Debilitating Pain

The hospital CEO asked me to accommodate a new patient in my pain clinic, a young woman visiting for a few days, granddaughter of his colleague. “Of course,” I said.

“Jessica” was sixteen-ish, thin, athletic-looking, brunette. As usual, I addressed my questions to her, expecting her to tell me about her pain. But she replied, “Mom, you tell her.”

That turned on the firehose. With pressured speech, her mother described how Jessica was healthy until the previous year, when debilitating pain, dizziness and brain fog consumed her life. She listed specific events, migrating pains, ineffective treatments and skeptical physicians. Her voice cracked with emotion, as though she, too, had experienced these pains. The mother produced reams of organized physician notes, laboratory and imaging reports. Jessica perked up, becoming more animated and engaged, the worse her condition sounded. I wondered why this young woman seemed to enjoy ill health. Now home-schooled, she had withdrawn from previous activities and spent most days in bed.

I asked, “What is bothering you the most today? What should I focus on?”

Jessica said the dizziness she experienced when she stood up was the worst. I offered a concrete suggestion for this symptom, a simple rehabilitation exercise shown to be effective.  The patient told me flatly, “I’ll never be able to do that.”

I wanted to talk with Jessica alone, but she and her mother refused, Jessica telling me the pair shared “everything.”

Our visit lasted over two hours but accomplished nothing. I asked the mother to let me know if new information became available, or if they found any helpful strategies. She promised to keep me posted, and we parted amicably.

Years later, I saw Jessica’s grandparents at a social event and inquired about “the family.” Her grandmother volunteered that Jessica had continued to suffer uncontrolled pain and other symptoms and had thrown herself in front of a bus.

To my knowledge, Jessica was my only pain patient to die by suicide. I was devastated that no one had been able to unlock the secrets of her pain and disability. Now I question whether her body was reacting to some un-named trauma that Western medicine struggles to address. I wonder if she had been the victim of sexual abuse.

I wish I could have saved her, but I’m not convinced I could have won the trust necessary to engage her in the hard work of rehabilitation.

Nancy L. Glass
Houston, Texas