffering soul that he is being shadowed by an assailant who will not back off.
The line between pain and discomfort can be hazy and hard to discern in the darkness of the difficult moment. Like the hot political border, it can wander, snaking across the landscape to suit the whims of the aggressor.
And the unhappy sensations of sickness are integrated with misery into a life. Somewhere there must be a limit, I tell myself. That point seems far away, if it exists at all.
And now, it is my knee. That silly little body part, designed to carry its own weight, is leaning on me.
It hurts, and I am saying enough. No one is listening. This pain is piercing, when walking up or down stairs, even stepping onto or off a curb. And it does not abate.
On bad days, even strides on the steady surface bring on the sting.
There is no consensus on the identity of the culprit. My neurologist and I blame stress from years of an eccentric walk caused by multiple sclerosis.
My orthopedist and physical therapist seem more inclined to charge a troubled tendon in the knee itself with the crime.
I see a hung jury and lose confidence that justice will be done.
I do not like whiners, and this low moan is sounded self-consciously and only to make a point. When pain rides shotgun, illness cannot be driven from the conscious mind.
Pain, however low-grade, adds up. The continuum of discomfort can be an unrelenting, constant companion. Hey, try not to think about this, Jack: put it out of your mind.
The challenge for anyone with lingering, chronic problems is the need to resist allowing the condition to take over and define a life.
I have spent too many years insisting that I am not the sum of my physical ills for me to look in the mirror now and see sickness staring back. That option is no option at all.
It is disconcerting to acknowledge, even to myself, how much my waking mind is filled by the limitations of illness kept on the front burner by the physical hurt.
Crises of health are hard enough to leave behind in the dust. Chronic illness brings signature problems that make day-to-day life a gantlet.
Pain magnifies difficulties, resurrecting and re-enforcing pessimism. Cumulative pain dims the spirit, a bit at a time.
I want to say I am inured to the pain. I am not.
When pain becomes discomfort, for however long that lasts, the pattern is to forget the bad instantly.
Memory is convenient. Troubled feelings are set aside, never ignored, but put somewhere toward the rear of the stove. And then the pain comes to the kitchen door again.
Pain breeds anger. I have had too much of that in my life.
There is a discipline for dealing with this menace that comes and goes. Mind games help. Thinking about what is right in my life and imagining a better day work to a point. I scoff at the power of positive thinking except that there is an element of wisdom hidden there.
Mostly, I tell myself that I do not hurt so much that sensation should get in the way.
I sit at a teacher conference or during dinner with friends, and I smile. Why shouldn't I? These are good times. Perspective, please.
I have lost friends to painful cancers. I am not going anywhere.
Copyright © 2003 The New York Times Company