In Absentia: Grief, Opioids, and Pocketing Pain

I finally decided to write about the thing that has been keeping me from writing—pain. I have lived long enough to develop the ultimate old-lady malady—hammer toes. Some websites attribute the abnormal bend in the second toe joint to wearing tight or ill-fitting shoes, such a pointy-high-heels. Guilty as charged. I loved dressing up for work and wearing heels—I did it for decades. I never wore four-inchers, but I did like a nice two-and-a-half to three-inch heel. I even had several pairs that were comfortable enough for a day-long conference. All this goes to say, hammer toe or no, I have no regrets for those years of high heels. A Lizfranc fracture on the same foot nearly a decade ago likely contributed to the hammer toe outcome.

Often, the malady can be corrected by changing footwear or adding inserts. Some severe cases require surgery. I needed surgery and scheduled same for mid-December. Then the father of my five children contracted Covid. He was hospitalized on a Tuesday, about ten days after he became ill. By Friday evening he was on oxygen and in the ICU. He died on Sunday morning December 6th, only one of his five children at his side. He had no advance directive and the children were split on how much to intervene and when to let him go. For him, the disease was quick and terrible. Our children were left reeling from the twice daily updates about his rapidly deteriorating condition. They buried him on the following Saturday. We have been divorced for twenty-eight years. I am surprised at how much I have cried for him; how much I have cried for our children.

Not surprisingly, all five of my kids beg me not to have foot surgery the week after his funeral. They have no capacity for more worries—no more capability for breath-holding. No general anesthesia. No possible complications. I am prepared to put off the surgery until mid-January, figuring that still allows me six weeks in a cast and six more weeks in a walking boot with physical therapy then I will be ready to get outside and walk the first weeks of April. I am completely unprepared for how debilitating a cast and confinement would be in the midst of our pandemic confinement.

I am lucky my husband is a wonderful helpmeet. He cooks my food. He helps me dress. He washes my hair—at least that first week. I get around on the main floor on a knee scooter. I scoot upstairs to our bedroom on my bum. Upstairs I use crutches. The actual surgery is a bit brutal. The middle joints on toes two and three are shortened and fused. The metatarsals behind those toes are cut diagonally and slid to shorten them, secured with a screw. The piece de resistance is a three-inch cut on the inner calf allowing access to the sheath of the tendon for my calf muscle which when sliced around will give 1 to 2 cm in length. The pain in my foot and leg has mostly calmed after four days, at least that is when I quit taking Oxycontin to sleep at night. During the day I am fine with Tylenol. As the foot gets better the pain in my shoulders, elbows and wrists seems to explode. I am so stiff I can barely massage one arm with the opposite hand. The further I go into my confinement, the further I sink into my chair and footstool. My world shrinks even further---I live in my PJs, never leaving the house. My single dress-up event in six weeks, for which I wear my aging grey sweat suit, is the post-op when I am witched from a splint to a cast, non-weight bearing.

I am convinced that the crutches have stirred up my tendency to osteo-arthritis. By three weeks in, I am on the phone to the GP and to my naturopath seeking help for pain. Finally, two-weeks before the cast comes off, I have a prescription for 14 oxycontin and a topical gel for arthritis pain. I may be able to sleep again.

On Monday before the cast removal, my youngest calls to check on me. I tell her that even with the oxy my claustrophobia with the cast keeps me awake for several hours each night. I have visons of clawing the cast off with my carefully manicured nails. I tell her I am seriously considering using the promethazine prescribed for nausea when taking opioids. I know I will sleep most of the day. I think I can make it to Wednesday. She says, “Oh, mama, I will bring you some CBD oil right now. Take .25ml every four hours just like the pain meds. See if that helps.” Lucky for me she lives 20 minutes away. It takes most of two hours for the CBD to kick in, but it is just the ticket. It takes the edge off. I sleep for most of the next two nights without the oxy. I am not plagued with cast-claustrophobia. I am calm during the day. Wednesday arrives. I get the cast off. I do not even pass out, a real possibility, when the PA removes the 4-to-5-inch long pins that run from the tips of toes two and three deep into the spliced metatarsals. I get a boot. I can walk as much as tolerable. I fist bump the PA. I do not have to sleep wearing the boot. I have received my Get Out of Jail Free card. I do take an oxy that night for the stirred-up foot pain.

The next week I am at physical therapy. I have a long-term relationship with Dr. J, the PT. Five years ago, she helped me get over the osteoarthritis in my knees to the point that I can add a sprint into every tenth round of my three-mile walk. Her help leads my GP to observe that I am “practically the poster child for physical therapy.” My relationship with her over bursitis in my left shoulder was more painful, on every level. In addition to her professional competence, Dr. J and I have a personal connection that I discover when we are discussing OJ Simpson and the docuseries “Made in America.” I comment that in OJ’s college days, “SC was the enemy.” Dr. J replies, “SC is still the enemy.” I look at her and ask, “Dr. J, are you a Bruin?” She is. We talk about my years working at UCLA while my kid’s dad attended dental school. Dr. J is young enough to be my daughter, but we still share may fond memories of that campus.

Dr. J is a bit puzzled by the intensity of the pain in my shoulders, elbows and wrists, even more so when I point out the exact spots mid-upper arm and mid-forearm that are especially bothersome. She checks and measures range of motion for shoulders, arms and neck. I am lying on my back; she is working on my neck when I mention the death of my children’s father. Tears well up and several slip across my temples. She murmurs her sympathies. We talk a bit about the details of his passing. And then she observes, “All this pain makes so much more sense now.” She tells me no doubt the crutches were an extra burden on my shoulders, elbows and wrists, but much of the pain I have described comes from stress and tension in my neck affecting the nerves that radiate out into my shoulders and down my arms. She asks whether I have had enough support for the grief and sadness I am obviously feeling. I think I have, but . . .

In absentia, the grief lingers.

In absentia, I pocket the pain.

Luckily, I stayed present enough to avoid that long walk down opioid lane.

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