Pain Isn’t Cheap

The unmeasured costs

That’s something that the pastor don’t preach
That’s something that a teacher can’t teach
When we die, the money, we can’t keep
But we’ll probably spend it all ’cause the pain ain’t cheap
Preach

— Kanye West

Tears are the surest way of knowing someone cares.

Most crying comes from a point of pain. Children, when born in a world different from what they were used to while inside the womb, have to adapt to the changed environment. Adaptation can be painful.

It isn’t cheap. The mother now has to make new products, promptly and on the ready, triggered by the crying or scent of the baby. Milk is the cost of a child crying. Often. But not every time a baby cries does it want milk.

Taking milk worsens a gassy stomach. This comes at a cost to the parents, not just the mother. A gassy stomach is uncomfortable and can be painful to the neonate, so it cries. In turn, some mothers cry, not knowing how to pacify their baby. They care.

The pain comes with a cost.

Pain is not only seen in the human world. Elephants grieve the loss of their calves. They can travel across countries, and the herd can take its time to revisit the point of death of one of their own.

Back in the human world, the place where the most painful transactions happen is at the most dreaded department in the hospital — the critical care unit.

In the ICU

My first meeting in Rotary had me introduce myself as a medical student. But I have never wanted people to know I’m a doctor. They box you in a category where they either feel they need to respect the title or have to match your implied wit.

So I got creative. Rather than tell people I work as a critical care doctor, I say that I’m a pain investor or that I transact in pain. The first line in Rotary, Is it the Truth, applies, because I do transact in pain.

And it’s costly.

The most expensive unit in the hospital is the ICU. In our country, before admission to any part of the hospital, you have to pay for the bed. The most expensive bed is in the ICU.

Most of the patients in this unit will hardly talk to you. The family will be the primary contact. You will see the pain, concern, and worry on their faces. You will hear it in their voices. You will experience it when they wail in anguish after one of them passes on.

Pain is costly.

The dicey moment comes when one has to grapple with the care of their patient, their loved one, and the rising costs. At such points, consultants consider the quality of life.

One of the senior consultants recently told me that he would never want to be intubated. He’s in his 80s, but walks fluidly with a youthful spring in his step. He doesn’t want that kind of life where his brain is soaked in sedatives, his lungs are supported by a ventilator, and his muscles are subjected to daily physiotherapy. It would be painful for his kids to accept and honour his stance. The cost of such a decision cannot be calculated.

Brain damage, for whatever reason, can be significant to the point of no return. In such cases, breathing could be unsustainable without the ventilator. Blood pressure could be supported by pressors. Still, the patient cannot return to their prior mental state. The cost of coming to terms with such a reality can be too much to bear.

Any form of pain can be costly. The ICU is simply an extreme means to prove this point. Something as simple as a thorn prick to the foot can evolve into an excruciating cellulitis. The costs of controlling the prick could be cheaper because the pain isn’t significant. Cellulitis, however, can be a nightmare.

---

I wrote this piece outside the train station. I got there a few minutes late. I missed it. The pain was not too much at the time, but it was costly. Among us was a group who had requested to see the manager, because the reasons for missing the train were outside our control.

Typically, the manager can’t do much if the train has already left, so goes the story. That’s the excuse they always flaunt. Passengers are ready and willing to offer technical’ solutions, but the technical team is reluctant to consider them.

It is somewhat similar, but at the same time, different from critical care patients. There is little that can be done. What is offered is supportive care, but besides that, there are situations where the train has already left, and one has to move on.

Pain isn’t cheap. The trauma can be too much.

On two occasions, a family brought their children for assistance. On both occasions, the children passed away. The first one was heart-wrenching, as the father told me. He felt encouraged that their then-current child was doing better. He got discharged. A few weeks later, he was readmitted. This time around, he didn’t make it. Same hospital, two different deaths.

I often wonder how parents handle such moments. I contemplate the situation of Marcus Aurelius, the most powerful man on earth at the time, but still couldn’t do much to prevent the death of several of his children.

