Painful Yarns Page 6

  Doctor: I am just going to pour a little olive oil into your ear. Remain still for about 30 seconds…………… OK. now sit up and tilt your head right over to the right.

  With this, he held a bowl under Anna’s right ear and a small amount of olive oil dribbled into it and there, in the olive oil was a dead ant. The relief on Anna’s face was obvious. She wiggled her head, moved her jaw up and down a little and we both turned to the doctor, who was holding the bowl and looking proudly into it as though he had just given birth to the ant.

  Doctor: There’s the little blighter – just like the one we had in here the other day. They must love the ear canal perhaps. I might cook up some pasta next time – ant fettuccine!

  Anna: Thank you so much! And thanks for seeing me so soon. Do I need to fill out any forms or give in my insurance details or anything?

  Doctor: I think so. Perhaps you should see a doctor anyway?

  This was somewhat surprising to us both.

  Anna & LM: But aren’t you the doctor!?

  No longer doctor: Oh no, no. I am here to see one too.

  With this, the fellow walked across the waiting room with a big limp, as big as you might have if you had a wooden leg two sizes too big. Indeed, on the bottom of his right foot was a big lump of wood. His shoe was stained bright crimson with blood and poking out the top was a big fat nail. This man, who we thought to be the doctor, who was charming and confident and calm throughout our ant in the ear ordeal, had a piece of wood nailed to his foot.

  LM (thinking quickly): You’ve got a lump of wood nailed to your foot!

  No longer doctor: I know! Amazing isn’t it – nail gun – straight through, nailed my foot to the floor! Had to cut the floor up to get in here. I walked over from the other side of the highway (about a kilometre) – save the taxi fare – those bastards charge a couple of bucks just to get up in the morning!

  so, what has ant fettuccine got to do with pain?

  The one sentence take home message: Pain doesn’t always mean there is tissue in danger.

  This story follows the last one because it does more than demonstrate that nociception is not sufficient for pain (as evidenced by the man we thought was a doctor, who had nailed his foot to the floor and was experiencing no pain). Actually, this scenario is an example that nociception is not necessary for pain. TMBA probably had no nociceptive input when the ant was in her ear. However, her head was starting to hurt and her muscles had started to protect that side of her head. Thus, nociception is neither sufficient, nor necessary, for pain.

  There are also some really interesting experiments that show that nociception is not sufficient for pain. Here is the most cheeky experiment: Researchers convinced subjects to put their heads in what they called a ‘head stimulator’. When the researchers turned up the intensity knob, the subjects reported that their head started to hurt. What’s more, pain ratings related to the intensity settings. That might not seem surprising, except that the stimulator wasn’t real – it wasn’t even connected to the control knobs! Ref List No. 5

  dusty’s bum crack

  Or: the brain samples information according to perceived vulnerability and threat.

  When I was in high school, around about that time I first encountered Mrs Smart and the visual perception system, I got a job at the local McDonalds. It was a great job, not least for the seemingly endless variety of injury-free practical jokes one could play on colleagues and on customers. I was particularly fond of putting 3 or 4 fish fillet’s in a Fillet-o-fish© burger and watch the absolute ecstasy on the face of whoever bought it when they opened the lid. I could fit 13 nuggets in a six-pack, although you had to hold the lid down and pass it over (to my dad, usually) in that way. Otherwise, the lid would pop open and, as they say, there would be some explaining to do.

  McDonalds stores are divided into two bits – the front and the back. When referring to ‘the back’ or ‘the front’, you had to preface it with ‘out’. For example, ‘out the back’ was where the boys worked and ‘out the front’ was where the girls worked, except the ugly or angry girls, who worked on drive-through, or possibly on salad. It was a job of the boys ‘out the back’ to keep the products available so that when the girls ‘out the front’ received an order, the customer never had to wait.

