sirens

Two police cars just blasted past Chez Impolitic with their sirens and lights going. They were moving easily at 50 down this residential street. I imagine some of the cars coming to our old house did the same thing a year and a half ago. That said, here's a little update on where I am with all of that these days.

Sirens and loud sounds still make me jump, but they have ever since (at least) the shooting at Arkansas in 2000. I still have occasional flashbacks. Overall, though, I've accepted a different take on the whole thing—I am a hero, but I am not larger-than-life; I'm not the only person who has ever been shot, randomly or purposely; the experience was awful and is immutable at this point; and finally, it has simply become part of a remarkable set of growth experiences within the past few years.

I'm not saying that the case is closed—it isn't—but I am saying that am finally beginning to move beyond a certain level of solipsism.

a sad day

Today's ruling by the Supreme Court should not surprise me. The court has been pushed so far to the right, so far in the direction of "strict constructionism" that the results are likely to stay with us for generations. Still, even though it shouldn't surprise me, the pain in my shoulder reminds me every day of the effects of readily available guns on our society. I survived not because I had a gun to protect myself, but because I was lucky; others with guns to protect themselves have not been so lucky. The self-defense argument means nothing.

382

That's how many days I've been in one sort of pain or another. Not that anybody's counting. And not that it's getting old or anything...

Don't get shot, okay?

Trauma, a year later

There will be a quick recounting of the New York trip later on.

One year ago, I was sitting in a room at MCV under the alias Trauma Case Plum. My wound dressing and IV were being changed while nurses and med students were brought through to see the patient who had been shot while interrupting a robbery, the hero. The news had already hit the newspaper and television news. My father had come to the hospital to see me, and I was wheeled alternately into X-Ray rooms where they took pictures of my esophagus and into CT rooms where they determined that the bullet was large but hadn't damaged anything vital. I had what the CT tech called "The MIllion Dollar Wound." I hadn't even begun to process what had happened yet.

A year later, I am still struggling to process what happened. I am still trying to put my head and body back together. Though the simple act that brought this about seems small and far away now, the scars and ache and muddle I often feel in my head are constant reminders of how much worse it all could have been. They are also reminders of my work over the past year to make my life a better, kinder, more responsible place—despite occasional recidivism.

At the time, I joked that it was Colonel Mustard in the alley with the revolver, and that I got lucky. A year later, I realize none of this is a joke.

/navel gazing

brief thoughts on PTSD

One of my physical therapists has concluded that some of the issues with my back and shoulder are related to my mental recovery. After this week in therapy, I'm convinced that she is right. With more pain and more rough work to break through some of the locked up parts of my back, my head has gone into a more precarious place. Certainly there is a lot going on generally in my life, but the muddle in my head seems to come along with more pain and release in my back. What really brought this home was thinking back to last August when the trauma and anxiety decidedly returned, and the realization that their return seemed to coincide with more physical activity—and more physical pain.

With the anniversary of the shooting approaching, I look forward to some sort of breakthrough in all of this. I hope.

PTSD updates

The odd thing about the psychological after-effects of the shooting is that they seem to have very little to do with actual physical discomfort. They also rarely come with the shocking realization that I was shot or that I was one inch from death. Now, the impact is subtler.

It comes at moments as happened this weekend when I realized that I was taking my first real hike with Reilly since just before the shooting. Or over the past couple of weeks when I realized that the last creative project I did went to press the week before the shooting. What comes from these parallel realizations is the recognition of how stuck I have been in the past ten months.

And it's not even in big ways such as these. No. It's in small moments when I stall out, when I don't know what I'm supposed to do next or why. This is beyond flashbacks. It's deeper, subtler, and in some ways scarier.

There are also the moments--and these are often lately--that I find myself touching the entry and/or exit scars. The action is absent-minded, but it is a reflection of the fact that I never--for a single minute of any day--forget that I was shot. It never goes away, dammit.

dry needling

So, the details of dry needling are:

• The physical therapist identifies the points in my muscles that are causing the greatest tension and pain.
  
