DOES IT HURT?

"You have some impressive burn scars. All up your left arm, down your back, across your chest, and belly."

"Tried to burn myself to death. I was drunk and couldn't take it anymore. Poured gasoline all over my body and lit a match."

"Did it hurt? I mean when you get third degree burns, it doesn't hurt. Did it burn right through the skin real fast so it didn't hurt or did it take awhile to damage the nerves?"

"It hurt like hell."

"Pulling off the burn scars was just as bad, I bet."

"That was even worse. Pulling those clothes off that stuck to your body and then pulling off that dead skin everyday."

"Looks like the doctors did a good job. You've healed up great."

"Yeah. Now my back's killing me. The doctors say my back has slipped out and is rubbing the sciatic nerve."

"Is that why you are walking U-shaped? I never saw anybody walk U-shaped before. Your walk is not from burn contractures is it?"

"No. Its from climbing too many ladders painting houses."

"I figured you were a painter--using paint thinner to burn yourself. You were drunk at the time. How many painters are alcoholics?"

"About 99% of 'em?"

"How come?"

"I don't know. Associations I guess. They drink, you drink. You drink, they drink. Climbing ladders with the wrong crowd."

"Drinkin' and slippin'. Bad combination for back problems. I can help you though. Need to get you on some medicines that will work. First I want to do an MRI on the back--see how much damage you've done"

(I figured correctly that there would be very little serious damage to his back. Bet two nurses two dimes that he would have no disk disease. They took one look at that walk and were suckered in. The way he walked told me there was nothing anatomically wrong with his back. People who are hurt don't walk that way. I got the MRI to build rapport so I could outline a treatment program that I knew would work--Lyrica, Effexor XR, high doses of Motrin, physical therapy, and--a medicine that most doctors would avoid given the patient's alcohol history--Valium. Valium was necessary to cut the muscle spasm. When you walk like a U, your muscles get tight. Valium loosens them up. Within 4-5 days, he was walking straight. There were a lot of nuances to his treatment that I won't discuss in detail, but it begins with talking the persons language, treating him with dignity, treating him like a regular guy, being a friend, asking questions that most people wouldn't ask, questions that a 5-year old would ask another 5-year old--"Did it hurt?” --discussing all the medicines with him and telling him how they are going to work, expecting him to get better, discussing the MRI with him in a way that he understands and doesn't feel criticized, trusting him with Valium, telling him to walk upright, congratulating him with each improvement, telling him I am proud of his progress, using humor and good cheer and just generally liking him.")

In less than a week, he was a changed man. Happy, hopeful. How long this good outcome will last is the great unknown, but if he does slip back into drinking or become depressed again, when he comes back to the hospital, he will make more positive advances and little by little he will learn to live a better live. I know in the long run he will do OK. I'm proud of him.