Painful Yarns. G. Lorimer Moseley

my card: “23:52 Friday.” It had taken me 12 hours and 52 minutes to travel 1165 kilometres. That is unbelievable hitchhiking time.

      After closing, Crazy set up the swag⁸ on the back of the ute and I slept under the tray. The sun came up about a millisecond before the council street cleaner sprayed me with water. We were both up and Crazy got in the ute so he could see this Bull Mastiff first thing – his theory was that dogs are always grumpy before breakfast, so before breakfast was the only time to tell for sure if it was a “Heckyl or a Jive⁹ – makes all the difference”. I bid him farewell and he took off up the main street.

      I have this thing about watching people as they drive off. I have to watch them until they are out of sight. I think it is a legacy of standing on the street as a kid waving my grandparents off as they headed back home after a couple of weeks with our family. Nanna would have her arm out waving the whole time and we would all wave as long as we could see them and then turn around and notice Mum’s tears, not really knowing what to do about them. Crazy was no more than a couple of hundred yards away when his left indicator came on but I could hear the ute accelerating into the corner. In fact, it didn’t turn the corner at all. Instead it just accelerated straight across the road, jumped the kerb and blew up. It turned into a speeding fire ball, still accelerating, careering across a big carpark until it met with a brick fence at which time it stopped dead still, on fire, back wheels spinning madly in thin air.

      Crazy Kivin dropped out onto the ground and crawled away. By the time I got to him he looked bad. There was a whole lot of blood. He already had a lump the size of a golf ball on the left side of his forehead and a gash across his cheek. He explained that the steering and brakes went and the car just started accelerating. Nothing he could do.

      CK: I hope that guy from the Kaniva Times got a shot of the old girl blowing up. That’d be my 12 minutes. But you know the worst thing?

      LM: What Kiv? What’s the worst thing?

      CK: I’ll not know if that Bull Mastif is a Heckyl or a bloody Jive.

      so, what does Crazy Kivin’s brush with death have to do with pain?

      The one sentence take home message: Pain is a critical protective device – ignore it at your own peril.

      If Nigel attempted to ‘anaesthetise’ the problem with his SuperSkoda, then Crazy Kivin might have been taking some more drastic measures. The whole point of warning lights on the dash of a car is to tell you, the driver, that something requires action. Sure, you can do things to turn the light off – to anaesthetise the dash perhaps. To surgically remove the apparent culprit, or end up doing neurolysis10 on the whole electric supply, but if your clinical reasoning is not sound, then there might be a major cost. The cost for Kevin was not simply that part of his ute that was in danger. Rather, the cost for Kevin was (almost) everything. Death. Kaput. All over. Both Crazy Kivin and Nigel were attempting to remove pain, rather than remove the cause(s) of pain. In Nigel’s case, it was a specific pathology (problem) with the engine’s attachment to the car. In Kivin’s case, there were many contributing factors and he just kept removing his ute’s ability to tell the driver about it.

      It is clear that both Nigel and Kivin were spectacularly stupid people. If they ever read this I imagine they will think the whole thing is a tribute to their cleverness. That is another amazing thing - Kivin convinced me that what he was doing was not stupid. Simply by knowing a whole lot about cars, or at least seeming to, I figured there was no reason to doubt him.

      I think there are plenty of things about these stories that make them useful metaphors for patients in pain. They remind us that pain is a warning system, which usually gives us early warning of something in the body going, or about to go, awry. To devise strategies that effectively remove that system is, ultimately, going to be problematic. In this sense, I have told this story to patients with the following types of issues:

      1 Athletes who push their bodies so hard that the normal pain protective system doesn’t work very well. If patients don’t change their behaviour in response to pain, then pain hasn’t achieved its goal.

      2 Patients who don’t care what is wrong with them as long as they can find someone to ‘block it again’, or a drug that will turn it off, so that they can go back to their full lifestyle straight away without having to actively do anything to help themselves (in a rehabilitation sense).

      3 Patients who are keen to use TENS or drugs as their main pain management strategy. This scenario is similar to (2) but also slightly different. For the TENS thing, I find patients are really receptive to Nigel’s SuperSport 110 story because of the whole turn the radio up so that the fuzzy noise is louder than the noise coming from the problem – it is an obvious link to the proposed mechanisms of TENS – to use non- noxious11 input to inhibit the noxious input.

      4 Those patients who tend to avoid things because they know that they will hurt. I use Crazy Kivin’s strategy of simply removing the light globes that lit up the various lights as a metaphor of the way some patients tend to avoid the pain, but don’t address the underlying problem.