• She takes a needle very similar to an acupuncture needle and puts it into my muscle at the trigger point.
  
• I squeeze the pain ball and try not to move.
  
• She works out tension on related muscles while I discover the exact meaning of referred pain.
  
• Repeat seven or eight times depending on the treatment, then ice the affected areas.

There is a certain amount of masochism involved here. After the treatments, my muscles ache and my left hip—the spot that seems to have taken the most problems after the shoulder—is stiff and painful. Still, I have more motion, and it's easy to see how these treatments may actually break through the final stages of my pain. As a collateral benefit, it's also easy to see how I may end up in better shape than I was before the shooting, or at least in the position to get into better shape.

For the moment, however, I am apparently going to have to go through pain to get rid of pain. If only I didn't hate pain meds...

dry needle trigger point therapy

Let's just say I'm achy. More details to come later.

Pharma notes

My recent forays into prescription drugs for treatment of pain have included, most notably, a neuroblocker named Lyrica. It is a formulation of pregabalin, and related to neurontin (gabapentin). At first blush, beginning in early September, 75mg twice a day of the stuff seemed great; my pain went away, and in general I felt better. My sleep cycles settled, and the only side effect I noticed was a greater sensitivity to alcohol.

After a while, though, the pain began to return. The pain specialist kicked me up to 100mg twice a day, and that's when the fun really began. The side effects began to include:

• greatly heightened effects of alcohol
  
• confusion
  
• loss of memory
  
• inability to find words
  
• thinning hair
  
• dry skin
  
• loss of balance and coordination
  
• blurry vision

Strangely, it was the blurred vision I noticed first and most acutely. The rest of the symptoms I began to put together as I looked back at the intervening month. After a bit of research, I also discovered that these are common side effects. In response to my concern, the pain specialist decided to move me to Gabatril. After discovering that Gabatril has many of the same (potential) side effects, not to mention a host of others, I decided to pull myself off everything but Ibuprofen.

I have no regrets. The pain is within manageable limits. The experience has made me question the pharma industry even further, however, since so many patients are put in the position of responding to one foreign substance with another. In spite of everything, I'm lucky. I feel bad for the people who need stuff like this to function day-to-day.

Pain, the next step

A couple weeks ago, I had an appointment with the pain specialists. The initial diagnosis for the ongoing pain was that the bullet might have damaged the brachial plexus. To test this hypothesis, they prescribed an electromyograph exam(EMG) with a neurologist. Today, I had that exam.

In short, the EMG entails pain to diagnose the source of pain. The first part of the exam is to shock the nerves and record the responses. This means that the arm jumps when the electrodes are touched. Fun stuff. But not as fun as the needles. The second part of the exam involves putting needles into the muscles to test the biofeedback. This is not like having a needle in a vein; in this case, you can feel the needle going into the vein.

This test was conducted at various points along my arm, my hand, and my shoulder. The result, despite less sensitivity to pain along my right arm, was normal. While this is good--no apparent damage to a major thruway of nerves, it also means I don't have an answer yet about the pain I am experiencing.

And that pain isn't going away, even with medication.

notes on ptsd

I wrote this in a note to a friend, and thought it was worth posting out here, as well, for anyone who wants to read what it feels like:

...Unfortunately, I seem to be experiencing something far closer to what war vets experience [ed. or so I've read/heard]. Certainly, there are moments when [ed. seeing] young black men cause[s] a heart-pounding reaction, especially when I hear loud voices [too - ed. that's what really gets me, the memory of the voices.]. But I can't hear a balloon pop or a whip crack [or a truck backfire] without my head going into a really messy place. My heart skips. I want to drop to the ground. Beyond that, in daily functioning I pause and lose my concentration randomly. I see the gun again. I simply remember that I was shot. I think about the fact that an inch could have a made a difference between life and death. I hear the doctors saying, "This could easily have been fatal." It's not fear so much as a constantly paralyzing sense of [still] living in that moment.

