Pain and Suffering

CS died. He was a patient of mine for about seven years. He had a stroke that had damaged his "motivation center". He had severe apathy. He was very pleasant, but always sort of "blank". He didn't try very much. He didn't walk. He was very overweight. He just basically didn't care about anything. I liked him. I like most of my patients. I like people and I like patients. I will miss him.
JM was in today. Her son is in hospice. He is dying from a brain tumor. She is very sad about it. I can't help her. She has Parkinson's disease, which is why she's my patient. Her Parkinson's is doing well, but I just had to stop her Azilect. Her blood pressure is high, and I think it's from that. That's too bad, because her Parkinson's will get a little worse.
There's been a lot of dying this week.

I saw BS today. He fell in a grocery store. It was a "slip and fall". He fell in just exactly the right way to completely crush his Sciatic nerve. I think he fell around the end of 2007, so it's more than a year, maybe close to a year and a half. Anyway, his nerve isn't going to heal so he has permanent pain in the leg. He has such an upbeat attitude for a person with nerve pain. I like him because I think he is one of my happiest patients. I have several people in the practice who have constant chronic pain every day but they are happy. It is very important.

People don't understand that there are different things that are "unpleasant". There is the simplest form: "noxious stimulus". Even a single-celled organism (ameoba) can move away from something. But it can't really experience "pain". "Pain" doesn't happen until there is a fairly advanced nervous system, nearly a "brain". Jelly fish don't really experience "pain". Pain (in humans) happens at the level of the thalamus. Then, there is a higher order of experience called "suffering". This is a critical distinction. "Suffering" happens at the cortex. It's not in the thalamus. They are different experiences that happen in different parts of the brain. This is why there can actually be "masochism". That is where a person "enjoys" a "painful" experience. The translation from thalamus to cortex doesn't prouce suffering, it produces joy. If we could "induce masochism" we would turn pain into pleasure. It would be a very good treatment for chronic pain.

I saw MM today, who has chronic pain that creates enormous suffering. She is a complete "anti-masochist". No one can figure out why she has all of this pain (including me) and she won't go to Mayo Clinic even though I keep asking her to (I don't think they're going to figure it out either, I just want to check). However, her pain makes her suffer greatly.

Anyway, CS never really cared about anything. So he didn't really have the ability to "suffer". He didn't care enough about the hurting leg or the hurting arm. BS doesn't suffer that much because he refuses to let the pain in the thalamus become suffering in the cortex. It's like there is a block. JM doesn't have pain right now, but she will because she is having such great depression over her son that her transmission from the thalamus to the cortex is going to be enhanced. And MM has actually augmented her transmission of pain in thalamus to suffering in cortex.

I had lunch today with my wife. We don't have lunch that much anymore, because it's not really in the schedule. We were talking about how much can people change themselves, change their brains. CS had a stroke that robbed him of all motivation. So she wanted to know how we can be upset with the people who are homeless in the streets but aren't motivated to get themselves going. (She is always sticking up for the poor and the wretched.) What if they have a "weak" motivation center in their brain? Still we all try to change ourselves and to some extent succeed. We have some limit, of course. I can never be totally different than me, I can only change me a little. Of course, if I'm persistent a little change at a time adds up after a few years.

I think that too many people don't realize that they have the power to change themselves. They don't even realize that there are these huge differences in people's perceptions. People think that the pain and suffering they have is similar to the pain and suffering that others have. But everyone's pain and suffering is different. Everyone is different and they experience different realities.