Sport 33: Spring 2005
A couple of days later in Nantes, in the Hôtel Dieu, a 915-bed university teaching hospital, the nerve was released from sites of severe entrapment on both sides of the pelvis. 'It's free in soft tissue in a more protected position,' said Professor Robert on his ward round the next morning.
He had performed 1,000 trans-gluteal surgical decompressions on patients, worldwide, since 1987. However, with 300,000 coronary artery bypasses carried out annually in the USA alone, PNE was hardly routine. Nevertheless, Robert reassuringly quipped, he could carry out the procedure blindfolded. Less reassuring was the state of the nerve: its long years of imprisonment and fattening, particularly on the left side. 'Until age seventy,' said Robert, 'the nerve is young.'
The nerve was young enough to recover. Suddenly the accident in Poland was assuming new meaning. Without the fall and exacerbation of the pain I might unwittingly have pressed on sitting indefinitely, writing, until the expert team was no longer available, or the nerve viable.
Was the injury a miraculum secundum naturam; could it be one of the rare occurrences under this heading; had an event of wind and sun brought me to Nantes where poet René Guy Cadou observed he had encountered enough 'subjective coincidences' to suggest he lived in the city of Orpheus, tamer of wild animals and writer of mystical books?
'I need to think of the pain as a positive force,' I said to John ten days into recovery, as we lent on a table, at bar height, sharing a sesame-coated panini and raspberry tart in the Nantes Monoprix café.page 28
In his Second Manifesto of Surrealism (1929), Breton had declared, 'Everything leads us to believe that there is a certain state of mind from which life and death, the real and the imaginary, past and future, the communicable and the incommunicable, height and depth, are no longer perceived as contradictory.'
The nerve, without the sedation of morphine or the restriction of scar tissue, irritated by handling, was registering pain at an intense Yellow Six, described on the Scale as 'comparable to a bad non-migraine headache combined with several bee stings, or a bad back'.
I was reminded of my poet cousin, Potocki de Montalk, and his belief in the mystical power of words. And Paracelsus who had urged doctors to take lessons from 'old wives, gypsies, sorcerers, wandering tribes', writing, 'Resolute Imagination can accomplish most things.'
'I need to believe that pain is a welcome or appropriate presence,' I continued. 'Like the wind after monotonous calm, or the visit of a previous but still meaningful friend; a burden, un fardeau, with a purpose.' The scrutiny of rationalisation and curing magic was turning full circle.
'You could convert to Catholicism,' John suggested. 'Follow the example of the Pope.'
'Or become a Buddhist—recognise that this is a physical pain, and know it is no more than a physical pain,' I said without assurance.
I walked cautiously from the café to the hospital for my final postoperative follow-up. My buttock muscles were in spasm. I felt as if I was walking through sand.
In the Service de Neurotraumatologie, a nurse, efficient in a white smock and tapered trousers, showed me to a treatment cubicle. My experience of the Hôtel Dieu had been positive. The anaesthetic had been effective; the pain of surgery contained by the intravenous administration of morphine commenced in the operating theatre as surgery still took place, and by the competence of nurses who did not speak English but were skilled in the slow arts of comfort and touch.
I lay face down as she swabbed the incisions, snipped the stitches at either end and noted a surface haematoma.
Professor Robert was called. He pressed either side of the wounds page 29and helped me to my feet. 'Good,' he said. 'Remember that the original pain could be worse for six months, perhaps more. This is normal: the nerve has been assaulted. You may increase your medications. Don't return to work for eight weeks. Don't ride a horse or a bike.'
'The muscle spasms?'
'During surgery the muscles were forced apart with retractors. The spasms will lessen. Nature provides.'
'The fattened left nerve—will it recover?'
'It's not possible to assess the success, or otherwise, of this operation until at least a year after surgery.' He shrugged. 'I perform a simple procedure, only God knows the outcome.'
We passed from the cubicle, to the corridor where his students clustered respectfully at a distance, to the office. His secretary collated a travel authorisation and Compte Rendu Opératoire in French and, because of the entrapment's obscurity, a letter of explanation in English. The letter advised that all branches of the nerve were affected and concluded that only time would determine the surgical outcome and ability to fully resume the activities of daily living and employment.
In a few days I would be on the other side of the world. I was seeking a lyrical moment, a prevailing wisdom; a conclusion worthy of the journey. A journey, I was to find, that would still be testing me a year later as pain became ingrained, the capability of codeine diminished, and sitting was not possible; as I investigated a five-day continuous epidural anaesthetic to block the pain pathways and eradicate old signals still firing, and Botox injections to relax the obdurator internus muscle near the troublesome nerve; as British scientists, testing pain sensitivity in mice in the search for biochemical pathways that will better combat pain, found that rodents with a yellow fur gene mutation require lower levels of pain medication, and heartened researchers at Stanford University, using magnetic imaging, visually affirmed pain in the brain as it occurred and hailed the potential of their new technology as 'the holy grail of pain research'.
Professor Robert said, demonstrating, 'Bend and lift your knees so the nerve slides back and forth.' He held out his hand for the letter.
'The Edict of Nantes,' I murmured, the pain limited by his presence.page 30
He clicked his pen. I asked, 'Can I sit?'
He nodded. 'You can sit—in accordance with pain.'
'How should I exercise—should I walk, can I swim?'
He spread the letter on the desk. 'Yes, but again, in accordance with pain.'
A bed was wheeled past the office, sides raised, drip stand attached, the tube running between the drip and a mechanised syringe barrel timing and dispensing relief from inside a plastic orange case.
Professor Robert paused as if in thought, or perhaps for dramatic effect. 'Pain is the leader,' he said, signing the page.