My therapist and I did have a bit of a breakthrough about it last week; unfortunately, we concluded that it's also tied in with all the emotions from the roller coaster of the last few years. The unfortunate part is that this means I still have a much bigger ball of wax to deal with. Oy...

navel-gazing ends now

trauma, pt. 600

The physical pain comes and goes. Apparently, though I avoided any severe physical damage (euphemisms, ahoy!), I have suffered some nerve damage. The extent of it will be tested next week. In the meantime, I am on nerve meds again. They are helping, but they exacerbate the effects of alcohol, I've discovered.

More than that...

As much as the physical pain continues, the psychological pain seems to get worse. I go through random moments when I lose focus on where I am. There are the occasional flashbacks which come more regularly than they did a few months ago. There is a distinct lack of motivation, and it's more than just burnout from work. The issues have gotten to the point that I even randomly lose my focus in the midst of a conversation. Worst, I can't seem to let go of how close I was to dying.

Apparently, I healed so quickly on the outside that I forgot healing internally would take a lot longer.

the wound

I visited the pain specialists yesterday. Their suspicion is that the chronic pain I'm experiencing is from nerve damage. Fun stuff. This means lidocaine patches on the back for a little while, Lyrica, and an EMG on my arm to determine how much sensation I may have lost. It also means dealing with the hairline fracture in my T1.

Fun stuff.

flashbacks

In the last few days, I've started having recurrent flashbacks to the shooting. I see the scene again, and it is bad. Worse, however, is the fact that I've started envisioning what might have happened if the bullet had been a few inches up, over, or down. That's the chilling, unsettling vision, and I have very little control over it.

All I need to do is see the scar on my shoulder, or think very briefly about the fact that I was shot. (This happens more recently because the spot where they took the bullet out has been hurting a great deal.) Soon after, I envision the bullet hitting me in the head or the chest or the neck. And I shake. I lose my train of thought. I also lose motivation for the things I want or need to do. Not having Banana around exacerbates the feeling of directionlessness. This happened several times yesterday morning, until I simply decided to meet friends at the Carytown Watermelon Festival (more on that circle of hell later) and began what turned out to be an afternoon and evening of drinking and socialization. Read: avoidance.

I've begun to wonder if this is the beginning of PTSD.

GSW victim

Just some further thoughts on the topic of getting shot...

1. I was extraordinarily lucky. Every time I look in the mirror and see the scar at the crux of my neck and shoulder, I realize how lucky I was. Any minor deviation in the act of shooting the gun or in the trajectory through the railing and I would be dead--or at the very least, badly maimed. In so many ways, I shouldn't be here now, but I am.

2. There may be nothing stranger in my 36 years so far than saying the words "When I was shot." Every time any variation of this comes out of my mouth, I stop for a brief moment. There is nothing right about saying it. And nothing I can do but marvel at the strangeness of the words.

3. I prevented a robbery from taking place. Perhaps something much worse. I don't know why I have to remind myself of this, but it's not the easiest thing to process.

4. It still hurts. Physically and mentally.

5. On my earlier post, I was vague about how much deeper the bullet was than expected. My attending surgeon expected it to be close to the surface--not more than a quarter of an inch. Instead, it was more than an inch under the skin and had cosseted itself just on the edge of the deltoid, kindly avoiding the ribs, clavicle, lung and other vitals. I was lucky.

So ends this moment of navel-gazing. Thanks for tuning in.

"This could easily have been fatal."

That's what my attending physician said today after he took the sutures out. Apparently, the bullet was deeper than expected, and closer to "real" damage than shown on the scans. He was also kind to add the comment that it was a big bullet, and that it was mostly intact.

