The curse of invisible pain

As I sit here with my crutches balanced beside me and a giant moon boot on my foot, I am struck by how utterly sorry for myself I am feeling.

Last week, in a split second that has since had a big impact on my life, I fractured my ankle jumping off of a tractor tyre at the Gym. The Orthopaedic surgeon who I saw earlier today said, “oh do you go to one of those gyms”, and then mimed throwing an object from behind his shoulder onto a chair, to which my husband replied “yes, there is a Thor hammer there too.” Apparently the Doctor injured his own shoulder with said hammer a few years ago when trying to lose some of the weight he gained while on a fellowship in the UK. He no longer goes to ‘those’ type of gyms. But I digress.

I like to think I have a fairly high pain tolerance, mostly because I have pushed out 2 babies who each weighed more than 4kgs with no epidural. On both occasions I was home a few hours later with my new baby, a whole lot of stitches under a giant maternity pad and zero mention nor need for any painkillers.

So when I jumped off the tyre last week in an exercise that I have done different variations of hundreds of times before, landed badly and heard a crack; I feared something bony had been injured, but was assured it was merely a sprain.

When two ladies on instagram messaged me saying they were running again a week or two after their ankle sprains while I was struggling to visualise ever being able to put pressure on my foot again, I thought perhaps my pain threshold wasn’t as high as I had previously imagined. It was almost a relief when after a night of having my foot suspended off the end of the cushion unable to even tolerate the weight of a sheet on it, the X ray showed I had cracked all the way through my lateral malleolus (the ankle bone that sticks out on the outside of your leg).

For the past week, I have been pretty immobile. With my swollen foot in various shades of yellow and blue, the large moon boot and my crutches, even if you were able to mute my complaining, it is very obvious that I have an injury, and that I am in pain. I have subsequently had endless messages of sympathy and offers of help.

As I lay in the bath last night, I thought about how if I was to draw a self portrait like my 5 year old regularly does at her school, I would currently draw my right ankle as the biggest part of my body.

Because where previously I was quite indifferent to my right ankle, I am now HYPER aware of it and it is literally dictating every move I make. Fortunately for me, it’s visibility garners me compassion, help and sympathy from everyone around me. My kids have just been dropped back home from their swimming lesson by a friend, and later I am going to enjoy the gourmet ice cream another friend dropped off earlier with 2 frozen meals.

A man I have been treating who was unable to sit for more than 5 minutes at a time when I met him 3 months ago; has just emailed me. Debilitating pain into your anus and testicles which persists for days after it’s been flared up is pretty dreadful for anyone, but even worse when you have a desk job. He can now sit for 30 minutes, but is due to attend an important work function next month where he will need to sit for 2 hours, and it is unsurprisingly causing him distress. Because not only is his pain an invisible one, it comes also with the evil siamese twin who resides alongside the majority of all pelvic pain, shame. As a woman said to me recently, ‘the worst part of when I had to stop talking mid way through my conversation with the plumber, was that I couldn’t exactly say, ‘so sorry, hold on for a minute, I’m just being crippled by a sharp pain in my anus’.”

I could write pages and pages on the experiences that have been shared with me of pain from undiagnosed and poorly managed endometriosis. Stories of period pains so violent that a week of school is missed most months of high school, before being put on the pill, which masked the symptoms for a short while, are commonly recounted to me. Bewildered Fathers not understanding why Doctors couldn’t fix the pain that made their daughters vomit and wail as they learnt to navigate using sanitary pads and dread their monthly cycle. Jobs that have been left, overseas adventures abandoned prematurely and anxiety and depression from being shrugged off by care providers are a recurring theme in my Pelvic health Physio clinic.

I think of how many women have told me how when all their friends were delighting in exploring their sexuality, they felt they were broken when they realised there was zero chance of anything fitting when they attempted intercourse. I recount the shame and self loathing of a woman who said to me recently ‘it’s no wonder he cheated in the end, he eventually got tired of asking and he knew it was sore for me’.

The ex Thor hammer throwing surgeon assured me today that the type of fracture I have had, has excellent outcomes. From what I understand I am very lucky that it happened in the place it did, and because it is stable I don’t need surgery. I will start Physio next week, which will be interesting to both be on the other side and be reminded of what Physio’s who work lower than the groin do in their days. My pain will continue to improve, my ankle will strengthen and I’m sure soon I will long for the downtime these days have afforded me.

And yet I will always remember this time with a visible injury as one of great physical and emotional discomfort. Of being deprived of the normal parts of my day that bring me joy like treating patients, doing the ballet run and (ironically) going to the gym.

My heart aches as I think about all the people I treat who have endured this level of pain and discomfort in their pelvis’ for years. Invisible pain with a side of shame, a sprinkle of being shrugged off repetitively by Doctors and the sadness and isolation that is inevitably served up because of it.