  The most important job ‘out the back’ was ‘Production’. In that job, you had to keep an eye on the customers and on the supply, so that you never ran out of product. However, you had to avoid being overstocked too, because products were not allowed to spend more than 15 minutes in the production chute. One put a timer in behind each batch so that they would be thrown out when the 15 minutes was over35. On Production, you would bark requests at the other pimply-faced youths out the back – each one of them in charge of a station – big macs©, salad, fries, grill, gofer36. The most demanding station was quarter pounders©. Only those blokes who had demonstrated their ability, in the midst of a busload of school kids or a university ski trip, to get the job done, were ever put on quarter pounders. Those who demonstrated they could cope with quarter pounders in the rush, were then eligble for production. This promotional criterion was not official, but it was how it worked.

  One day I arrived at work and saw my roster – production. I was reasonably chuffed with that, not because it is the captain’s gig, but because it was one of about three spots in which your clothes didn’t become toxic over the course of a shift. ‘Fat pants’ was particularly nasty on ‘Grill’. You could wear two aprons over your shirt and pants, and you would still get greasy fat-blisters on your legs by the end of a shift. I was as pleased about getting Production as I was disappointed that Dusty got Quarter pounders. Dusty had worked in our store longer than I had but had the misfortune of being (i) the son of the manager and (ii) crap at Quarter pounders. Dusty knew he was no good at Quarter pounders, but because he was the manager’s son, he was too afraid to refuse the shift when the manager rostered him on. He was even too afraid to swap stations when a busload arrived. Instead, he would duck off to the toilet. Bad strategy.

  Being on Production when Dusty was on quarter pounders was bad news. I kept a particularly close eye on quarter pounders – I scanned the environment for customers that looked like they might be quarter pounder eaters (not that I really knew what they looked like, but I was hoping that I would recognise them when they appeared). I kept an eye on how many meat patties Dusty was putting down on the grill. Everytime I barked him an order –

  “can I have 6 turn-lay quarter pounders please Dusty”

  Dusty would reply with:

  “6 turn-lay quarter pounders, thank you production”.

  I took special notice of whether or not he implemented this instruction.

  In this manner, the evening passed fairly uneventfully, although I did end up over-requesting quarter pounders a couple of times and having to dump them when they passed the timers. I think my action was justified, particularly when one family, fat mum fat dad and two fat kids, waddled in, t-shirts that said:

  “My grampa went to Texas and all he got me was this lousy T-shirt (and a semi-automatic shotgun)”.

  I thought these guys were sure-fire Quarterpounder eaters. That I over-compensated for Dusty’s anticipated vulnerability is evidence that, before he had even stuffed up, I was changing my behaviour, and changing the way the whole body of staff were working. I did all of this to protect the store.

  But then the inevitable happened – three buses of hungry uni students on the way home after a weekend of skiing. Not wanting to overwhelm Dusty, I upped the request slowly:

  LM: 9 turn-lay Quarter pounders please Dusty

  Dusty: 9 turn-lay Quarter pounders thank you production

  Suffice to say, Dusty fell apart. Quarter pounders came out so raw that one kid complained that there was water in his ketchup when blood was oozing down the bun. Some burgers had no slices of cheese, others had extra slices. The production chute was empty and Dusty was completely flustered until he left 24 patties b
urning on the grill and went to the toilet (such was his habit in times of stress). Such a malfunction imposes a serious threat to the whole place – customers get angry and impatient, workers get testy, the whole place gets messy, pickles on the floor, rubbish bins overflowing, Drive-thru traffic banks up, etc etc. I took solace in the fact that the store would eventually close for the night and, ultimately, we all knew that Dusty was at the bottom of it all.

  It was months before I was again faced with the misfortune of doing Production when Dusty was on Quarter pounders.

  This time, however, I had strategies in place to help minimise the impact. This is what I did:

  I had the drive-through staff be on alert for buses, so as to get some early warning.

  I had the guy on Nuggets keep a look out for Dusty’s bum crack – loss of altitude on the pantline was the first sign that Dusty was starting to lose it.

