Your physio was off sick, but you were desperate and so made an appointment with whoever was free on the day. R has a mop of blonde curls and a baby face that rivals your own. He has read your file and is unhappy with what he has seen and the answers you have given. Raise your arms here. Now here. Tilt your head. Hold your hand out.
Thoracic Outlet Syndrome
Thoracic outlet syndrome(TOS) is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene. It can affect the brachial plexus (nerves that pass into the arms from the neck), and/or the subclavian artery or rarely the vein which does not normally pass through the scalene hiatus (blood vessels as they pass between the chest and upper extremity). Rarely a Pancoast tumour in the apex of the lung may be the cause.
The compression may be positional (caused by movement of the clavicle (collarbone) and shoulder girdle on arm movement) or static (caused by abnormalities or enlargement or spasm of the various muscles surrounding the arteries, veins, and brachial plexus), a first rib fixation and a cervical rib.
Beneath his fingers your muscles, nerves, tendons and scalenes shriek and shiver, and you lie on your belly with your teeth grit and your concentration divided between merely breathing and listening to him. It's a tirade, and you're not sure who it is aimed at; these stories of patients with symptoms and stories identical to your own, fixed after a mere four months of therapy and exercise focused on different muscles, and he didn't like that you've been like this for years, he didn't like it, he wasn't happy, and he knew with this and that you could get better, because you're still young, what do you see in your future?
Remember to breathe.
You may not agree, he says, as his fingers press here and sends a knife of pain there, you may think everything I've said is a pile of rubbish, and that's fine, but, I don't care, I've read your file and I'm not happy with it. It's up to you what you want to do, but I don't like it-
It's your lack of reaction, always your lack of reaction.
You can't afford hope on a new diagnosis. You just can't.
At the end of your session, your counselor says
I don't know if we should continue these sessions. I'm just not sure if this is giving you any benefit or if it is making it worse.
Remember to breathe.
On the train those brief minutes between Richmond and Flinders Street, trying to smother the howling heart, dam the tears and stop, just stop, turn it off, turn away.
With a new diagnosis R gave you hope which terrifies you, and his vehemence highlights its absence in your normal physio, H, and you wonder what she will think, you wonder if she even cares, and you wonder how to put this to your GP, who is absolutely set on the diagnosis of Fibromyalgia and will fight this new suggestion, and your counselor, who-
Does she think you're beyond help?
Winter comes and sows cold into your bones, and with it your pain blossoms. Back to flinching when laying your hand on the mouse, snatching your hands from the keyboard, holding your wrists and staring out the grime-flecked window at nothing because there is nothing you can do. Back to weekly physio treatment and taking whole days off work to rest your hands that little bit extra.
Remember to breathe.
But, what for.
The weeks pass, the cold is sinuous in your veins and no amount of wool and warmth can soften your terror. Reel in your future, because to look at it is to see nothing worth living for. Think not of Scotland, new lands new people new adventures. There is nothing you will discover that you cannot find here. You will change nothing by going there.
You must take yourself where ever you go. There is no escape.
This room is too crammed with things, just things. This house is full of people. People who love you and care for you, people who know you and around whom you can relax, but there is never any stillness, silence, solitude. Their presence echoes in the floor boards, the kettle boiling in the kitchen, unmuted conversation through the wall. You cannot go to the toilet, get a glass of water, stretch, without having to leave this room and put a face on because they will see you, talk to you.
You cannot howl. They will hear you.
You go to bed early. Earlier. Earlier. The sun follows you down and you lie there with heat packs swallowing painkillers and waiting for random bleeding and low blood pressure. You can't get to sleep fast enough. You wake too soon, too often.
He fights. The GP shakes his head and disagrees and argues. The spare cervical rib he will not let go, he's sure you don't have one, and for that matter so are you. You don't believe you require one to have TOS, but he does. He wants to raise your dosage. You don't.
You go to bed early. You wake before your alarm in a cold sweat. You miss your alarm. You're late. Later. Later.
Drown yourself in work, but, you cannot.
R discusses medication. Celebrex and Cymbalta are heavy duty stuff, he says. You agree. He recommends other pain medications, stating you should go off both. You say you were prescribed Cymbalta as dual purpose.
Ah, he says, and says nothing more.
Your GP shakes his head at the medications R has suggested. The relief and disappointment are equal and equally perverted. You'd looked up the numbers for an overdose of Valium.
He shakes his head at the pain management specialist who specialises in TOS. He wants to send you to one specialising in Fibro. He talks about rehab. You argue why can it not be both diagnoses, and he shakes his head and shakes his head and disapproves and disagrees but it is your body and your decision and he types out the referral letter.
His disapproval evaporates when you start crying, even though you have already won.
No one wins in this.
The void will not be ignored. Nature abhors a vacuum. This hunger saturates your minutes - there is only so much future you can turn from - and you are weak and feed it and feed it and feed it. With good friends. With friendly acquaintances. With distant friends and far friends. You sign up to dating sites and rummage around forums and fuck with strangers and buy drinks for strangers and flatter strangers and press them down stretch them out and force as many minutes upon them as they will suffer. You seek out new people, meet new people, people worth knowing, people who could become quite good friends if only they had entered your territory in a different era an era without famine and hunger and desperation. You push your true friends away in favour of these strangers, because you know exactly what you are doing. No one can fill this void, and yet you will try to make all do so, and when they inevitably fail you will still resent them for it. Keep your friends away from that. Keep them precious.
