HEARTBREAKERS

Long ago… about more than a decade ago. I was practicing Anaesthesiology and also would do OPDs(Outpatient Department) as a Pain Physician. I carried two phones, one given by the hospital and one, my own. At no point was either allowed to be off, mute, or unreachable. That amusing afternoon, the landline in the doctor’s room rang. Unusual. Very unusual. I checked whether my other two phones were alive or needed resuscitation as I jumped and grabbed the landline. A small note, as Anaesthesiologists, we not only multitask but also have a very different understanding of speed. Fast is normal. On the other line was a very nice lady from the OPD who told me I had a patient for a pain consult. He and his mother were very distressed. Although I was very sure I took my time, I believe I had arrived at breakneck speed. Cool. 

Scene 2: 

OPD, 4 pm, well lit thanks to the summer sun, cool and pleasant thanks to the AC. Other than that…. A lot of other OPD things.

After the preliminary smile and welcome speech that we say to make the patient comfortable, I started, “So, how can I help you?”. What happened after that was unexpected, startling, baffling, and similar synonyms. Over the years, I have seen patients break down as they try to deburden themselves of the emotional and physical pain. It was different this time. They both started crying. I usually keep tissues handy for the patient. This time, I was handing it out to both of them. As I saw both of them wailing, I had a comical idea of whether I should cry too to show solidarity.  

After some time, they both calmed down, it was as if two children had poured their hearts out and had been asked a question nobody had bothered asking them. The mother lovingly looked at the young lad and nudged him to talk. “It hurts.” I asked him to be more specific. He told me his chest had been hurting. As I went about trying to elicit the clinical history, his mother told me how they had visited every specialist and gotten all the tests done until one of the doctors had suggested they meet me. I had everything in front of me, months of tests, scans, reports. My good peers had not left a single stone unturned to solve this problem. They had treated him diligently using the best treatment they could offer. The mother excused herself after I requested her to do so. As the door closed, the young boy started talking. He spoke of his fears, his insecurities, and as he rambled, he spoke about what was probably the source of this pain. He clutched his chest and cried. He told me that he felt lost and alone. “I have pain in my heart.” Concerned, I asked, “Your chest hurts?” “No!!” he screamed. “My heart hurts. She left me.” And the wailing and chest thumping resumed. Break-up. ABANDONEMENT. The experience of being left out, in this case, is the loss of a relationship. There are many ways this loss can manifest. Every individual is unique. Here, there was a strong physical manifestation. Physical pain. Not an exaggeration, but hidden under the garb of chest pain was a very deep-seated emotion of abandonment.

The world of being lonely. The loss. The grief. The loss could be physical, mental, emotional, social, or financial. So many. Assorted yet the same. There is a component of physical pain when abandonment sets in. The pathway to parts of the brain is the same for both abandonment and physical pain. The roadmap to this similarity can be traced to the proto-humans. In those days, any individual who had either contracted an infectious disease or had done an act against the community was abandoned and was left to fend for themselves. They either met their end in the stomach of a hungry predator or realised that they were struck with grief, and the lack of expression led to a different coping mechanism. The same is seen in this time and age, too. If one is fortunate enough, expressing this grief or finding another social fabric is not unheard of in modern times. The story may take a different turn if one decides to internalize and cope with it. We live in a very transactional world. Abandonment is not just physical distance. One may find oneself alone in a room full of people and sense the grief of abandonment.

It is interesting how this track can run both ways, it is not unidirectional. Chronic Pain fatigues the individual so much that they may end up abandoning their social fabric. Their inability to be a part of activities and repeated no-shows leave them out. Abandoned. This may be by the outside world or themselves, the result is the same. Pain and abandonment go hand in hand. None wiser than the other. Not always together, and yet they find their way to each other. As dramatic as my young hero was in the OPD, his pain was not a lie. His suffering was not a lie. His feeling abandoned was not a lie. The understanding of this phenomenon tries to shed light on how our brain, which processes both the neurochemicals for pain and emotions, has similar pathways, receptors, and proteins, and other very intricate mechanisms. The discussion of the connection between pain and emotions has been a classic topic. This article is an attempt to create a mental note that at some point, when we find it tough to understand the origins of pain the standard way, the possibility of thinking out of the box may give us some clarity.