Thread by @WesElyMD

1/ 🧵🎥 Chronic Pain

#Pain comes in all shapes & sizes. Let’s explore how we process pain. Watch & Listen to what Anderson Cooper tells Stephen Colbert about #grief and #suffering: “You can’t have happiness without having loss and suffering.”

2/ My lucid & kind patient (pic w written perm) uses scalding water as a coping mechanism for abdominal pain from pancreatitis. He wants to share his rationale.

#MedTwitter #ChronicPain #nurse

3/ Before I share what he told me, I first want to make my mindset as his #physician clear: My first job is to believe in him. Then to understand him. Then to devise a plan to help him.

4/ This is a young man with 10 years of idiopathic pancreatitis, which means inflammation of the pancreas from an unknown cause. He didn’t cause it, and there’s no cure. It causes real and immense pain in his belly. He says, “Doc, I know it doesn’t make any sense, but…”

5/ “When you dive down into the type of pain I get, you don’t know when you’ll be able to resurface. It could be a day, a week, or even a month. So we got a special water heater that allows me to stay in the shower at times for over 24 hours.” The water temp is 120 degrees!

6/ Why? “It allows me to avoid coming to the hospital for pain medications and admission. They just call me a drug seeker there anyway. When I’m under the water, it’s the only thing that immediately reduces my #suffering. I know it doesn’t make any sense.”

7/ I reassured him, “Well, it doesn’t make sense to anyone but you! But to you it does. So we need to focus on that and determine a way to help you avoid 5% to 10% body surface area 1st & 2nd degree burns that put you at such high risk for infections & other medical problems.”

8/ “Doctor, I’ve seen #psychiatry. I know this is a coping mechanism like cutting and one used by people with OCD, but I don’t meet those diagnostic criteria. Can you help me? I do want to stay safe.”

#NurseTwitter #mentalhealth

9/ He came in w profound electrolyte abnormalities that we are fixing. Now we embark on this journey w him. The important thing is to establish a covenant in which he knows there is no judgment & 100% impetus to help him. That’s where we started…

#PalliativeCare #Listening

10/ “The sorrow which has no vent in tears may make other organs weep.” Henry Maudsley

Dr. Maudsley was a famous British psychiatrist who influenced #CharlesDarwin. They met & #Darwin studied Maudsley’s lecture on “Body & Mind,” correctly citing Alcoholism as an inherited dz.

11/ Maudsley’s quote above is 🔑.

Our pain must “come out” somewhere! It must be processed. Mental or physical, it doesn’t matter. Like pus in an abscess, it must be drained. One of my goals as a physician is to help my patients find that outlet & path for drainage & #healing.

12/ 🎥 “Drainage” (processing) of pain and suffering is a pathway to peace. In this moving 20 min interview that I recommend you watch, Cooper and Colbert unpack grief.

Youtube: bit.ly/2TPNh5R

13/fin
I do not believe suffering is a good in itself, but I do believe my pts’ paths through it must be respected and are a deep part of my journey with them at the bedside. Diving into their chaos teaches me and I hope helps them in the process. It is immensely humbling.