Pain can’t be enumerated. Pain isn’t cheap.

For the patient, the body fades away. For the family, they fall apart.

When the heart breaks

’Cause when a heart breaks, no, it don’t break even

— The Script

Heartbreaks are not amenable to recompense with money. The manager could have made several calls and seen how to sit all of us on the next train schedule, but you cannot replace a broken heart.

This pain does not show in the brain the way a nail through the hand does. It is heavy. A lump forms in your throat. It persists. You have to continue with your daily routine as if nothing had happened.

You may encounter those who belittle it. You can’t do much to fight such people. They will only drain you, worsening the invisible yet palpable pain already coursing through your body.

Heartbreaks are so painful that there is a syndrome recorded for it — the Tokatsubo Syndrome. It is usually a diagnosis of exclusion. That is, only after other causes have been eliminated does a physician consider it a cause of disease.

Social media can dig deep into this wound and squeeze the blood out of it. You could see him or her having the time of their life with another partner, while you wallow in sadness. As The Script sings:

Her best days will be some of my worst.

How painful does a heartbreak have to be for a condition to be named after it?

I know of families where the child was reported to have passed on, and when the father or mother heard the news, they fell on the floor and died. Sometimes the pain is so much that it costs another life.

Pain isn’t cheap.

---

Just when I was about to edit this post, I got the news that my cousin had passed away. My close cousin. And here I am…

…still alive, but I’m barely breathing
Just praying to a God that I don’t believe in

We were agemates. Her father always pitted me against her. Regardless, we hardly paid it any mind.

She was just as tall, went to one of the most coveted girls' high schools, and had a resume to match. Even though we would not talk for months, whenever we reunited, it barely showed.

I recall when she graduated with her masters. For reasons I will never know, only a few people got the invitation. Her nuclear family had flown to show support. This was after I guided her to the local library, discussed regularly how she was handling her project, and occasionally chatted online when she celebrated how the university strikes never halted her education.

Still in her graduation gown, and before travelling back home, she reached out to me. They were not that far away. I promptly changed into presentable clothing, somewhat, and was there a few minutes before the announcement for the passengers to board.

I was glad I didn’t miss seeing her in her gown. What I took from that moment was that she appreciated I showed up, despite the day’s arrangements, which she confessed were outside her control.

That’s how I remember her — always fighting, more aloof than in a crowd, and stacking one achievement after another.

Recently, family tussles got my relatives arguing. She was one of them. The other was another cousin whom I endear just as much. I was heartbroken by the exchange.

It got me asking: how do you act when everyone you love is on the edge, bitter with each other?

Deeply saddened, I chose not to engage.

Then the other day, with my friends, I broke down. I couldn’t hold my tears.

As a critical care doctor, you know of certain inevitable outcomes. This was one of them.

Years back, when she told me about her condition, I couldn’t believe it. But she still stood there, at the door of my cousin’s kitchen, bravely smiling, knowing she had a fighting chance. She always had that tenacity about her.

Over the years, projecting the possible outcomes, the painful ones, I had to send her a letter.

In retrospect, I have never seen her reveal her softer side. When she received it, she showed it, a tiny bit. And now, she’s left the group. And she’s left me with questions. And she’s left us with uneven hearts. And I’m falling to pieces.

When a heart breaks, it doesn’t break evenly.

Pain isn’t cheap.

What I’m trying to say is…

Pain is like a grasshopper stored inside a matchbox. Everyone has such a matchbox, and only you can see the grasshopper. No other person.

The cost of pain, therefore, can hardly be measured. You can only see someone’s matchbox, but not the grasshopper. You can acknowledge one’s pain, but not know how much it costs.

The matchbox is all you need to know about the endurance and resolve someone goes through to make that pivotal step on that particular day, to move on with the burden, hoping it gets lighter in the next step.

You don’t need to see the grasshopper to appreciate that pain isn’t cheap.

---

This song inspired some of the lines used in this article. Source — YouTube