  I had the girl on Salad keep a look out for Dusty’s stress rash that started beneath his left ear and slowly crept around his neck like an Amish beard.

  I planted a note on the crew room toilet door that said “Bathroom undergoing emergency repairs – see Lorimer for alternative key”.

  All of these things were ways in which I had increased the likelihood of detecting something starting to go amiss on Dusty’s station. The strategy worked pretty well in so far as we didn’t run out of food and the place seemed to keep operating fairly normally. However, it meant that there were some false alarms. It meant I had fewer resources to allocate to other jobs. It meant that we had to throw away more food than usual. Occasionally, those people who were working extra hard to compensate for Dusty, to protect the entire process from Dusty’s vulnerability, started getting grumpy. They also started slipping up themselves and the whole mood of the place headed south. As they say, a bad mood is a bad move.

  Dusty didn’t last long enough at McDonalds to get three gold stickers on his name badge. He had two golds (salad and fish fillets – very uncool) and a silver (dining room – even more uncool). Dusty convinced his dad, the store owner and manager, that he should have the jurisdiction to fire people. His dad reluctantly agreed and Dusty fired himself. “Gee that felt good” he said as he gave himself the marching orders and responded back to himself with the two fingered salute.

  so, what has dusty’s bum crack got to do with pain?

  The one sentence take home message: If the brain perceives a part of your body is vulnerable, then it will protect it in everyway it can, which may become a problem.

  I use this story to talk about two aspects of what the brain does when it perceives a part of the body is vulnerable.

  First, the brain implements strategies that protect that body part. Those strategies include changing the way the brain scans for threatening cues, using other body parts and systems to protect the area, moving slightly differently, behaving differently, avoiding some movements, activities and situations that might worsen the situation, reacting quickly at the first sign of danger, laying down more receptors for certain chemicals or stimuli.

  Second, this is ultimately unsustainable. It leads to false alarms, over-reactions and break down of other body parts and systems. It prevents the vulnerable bit from becoming strong or more effective because it is always preventing that part being exposed to the threat. This is important because it is threat that promotes adaptation.

  I also spend some time on the whole mood thing – to be protecting a vulnerable body part is stressful and chronic stress is a kill joy. The effects are substantial and widespread. Why don’t zebras get ulcers? Ref List No. 6 is a great account of the effects of long term stress.

  ornithology & amazing grace

  Or: neural networks that produce pain become more sensitive when pain persists.

  When I left physiotherapy school, I wanted to be a musician. Not an obvious link and one that my dad accepted bravely over a Super Supreme at Belfield Pizza Hut. I remember it like it happened yesterday – Dad’s oily lips pursed together, a strand of mozzarella (or mozzarella-like imitation dairy product) clinging to his well-trimmed beard, his jaw muscles pulsating rhythmically. The fact is, I didn’t want to be a physiotherapist. I had seen Cam Williams get coughed on through a tracheotomy and remember remnants of phlegm that were still wedged in the hinges of his glasses a week later. I had worn the sky-blue long socks that were required clinical uniform when I went through Uni37. I was not interested in doing that for a career. No no! I wanted to be a muso.

  A critical issue that I had until then overlooked was that I had never played a musical instrument before. I had never had any type of music lesson and I had sold my unused recorder for some football cards as a kid. None-the-less, I got out the phone book and looked up:

  Music – Tuition – Brass – Saxophone

  To my dismay there were no teachers of saxophone in the whole of New South Wales. On making this remark to a friend of mine, she explained that the saxophone was a woodwind instrument, which I thought quite daft because it is clearly not made of wood. She mumbled something incoherent about reeds and I went back to the phone book:

  Music – Tuition – Woodwind – Saxophone

  I have a policy of never selecting a business that has a boxed or bolded entry in the Yellow Pages. This policy is why I ended up knocking on the door of a dark, mouldy terrace in the rougher part of Petersham. Papa Smurf opened the door. Keith Silver. Keith Silver, Maestro. He looked a bit like Papa Smurf, but he had played saxophone with some of the best and I knew of him by reading the album covers of work by some of the best. Keith Silver thought that James Morrison was a rare talent who was predisposed to being a poser.

