Pain

“My headache is a ten out of ten, Dr. Gillis. And I usually have a high pain tolerance.”

The patient plopped onto the exam table relatively easily as he said this, even though just a few moments ago he insisted he was in so much pain that he had to be transported to his room in a wheelchair.

Dr. Anne Gillis tapped her pen on the patient’s chart. The name on top said: Joe Sims. She was thankful for the mask covering her facial expression. “Okay, Mr. Sims, and it says here you’re also allergic to all anti-inflammatories?”

“Yes, I can’t take any of them.”

Anne could guess what was coming next:

“The only thing that works is this one medicine they gave me years ago… I think it starts with an N. Noro? Noco?”

“Norco.”

“Yes, that’s it.”

Now, Anne was a relatively young doctor, but this wasn’t her first rodeo. At the same time, she really did try to give every patient the benefit of the doubt. Some patients just made it very hard.

“The good news is that your MRI came back normal, Mr. Sims. That tells me this headache is most likely not a tumor or a bleed. This might be an atypical migraine, or even a cluster headache. You can still take Tylenol for this, and I can prescribe you a triptan, a medication class that can be very effective for these types of headaches.”

“I’ve tried those, they don’t work.”

Anne tried to keep her voice even, light. She’s always been told she had a calming bedside manner. “The next step is for you to see a neurologist.”

“I’ve already seen neurologists. Why can’t I just have what I already know will work for me?”

Anne softened her voice. “It has a risk for addiction, Mr. Sims, and it’s not something I would recommend in this situation. Rather, let’s find the cause of your pain and try to focus of that.”

The patient’s demeanor morphed into something ugly. “Have you ever been in pain, Dr. Gillis?”

“I--”

“I also don’t appreciate you talking to me like I’m a child.” Joe stood up from the table and walked across the exam room to the stool where Anne was sitting. At six foot two he towered over her, his expression eerily blank.

“Mr. Sims, I’m sorry you feel this way, but I believe we are done here.” Anne stood up and positioned herself close to the door, keeping her eyes on the patient. Thank God Joe didn’t think to block her exit. She thought back to de-escalation techniques she was taught in medical school and thought about employing them, but at this point she just really wanted to get out of there.

She could feel it in the room, the change of energy, the electric feeling of something about to happen.

Something bad.

Joe’s blank look suddenly reverted to something human again. Now it looked pleading, desperate. “I’m not making this up, Doctor, there is something in my head. It feels like it’s trying to claw its way out. I just need something to help me sleep, just to dull the clawing. Please.”

“I’m sorry, Joe.” Anne reached for the door.

“I’m sorry, too.” Joe whispered.

The last thing Anne could remember was everything going blank.

—

“Anne?”

Anne struggled to open her eyes, the light in the room was too bright. Her head felt like it was about to burst open.

“Turn the lights off.” Anne snapped irritatingly. A car horn blaring from the parking lot amplified the pounding in her head.

Not pounding, exactly. More like... clawing.

Like something trying to claw itself out.

Anne sat up suddenly. “Oh my god, wait. Mr. Sims.” She looked around frantically, her eyes finally resting on her bedside visitor.

“Hi, Anne.” The woman said, a placating smile on her face. She was striking, with dark skin, high cheekbones, and brown-black hair that shone copper against her white coat.

She radiated a calming but intimidating quality. Like she was in charge here, and she was being magnanimous in allowing Anne an audience.

“I’m Dr. Leigh.” The woman paused. “You can call me Theresa. I understand you’re a physician yourself?”

For some reason Anne found it hard to remember the answer. The pounding in her head was too loud. “Uh, yes.” Anne finally managed to respond. “Sorry, yes, internal medicine. What... happened?”

Theresa had a slightly amused look on her face. “You were found unconscious in your office.”

Anne ran her hands through her hair, expecting to feel a goose egg, or maybe staples in her scalp, but felt nothing. That couldn’t be right. If Joe hit her hard enough that she lost consciousness, there should be some kind of break in the skin or at least some swelling.

Her head did hurt something fierce, though, like it was being hit repeatedly with a baseball bat. She looked at Theresa imploringly. “I was struck? By that patient, Joe. I’m being admitted for observation, then? You must be the hospitalist. I’m assuming my head CT is clear? Was the police called? This guy, he’s dangerous, I mean, look at me, he must have--”

“Anne.” There was something about how Theresa said her name. Like it was a delicate thing, easy to break.

Anne didn’t like it. It made her feel like a child, being distracted by a lollipop before her shots.

“You’ve told the nurses in the ER a patient named Joe Sims hurt you?” Theresa asked neutrally.

“I have? I don’t remember that.” Damn, she must have some amnesia from the traumatic brain injury too. “But yes, I mean, the last thing I remember was him threatening me in my office.”

“Okay. The problem is, the police looked at your files, and there’s never been a patient named Joe Sims in your system.” Theresa said gently. “You’ve also not been in your office all week. According to your own office records, you’ve taken the week off. Your nurse found you this morning.”

The room felt small all of a sudden. Anne found herself breathing more rapidly. “But… that’s impossible, he must have registered under a different name, or altered the files somehow… And of course I was seeing patients, I was looking right at his chart--” Anne’s eyes suddenly focused on the embroidery on the woman's white coat: Theresa Leigh, MD, Psychiatry.

Wait. That can’t be right.

“Why... are you seeing me, Theresa?” Anne asked slowly.

Theresa gave a small sigh and stood up. “I’ve been asked to consult on your case. Apparently there’s been some… concerns.”

“But.. why?” Anne fought to keep her voice even. The pounding in her head was getting worse. Her own voice sounded too loud, as if the sound itself was physically scraping, etching words into her brain, like nails on a chalkboard. She winced. “Ow.”

Like clawing.

Something clawing itself out.

“Are you in pain, Anne? I can get the nurse to get you some pain medicine.”

“No, wait--”

“I’ll come back when you’re more… comfortable.”

Sedated, more like. Anne thought. But before she could protest Theresa was out of the room. A moment later, a young nurse with large brown eyes not unlike a baby deer took her place.

The Bambi-eyed nurse was smiling. “Hi, Dr. Gillis, I’m Lisa, your nurse for the night." She said her sentences liltingly, like a nursery rhyme. It grated on Anne's nerves. "What is your pain level? On a scale of one to ten, ten being the worst--”

“It’s a ten.” Anne answered before the nurse could finish. Anne grinned rather maniacally as she said this, as if Lisa was privy to her inside joke. The nurse’s smile faltered with something that looked like fear. Anne felt like she was on the verge of either laughing or crying.

She stared the young nurse down.

“My pain, Lisa, is ten out of ten.”