depress |diˈpres| verb [ with obj. ]
(1) make (someone) feel utterly dispirited or dejected: that first day at school depressed me.
(2) reduce the level or strength of activity in (something, esp. an economic or biological system): fear of inflation in America depressed bond markets | alcohol depresses the nervous system.
(3) push or pull (something) down into a lower position: depress the lever.

Depress is a strange word. The language conventions which dictate a plurality of the English vocabulary would seem to indicate that it signifies the reverse of press. As in ‘decompress,’ or ‘devalue,’ or ‘detach.’ But it doesn’t. It means, as denoted [sic] above, to press down, to suppress activity, to reduce strength. That’s what this last week has done to me. It has, as the example phrase in the first part of the definition states, depressed me. Pulled me down. Sapped my strength. Defanged my resolve.

This is not to say that good things haven’t happened. My new career pursuit is taking off; in fact, I’m already doing a bit of contract work through one of the university research facilities. It’s the first promising sign that I will be capable of gainful employment, and some modicum of financial stability, no matter which way the pendulum swings with regards to my physical capabilities. And as I said not too long ago, I have been in dire need of some good news.

My pain level and nausea, however, have ramped up considerably. This is interfering with my sleep, with predictable results. I’m on a new anti-depressant, and just in time; the fact that I’m having trouble keeping my head above water despite it is troubling in and of itself. It would be easy to blame the low mood on the pain, nausea, and loss of sleep, and leave it at that. But it’s this past week’s session with my physical therapist, and the realizations that came with it, that are the more likely culprits.

As I’ve mentioned in a couple of other posts, my left shoulder, undoubtedly a bit miffed at having to do the job of two shoulders after a relatively cushy existence the first forty-odd years of my life on the non-dominant side of my body, is now a card-carrying member of the the causing-Ape-pain club. It’s now also being treated to the same ministrations previously reserved for the injured one; cortisone injections and an evaluation by my physical therapist.

The news is not good. The cortisone injection did not help. I have the same maladaptive muscle development around the left scapula as I do in the right one; atrophy in the muscles that adduct it to the spine, and improper recruitment of the levator muscles to compensate. This is why I have a knot of pain at the upper inside corner of my left scapula; the levators just weren’t designed for this sort of work, and they remain in a perpetual state of injury because of it. The only way to make the pain go away is physical therapy and pain management. And just like on the other side, improvement will be measured in months, not weeks.

I’m already on as much pain medication – more, in fact – as I care to be, so the idea that the additional pain I’m enjoying courtesy of the left shoulder is going to be around for a while is pretty upsetting. I waited for the tears to well up, but they seemed far away, as though locked in an otherwise neglected closet. At the time, I interpreted this to be a sign of finally coming to terms with the fact that my body has a mind of its own. But the more I think about it, the more I realize that may not be what’s actually going on.

Until I got the most recent cortisone injection in my left shoulder, I didn’t realize how much my pain tolerance had increased. Yes, I’d gotten a shot in the right one the month before, but attributed barely feeling it to an aftereffect of the nerve ablation. But I didn’t get a nerve ablation in my left shoulder. I was expecting some discomfort. There was a needle stick, and the usual pressure. But it didn’t hurt. It wasn’t even all that unpleasant. My brain intercepted it more as a curiosity than anything else. Oh look, another cortisone injection. Oh, that reminds me, I forgot to pick up cotton balls at the drug store yesterday.

“I wish I could give these to women all day,” the orthopedist commented.

“Guys are babies, huh?” I replied. I was getting lidocaine. It numbs the whole area, which puts me in a good mood. I’m all about the cheerful banter when I get a shot of lidocaine.

“I’ve had a couple pass out on me.” he said. “Women are a lot tougher than men.” I laughed, but he continued, “No, seriously. Especially that one under the shoulder blade; those really hurt.”

Um, no it doesn’t, I thought. But I didn’t say so. I was too busy wondering why it hadn’t hurt. Maybe he gave it in the wrong place? But why would the wrong place hurt less than the right one? It was still a big pile of medication being squeezed in between tissues not designed to accommodate such things.

The train ride home, I couldn’t stop thinking about it. What has happened to me? And then, wait – how much pain am I really in? How am I supposed to know any more?  My left shoulder has been bothering me enough to keep me awake nights. On bad days, I’m currently classifying it as a 7. But what is my new 7? Is that my old 9, or even 10? I honestly have no idea. I also have no idea how much it would hurt without all of the NSAIDs and opiods I’m on already.

Not that they’re doing much. Pain medication was not designed to work on chronic pain. Normally, it’s prescribed due to some particular traumatic injury, like breaking an arm, or having your wisdom teeth out. There is an initial insult, and then your body or a surgeon starts goes in and fixes it and the pain gradually subsides.

In a chronic pain situation, though, there is no healing phase. The injury is continuous, like a muscle pressing on a nerve, or an edge of a scapula pushing into a bursa. Pain medication just isn’t equipped to mask that sort that of thing, where fresh injury messages keep getting sent, over and over and over.

Be that as it may, this all means that my left shoulder might have rendered me bedridden if the right shoulder hadn’t stomped in first and done away with my old pain scale and gotten me shored up on all this medication. So I suppose it’s a good thing that I’m still able to function, thanks to that injury to the right shoulder, in a perverse sort of way. More troubling, though, is that it also means that my pain, however much does or doesn’t register any more, is no longer localized to my right shoulder; other parts of my body are also starting to break down.

This realization would have laid me out a few weeks ago. And my experience at the physical therapist suggests that it’s not that I don’t feel pain as much any more. It’s that I’ve simply built up some distance between my emotional reaction to it and my normal state of awareness. That emotional reaction is still going on, somewhere; it’s just locked up in some closet or another, just like my grief over what’s happened to me, just like my chagrin at the knowledge that more pain is going to happen and I haven’t yet found that elusive steady state I thought I had.

Is it the anti-depressant keeping these feelings at arm’s length? Possibly, although I haven’t been on it that long. But real or artificial, the emotional distance is still there and appears to be the latest questionable coping mechanism I’ve employed to deal with the emotional freight accompanying me along this journey.

The idea that said freight is swollen and bruised in some dark corner of my mind that I have limited access to is not exactly comforting. I worry that it’s unhealthy; that I’ve got some psychological pressure cooker inside me, and that if I don’t figure out how to release that pressure from time to time, the lid will eventually blow and that will be a very bad scene.

But even as I realize the untenability of the situation, I’m loathe to dismantle it. I do not want to start opening closet doors to see what’s in them, especially if the contents are under pressure. My distance from the pain this first week of sitting in class has caused me is one of the only things keeping me from giving up entirely, from deciding that my mind is not capable of triumph over the matter of my pain, and that I’ve once again set myself on a course that will prove to be unsustainable.

I’m praying that I just get used to the new pain, and that I’ll eventually be able to bring some less powerful emotional responses to pain a little closer to the surface. Which isn’t the arrangement I have now. I’ve peered through a couple of doorjambs, and I can see the bright, sharp feelings crammed in behind them, saturated with potency all the way through to their hard edges. If I let even one of those out, it will slice me to bits, and I just don’t have the time or energy for that at the moment.

I can’t afford to be pulled down, not now, not just when things are finally starting to turn around. I still may not know what the right way is to handle what’s have happened to me. But shutting things up in closets is the best option among a paltry and unappealing selection of them, and if I’m ever going to be independent, financially if not physically, then this is what I have to do.

So for now, I have to depress my feelings, so they don’t depress me, or reduce my strength. I need it. All of it.