TRIGGER POINTS Eli Cahan

 

It hurts everywhere.

“But where, specifically?” asks the nurse.

It hurts everywhere, Ms. G repeats.

“But where, if you had to point with one finger?” asks the student.

It hurts everywhere, Ms. G repeats.

“But where is it the absolute worst?” asks the resident.

It hurts everywhere, Ms. G repeats.

“But where compared to last time?” asks the attending.

It hurts everywhere, Ms. G repeats.

I. Midbrain

This isn’t the first time Ms. G has endured the work-up—or, better, the run-around. Mamá mia suffered a similar malady.

She recalls the moment the affliction declared itself to Mamá. It was an oppressive day: heat unremitting; humidity unforgiving; sun unrelenting. It was also a peculiar day: behind where they stood, zombies mobbed; above them, skulls dangled; aside them, shadows encroached; in front, skeletons pranced. To her left, a walker in a floral pink dress bit angrily into a skull, viscous pus-like cream drip dropping down her chin. To her right, another in a midnight navy suit drank, parched, a deep maroon fluid, spilling, staining, his starched white shirt.

Dia de los muertos, Mexico City, Mexico.

She grasped Mamá’s hand fearfully. She held on tightly, as if for dear life, surrounded by death. Enveloped in flesh, touch offered salve to the surreal.

Then, in an instant, Mamá released and withdrew. Face contorted, she stared at the hand, pain equally unremitting, and unknowable. Then, she collapsed.

What happened next, Ms. G does not exactly recall, but the words of the healer rang through her head—el maleficio de los Tlaloques—the curse of the Mountain gods. One more word echoed—the one the doctors had intoned—fibromyalgia.

After, Mamá was a different creature entirely. A shadow. A body certainly, yet spiritless. A corpse. She seemed for eternity stuck in limbo between dead and alive, dying and living, her own personal vida del muerto. Ms. G never again held Mamá’s hand.

II. Neck

Saturday. Ms. G wakens to blinding sunlight. She pulls the shutters. The room is dim. Peering groggily in the mirror, she hardly recognizes herself. Today is her thirty-fourth birthday; this is not what she imagined she would look like at thirty-four. She is not obese; technically, overweight is the term. More surprising is how much she appears as she feels: that is, under weight. The weight of the world, ever bearing down, ever compressing, ever depressing.

It has been worsening for months. Whether the burden brought the pain, or whether the pain brought the burden, she does not know. What she does know is that they are both here, and there, and everywhere. They are both here now.

A knock on the door—Ms. G turns to look—and her neck erupts in pain.

III. Shoulders

Sundays are for fútbol, and today the G’s are due to host. As always, while Ms. G’s husband and los hombres are fixated on the match from the couches front and center, dear Dolores and las chicas help with the preparations. Yet today, Ms. G was ill-equipped to produce comfort for others, as she could not find comfort herself. With but the slightest abduction towards the cupboard, the smallest extension on the cutting board, the mildest flexion with the party bowl—the dolores came (and came, and came). Sitting quietly to rest, she found herself listening to the mutters: lazy—manipulative—ungrateful. Another voice murmured: if my friends don’t get it, who will?

IV. Hands

After taking her joy, the Tlaloques came for her job. A pastry chef, her passion and her profession was steeped in the tactile: sifting flour; pinching salt; kneading dough; braiding loaves. This Monday, though, the subtlest of maneuvers was unsubtly excruciating. Distraught and dysfunctional, expelled early, the chef de cuisine intoned: “don’t let this happen again.” Tuesday was more of the same. Wednesday, she was laid off: the restaurant had little pathos or patience for pathology. No job, no income. No citizenship, no fallback. Onwards, her stress. Downwards, the weight.

V. Hips

Then, her other passion. Thursday evening, lying in bed, noses abutting, she looked deep into his walnut eyes, and he into hers. He gazed on as her lacrimal fossa bubbled, as the dam broke, as the pioneering tear rolled. Under the covers existed a glorious, exclusive, intimate land of innocence, and lack thereof. That night, it was another land to which she lost citizenship. Indeed, the lightest kiss of the covers on her limbs, the lightest kiss of her husband on her hips, evoked a sensory maelstrom. Visa revoked, abandoned at sea, a refugee amidst the refractory, her tears swept her away.

VI. Knees

Finally, the children. It didn’t happen in Mexico City, or anywhere else remarkable. No—it happened sitting in front of the fireplace, on a quiet Friday evening, niño suya on her lap. It was as if the fire leapt out, craving flesh, consuming bone. Ms. G, in an instant, recoiled and withdrew. Niñito tumbled to the floor, without trauma, traumatized. On Monday, she lost her ability to provide for the children. On Friday, her ability to embrace them.

VII. Cerebrum

Now, six years after that devastating week, Ms. G, a 40 year-old Hispanic female with past medical history of fibromyalgia presents with complaints of “worse pain everywhere.” After being seen by the nurse, the student the resident, and the attending, physical exam notable for hyperesthesia, allodynia, and a positive PHQ-9, their impression at this time is most consistent with major depressive disorder. Consult psychiatry.

Psychiatry?!—she almost yells aloud. She knows what this entails: a one-way ticket to the leper colony of the medically untreatable. But she is no less frustrated, as she was diagnosed, after all. Labeled, seemingly, for disposal.

Why call it “healthcare,” without recovery of the former, or administration of the latter?—she asks, in fact aloud. Why see these insipid “doctors,” sterile yet sterilized without their pills? Where were the “healers” when she needed them?

Whether the burden brought the pain, or whether the pain brought the burden, she does not know. They are both here now. Downwards, the weight.


Eli Cahan is a medical student at New York University, conducting a research year at Stanford School of Medicine. He graduated Phi Beta Kappa from the University of Michigan, where he majored in business and served as columnist/editorial-board member for The Michigan Daily. At NYU, he has engaged with the medical humanities as a Rudin Fellow, editor/contributor for the Agora, founder of the “Storytelling in Medicine” seminar, and recipient of the Anthony Grieco Essay award. At Stanford, he won the Paul Kalanithi Writing award. His work has been featured in Scientific American, PBS, and STAT News. His current work addresses clinical research, economics, policy, and ethics in pediatric orthopedics. In spare moments, he eats, runs, swims, reads, kvetches (with his twin brother), and eats again.

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