regard me stony faced.
“You don’t trust shrinks,” I continued briskly. “You’re not even sure you like me. And yet, of all the interventions you could’ve done for your pain today, the only one you managed was to show up at my door. Surely that must mean something to you.”
She offered a small nod of acknowledgment.
“All right, let’s build on that. Have you done your physical therapy exercises today?”
“Not yet.”
“I’m assuming at this stage of the healing process, you’re limited to pendulums?”
“You know a lot about injuries and physical therapy.”
“Yes, I do. Now I’d like to see yours. Fifteen pendulum swings. Please begin.”
D.D.’s face paled. Her chin trembled; then she seemed to catch the motion, setting her jaw. “No . . . thank you.”
“Yes, please.”
“Look, my pain is already at a twelve. You make me do PT, and that’s it. I won’t be able to drive home, not to mention I’ll probably puke all over your rug.”
“I understand. Physical therapy is extremely painful for you. You start it in distress and end it in agony.”
“Says the woman who can’t even feel pain.”
“True. I could break my arm and still do pendulums. In fact, I could break my arm and do back handsprings. I’d be destroying the rest of my bones, joints and muscles in my body, but I’d look really good doing them.”
The detective fell silent.
“Pain is good,” I stated quietly. “It’s your body’s primary technique for protecting you from harm. You can’t see that right now. You’re angry with your pain. You yell at it or try to ignore it altogether. In return, your pain growls louder because it needs your attention. It’s doing what it’s supposed to do to help you avoid further damage. Perhaps rather than curse at Melvin for speaking up, you could thank him for his efforts on your behalf. Tell him you understand what he’s trying to do, but, for the next ten, fifteen or twenty minutes, you need him to understand that you must move your arm and shoulder. Even if it inflames your injury in the short term, your exercises are necessary for long-term recovery. Talk to him. Don’t just curse.”
“Now, see, this is where it starts to sound like bullshit again.”
“Consider this: Ten years ago there was a study of major athletes and their pain thresholds. These were individuals who consistently performed at nearly inhuman levels of physical ability and had the training regimens that went with it. Now, the primary assumption of this study was that such athletes most likely had higher thresholds of pain than mere mortals—hence their ability to push their bodies to such extremes. Much to the surprise of the researchers, however, the opposite turned out to be true. In fact, most of the athletes reported significantly higher awareness of their pain, while showing more active central nervous systems than the control group. According to the athletes themselves, they felt their acute body-pain awareness actually helped them function at the levels they did. Success wasn’t being unaware of physical limitations or injuries but acknowledging the constraints, then working with their own body to push through. Not mind over matter, per se, but a mind-body connection that enabled them to register, adjust and improve upon their functioning at all times. Does that make sense?”
D.D., frowning: “I guess.”
“That’s what I’m advocating here: Don’t ignore your pain. Register, accept, then work with your own body to push through. Naming your pain . . . It’s simply a device to help you identify and focus. If calling your pain Melvin makes you feel stupid, don’t do it. Refer to it as Pain or don’t call it anything at all. But acknowledge your pain threshold. Consider how your injury feels. Then work with your body to do what you need to do. Which, I believe, is fifteen pendulum swings.” I gestured to the open space in front of my desk. “Please. Be my guest.”
D.D. thinned her lips again. For a moment, I thought she might refuse. She hadn’t been exaggerating before. I’d seen patients end PT sessions vomiting from the intensity. It wasn’t just a matter of forcing a broken arm to try to move, but given the accompanying inflammation of the nerves surrounding it . . . An avulsion fracture was one of the most painful kinds of injuries there was. Or so I’d been told.
Now Detective Warren slowly moved to the edge of her chair. She bent at the waist and allowed her left arm to hang straight down, like an