You cannot make the appointment with the pain management specialist. It is too great an ordeal and you have not the strength to lift the phone.
This is your 30th birthday.
Imagine that. Three decades. You're still here. Remember to breathe. But, what for?
People will say that how you spend New Year's Eve is how you will spend the coming year. This sentiment you've applied proper logic to, because the Roman calendar means nothing, but the internal calendar listens. Do not repeat your last birthday. It was your own doing as much as anyone else's. This birthday will be your own doing as well.
Make it a birthday week. Go out, every single night. Fuck more strangers, meet more strangers, drink more drinks and eat more junk and laugh a little louder and with a little more ice. The cold is every where. You're good at this. You're really good at this.
Some sanity in the sunshine, with family and friends. For a day or so, you don't have to concentrate on breathing. Years of having a birthday in the middle of exams have scarred you well, and combined with a marvelous lack of self-worth have made a formidable obstacle, and in spite of that you organise your first birthday do. The anxiety of who to invite leaves you in tears and sick. People come. More than you anticipated or booked for. On the night, you're in a room full of people you know and people you like and people with whom you have no social awkwardness. An amazing night. The cocktails stop your high heels from hurting your feet, but not the grinning from hurting your cheeks. You jump out of a plane and fall 14,000 feet to the Earth. You use your birthday to bully a number of leads into dancing with you. You sleep exhausted and exhilarated.
None of this is shared with your counselor. There isn't time. This is your last session, and you ask her what she meant by her parting comment; that she did not feel she was in a position to help you, or that you are not receptive to help.
She speaks of psychiatrists and medication, and the fact that your depression is so intense and deep seated, and most of the sessions have seen you in a high anguish for their duration. There needs to be more discussion, less silent howling, for progress to be made. You need to have already started to heal yourself.
You go to bed late. Later. Later. Because you get home late. Later. Later. Arrange to meet more strangers. Buy more drinks. Walk slower between the station and the front door, you have to have control of yourself before you set foot on the front verandah, they might hear you.
You haven't done your washing for weeks. Your room is filth.
Go out. Find more excuses to go out, stay out, stay in company. Name after name is added to your contact list. You can dazzle them with the shit you talk, make out like you're someone worth knowing, a bit of sleight of mind and you don't even need your neckline that low cut.
Hunger has no end. Now fed, the void grows, because this is not what it wants. Plans are canceled, rescheduled, canceled, and you take it because it is still something, anything, that will sit in the forefront of your mind for long enough.
Friday night you end up in a lovely guy's flat, a thai restaurant, an unknown bar, where you meet yet another stranger, the three of you talking shit as the music gets louder and the lights lower and the arrivals uglier. Wing it. Why not?
Until it's just gone midnight and you're standing in a warehouse in Abbotsford with a long neck in one hand and the wall painted with ghoul sperm by your shoulder and the toilet being the rape alley around the corner and someone in a ratty beard is telling you that another in a ratty beard rolls the best joints ever no one rolls a joint like him at least you think that's what he said because you can't hear anyone over the band crammed in a room under the stairs and and you know no one, no one here, and you don't know what you're doing here, or why you're here, or what you were expecting, you only know that this isn't what you wanted and the resentment and bile rises up because no one here is saving you from yourself.
No one is capable of that.
Blink hard on the train home. Oversaturated by people. Overstretched. Easy to fix, simply cut everyone out for a while-
-and sit in the void.
The void will not be ignored, and you are not strong enough to withstand it.
There is no escape. Remember to breathe.
But, what for.
The hangover is sullen. You're weary and broken. So broken. You'll do your washing today, clean your room, make the bed, stay home because there are enough chores to keep you busy for this one day, surely. You'll write this post, because this has to come out, this must be written, it must, surely, it must, you'll feel better for it. A day, surely one day, surely that would be just enough, just enough to make the difference between a trip and a fall.
A stranger asks if you want to see a movie.
After the movie you find old friends, and cannot dazzle them so sit sullen and ill at ease with the delusion you're clinging to.
Later, after drinks, after dinner, decisions before you. You could call that person. This person lay out an open invitation, they're only a few blocks away. This person would jaunt in to catch up. There's this event and that event. Choices.
You find yourself slumped beside the parking pay machine at the end of the escalator, heart hammering and staring at the options listed in your phone, and paralysed. You could go out, it would be great. You could. You should. You could. You would. You press call raise the phone to your ear and immediately hang up oh no oh no you can't you just can't face any more people not tonight not now but you don't want to go home because there is nothing there but the void framed by all the evidence of what you once were.
There is no escape. Remember to breathe. But, what for.
With the new diagnosis comes hope and thus more terror than you can bear. A wonderful counselor cannot help you. Doctors will agree with specialists who've seen you a total of ten minutes and dismiss what you know of your body. So many brilliant new people unearthed, worth nothing. Too long. You can't do this any more.
Raise the dosage. All of them. There is nothing to preserve.
There are people who care, still, and love you, still.
But, you are not one of them.