Debbie is a 45-year-old woman who I have worked with for about four years. She was diagnosed with a severe bipolar disorder at age twelve.
About 10 years ago she had a lifting injury at work and advanced persisting low back pain. Over a series of eight years she underwent multiple low back surgeries. It began with a laminectomy at L5-S1. About a year later a fusion was performed and it did not heal. She then required another surgical operation to fix the fusion. Her back pain did not improve and in fact worsened. Her fusion was extended up to L4-5, which still did not improve her symptoms. In an attempt to improve the outcome her screws and rods that had been place to create the fusion were removed and bone spurs were trimmed away from her nerve roots.
Up to this point she was not my patient. I had assisted on her last doing that was done on a Wednesday morning. I was the on call surgeon for my orthopedic group the next weekend. I made rounds on her about noon on that next Saturday. She was in a lot of pain and was not thoughprovoking her legs. I thought it was probably just from the pain and turned around and walked out of the room. About five minutes later I turned around and re-examined her. I still could not tell what was going on so I ordered an urgency Mri. By some unfortunate opening she had a heavy disc rupture at L3-4 just above where we had done the surgical operation at L4 to S1. We took her to surgical operation immediately and excised the disc. She ended up paraplegic.
Over the next 18 months she advanced repeated bladder infections requiring any urological interventions. She additionally had yet another major spine doing to increase her fusion up to L3-4. All the while her pain did not abate.
Life became progressively worse. She had to fight with the state for basic medical coverage. She had exiguous family support. There was a neighbor who was extremely difficult to get along with. I don't think there a word in my vocabulary to retell the depths of her anger and despair. I would see her on a monthly basis avow some sense of structure and deal with need for pain medications.
She was open to the Docc protocol and to reading the book draft that I have been emailing to my patients. The book lays out a detailed plan addressing most of the variables that sway their perception of pain. The one tool she engaged in with a vengeance was writing down her negative thoughts and throwing them away. In the midst of all of her bladder and medical issues, I would see her back monthly and to refill a carport dose of pain and sleep meds. As I was able to improve her sleep she felt somewhat better. With the writing her pain also began to diminish. My role was to guide her dissimilar directions with the writing and other reading resources. I tried for a year to get her to a pain psychologist but the state would not cover psych services.
I was feeling pretty good about the enlarge she was making. Her pain was at a manageable level, her medical issues stabilized, and she began to get definitive rehabilitation for her bladder issues. I was ready to plainly avow her program, then it fell apart.
She got sick from her bladder infections. The fighting within her apartment involved became more intense. Her pain level shot through the roof. She was so angry I did not know what to do. So we had it out. My point was that her life was not bad it was terrible. She had every right to be extremely angry. I would retell her mood as rage. I confronted her with the idea that the energy she was burning being angry was the energy she needed to solve her problems. Our conversations were blunt and she became even angrier with me as I was "not supportive". I acknowledged her right to be angry but it was still destroying her.
The more legitimate your anger the harder it is to let it go and the more destructive it is to your sense of well- being. Additionally it was surely firing up her pain pathways. She was also upset with me because I would not growth her pain medications.
Whenever your peace of mind is dependent on external circumstances you are at the mercy of those circumstances. For three months we went at it. Every conversation began with her ranting about all the things that were wrong with her life.
Meanwhile I ran over a book, Forgive for Good by Fred Luskin. His book is based on his perceive doing any major study projects at Stanford University on the physiological effects of anger and forgiveness. One of his projects involved studying parents who had experienced the horror of having a child murdered. As much work as I had done on seeing at my scholar role of playing a victim this book surely shook me up. He is very blunt on the effects of anger. You either have to truly forgive the person who wronged you or pay the price. Last summer I gave Debbie this book. She had continued to do her writing exercises and work with the "Feeling Good" book.
About four months ago she came in smiling. Her demeanor was dramatically different. She was pleasant and engaging. There was also a marked decrease in her pain. I don't know exactly what happened, as I am not a counselor and my role is more of a coach. I had just held out the idea that although she surely was a true victim there was nothing that was going to change. She was constantly paralyzed. She had long-term persisting pain and she had no real capability to improve her financial situation. I had been discussing the role of anger in flaring up her pain, but her anger was so deep she could not hear me. To her strong prestige she could still hear me adequate to read "Forgive For Good" and she got it. With the same commitment she had engaged in with the Docc project she embraced his concepts and did the exercises Dr. Luskin had recommended. Forgiveness is not an intellectual exercise. It also takes awareness and admission that anger is a problem. It is difficult to let go of "being right." Somehow she did it.
But what was remarkable is that her bipolar symptoms essentially disappeared. Her anxiety diminished and she came off all of her bipolar meds. She re-established a relationship with her family and any friends. Her family is planning on helping her buy a computer. It is leading to her to begin to reach out and help others who are in a wheelchair and in pain. She is starting to create a life for herself.
Initially I did not believe her and every month for the last six months I kept asking her the same questions about her capability of life. She is very clear that she is happier in wheelchair than she was when she was bipolar and able to walk. Her pain continues to steadily diminish.
Her case is one of the most surprising and rewarding situations I have witnessed in my practice. I will give myself some prestige for sticking with her although I was surely ready to removal her from my care any times. It was her being open to new ideas and committing to herself to seeking real change that made the difference. I offer the same tools to all of my patients but only a small percentage will engage with the concepts.
Sustained anger will destroy every part of your life that has value. It also intersects with pain pathways. Make a uncomplicated choice. Let it go!!
Bladder Lift Surgery:Defeating Bipolar Disorder - One Woman's Journey
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