  I figured that Keith Silver could recognise talent when he saw it. He didn’t recognise me, which was disconcerting and probably should have been a ‘Yellow Flag’. He stood at the door in his red and green tartan dressing gown, chewing on such a volume of Nicorette that his mouth looked like a harpsichord. Unfortunately, I had to remind him of our phone call and his promise to let me try before I buy. Memory jogged, he brought me into his studio and there sat an alto, a soprano, a base and, pride of place under spotlight, his Selmer Mk VI Tenor38. He gave me three reeds to suck on while he explained a couple of things about one’s instrument being like a lover and that life was ultimately about music and sport and sport was for moron’s, which made life about music. Sufficiently sogged, the reeds were inserted into each of the horns. He showed me how to hold it, and then how to blow it. I squeeked the soprano. I choked the bass. When I blew into the alto, there was no resistance, the wind just flew in and was replaced with this wonderful sound. I got the best part of a scale out of it and then ran out of air. “That”, said Maestro, “is your horn”. I was hooked. He didn’t offer the Selmer, which is no surprise I guess.

  A couple of months later Maestro started giving me technical exercises, which are specific tunes or passages of notes that one plays over and over and over again. The idea is to get the fingers moving. I remember one exercise in particular because it led to my sacking from the only professional band I ever played in. It was a Charlie Parker tune called Ornithology39. Now, Charlie Parker, aka The Bird, to Jazz is like Rene Descartes to Pain sciences – both confronted the thought of the day head on and both totally revolutionised their world. I wanted to play Ornithology as fast, and as swinging, as The Bird. So, I played it to death – I played it during the day in the cupboard. I played it at night on Clovelly headland with seagulls, winos and young lovers for company. I played it until my lip bled and my octave thumb blistered. Ornithology rattled around in my brain like a bee in a bottle. It became part of me. The point is, I played the tune, the whole tune and, pretty much, nothing but the tune, for weeks. Months.

  About a year later I had a regular gig as part of a five-piece jazz band. We played standards primarily and a few original tracks when the proprietor was too drunk to notice. One night someone in the club asked the band leader if she could sing with us. She was a beautiful black woman with a generous mou
th and substantial curves – would have been hard to knock off her feet. She said ‘corrl me Black Mama. Mazen Grace. Jerss farlo me borrs”. She had a voice like chocolate and pretty soon we felt like a bonafide Gospel band - James Brown himself could have been in the house. Black Mama did some sublime scatting and the wonderful Amazing Grace theme bubbled around the band – double bass solo, piano solo, drum solo. Then me. I was, as they say, wailing. I had my sunglasses on. It was dark. I was dancing around a simple but stylish theme, fluttering and flirting irreverently with Amazing Grace. My mind wandered with the exploration – I could feel the wind in my hair as together, the tune and I scampered across waves and over rock pools. Then it happened. Something unpredictable and uncontrollable occurred and I snapped without warning from Amazing Grace, straight into Ornithology. I was possessed by it. My fingers were flying! There I was, playing a perfectly tight Ornithology, right smack bang in the middle of Amazing Grace. It kept going – Ornithology had hijacked my body and my mind. Black Mama was staring at me with a look of ‘what the -’ The band leader was mouthing “what the – ?!” I was mouthing over the top of the sax “I don’t f*!#$-ing know”. I had no control over it – it was just out there. Everyone stopped playing except me. I stood there on stage, on my own, and finished Ornithology to the very end, even the tricky syncopated parts toward the end. The band-leader left a note in my sax-case:

  You are a tosser and you are now out of work.

  so, what have ornithology & amazing grace got to do with pain?