November 22, 1996

Boy, I haven't written anything in a long time-two months to be exact! Unfortunately, I've been stuck in a funk (I think it's seasonal affective disorder). I've just spent two rather painful months as the pain resident.

Chronic pain management is everything I really love (NOT!) about medicine. You basically sit in an office, listening to the hard-luck stories of a bunch of whiners about how much their groin hurts since that dreaded work-related accident in 1989.

"Well ya' see doc - I was leaning over to pick up this 3 pound box and as I arose I was struck in the testacules by a faulty device, which I was unable to identify. I heard a "pop" and since then I've been unable to computate with my wife (if ya know what I mean). I think the company owes me the cost of acquiring and maintaining a surrogate partner as well as a lifetime supply of morphine to control the pain."

No story is complete without the "pop". Everyone hears a "pop" before the onset of the pain. I've come to think that the "pop" is a very important part of the medical history.

"So, Mr. Smith, when did you hear the pop?"

"What were you doing when the pop occurred?"

"Was the pop associated with any other symptoms?"

"Have you ever had a pop like that before?"

"Have you taken any medicine that relieves the pop?"

I have enjoyed the great stories that some people come up with to embellish the events surrounding the "event".

"My entire body was smashed up into my skull and I almost lost conscience."

"I was holding on for dear life when I slipped and smashed my butt onto the floor."

"After I fell down those three tall steps, I smashed my kneecap onto the carpeting."

"I was smashed - hard."

I have learned that all work-related injuries fall into one of three categories: the smash, the pull, or the twist.

Smash: crushed, squashed, mashed, sandwiched, compacted, plastered, and my personal favorite - smooshed.

Pull: yanked, stretched, elongated, jerked, and the dreaded - tugged.

Twist: bent, turned-every-which-way, tied-up-like-a-pretzel, distorted, knotted, wrenched, and the ever frightening - coiled.

My all time favorite was a guy who had pain all over his body:

"Describe your headache to me, Mr. Jones."

"Well, it's as though someone poured lighter fluid on my head and then lit a match."

"Wow, that's terrible. How about your chest pain?"

"Well, it's as if someone poured gasoline on it and lit a torch."

"That's horrible, how about your arm pain?"

"Well, it's like someone poured kerosene on it and shoved it over an open flame."

"Oh my god-how about your leg pain?"

"Well, it's exactly like someone soaked it in jet fuel and put it in a barbecue."

"And your testicles?"