Again, I must say: I got lucky.

post-surgery

The actual surgery took 15 minutes, the pre- and post-op time two hours each. I spent the rest of the day and evening feeling woozy and a little lost from all the sedatives and morphine they had pumped in my system. The next day I woke up for a bit, and then realized that being up and moving around was not what I needed to do. By the afternoon, though, I found a few bursts of energy to organize things around the house. Meanwhile, my mother was tackling the kitchen. Later that evening, the pain crept in again. The next morning I was feeling good enough to do a little more around the house. After we took the bandage off, however, there was a whole new set of sensations. Taking a shower was phenomenal, but having shirts rubbing against the sutures hurt. By this morning, then, I moved off the percocet altogether.

The remarkable part is that my body already feels better. I feel looser without having the bullet back there. And stronger. This is good.

In other news, Tyrone Singleton has been released from custody. The detectives claim to have other leads, and they now have the bullet to use for forensic evidence. I want to move on from this, but I also want the fucker to be caught.

removal

In nine hours, I will be at the hospital. They will be prepping me for the removal of the "foreign object." I will not get to keep the "foreign object." It will be taken for forensic purposes. If they convict Tyrone Singleton or someone else for the crime, I may get it then. Who knows...

The whole "foreign object" thing is really amusing to me. Why do we have to be so euphemistic with language? (And I don't just mean in this instance.) Why not just describe what the object is? Does it remove the reality so that the physician does not have to consider the circumstances as s/he performs the procedure? So that it is all just a procedure?

I ponder this partly because the process has been so fascinating. At no point in this process, from the shooting to the doctors' follow-ups, have I had any control. I have been told when my appointments will be--even if they don't jive with my life--and when my appointments will not be. I understand that the trauma circuit is a difficult gig, but that doesn't really seem like an excuse for treating patients like commodities with no restrictions of their own, as though we do not have to worry about our own schedules. It's patently absurd. I have to compromise my work timelines with my clients' schedules. Why should physicians be able to to insist that everyone work around their schedules?

Then again, I have only met my attending physician once--the night I was shot. I've seen other doctors and residents since, but not met the man who is supposedly responsible for me since that night. It's as if I am no more a person than the alias I was given for my stay in the hospital--Mr. Plum is a phantasm, not a real person with real worries, and therefore can be manipulated like a marionette.

Not quite... At least I got them to move the surgery reporting time from 5:30 to 8:45.

the shooting, an update

I am healing well. The pain meds are gone altogether, except for the occasional ibuprofen. Tonight, however, is a little more uncomfortable. Maybe I shouldn't have given Banana the piggyback ride all the way to Plan 9. I guess I fool myself about how much better I'm feeling.

***************

Here's the rest of the story, such as it is right now...

Tyrone Singleton is still in custody, though they have not brought him to trial yet. According to the Commonwealth's Attorney, this is because they still do not have anything tying him directly to the crime. What is particularly galling about this is that the detectives seem to regard it as a done-deal.

In their pursuit of the case, the detectives do not seem to have worked to find the car that was witnessed leaving the scene. I guess this because none of the other prosecutors or other police officers I have spoken to realize that I and my neighbors said we could also identify the car. They also waited six weeks to talk to Phil, who was on the porch with me that night. Granted, he wasn't sure he got a good enough look in the first place, but by the time they actually called him, his recollection was too crowded.

On the subject of ID-ing the suspect, my neighbor and I identified the same suspect. the picture was not, however, the suspect the police really expected. Nonetheless, one of the lessons here is that real life is not like Law & Order. Not at all. If it were, we would have identified Singleton--or whomever--in a real-life line-up, rather than a photographic line-up. And what amazes me about the process at this point is that we haven't even been given this option. I can see the scene clearly in my mind still, and I think I could be confident in my testimony and identification if I were actually able to see the shooter's eyes.

The police from the local precinct worry about the case going cold. I do, too, but I also think it will go cold--if it does--because of lax attention. None of this, of course, helps with my psychological recovery.

My shoulder hurts

This isn't too surprising, I know. There's a bullet in there, and a hole that's still healing up. Even so, it's rainy here this morning and I feel like I should be saying something like, "Eh, there's rain in the air. I can feel it in me bullet." Ah well... The pain and discomfort change as time goes by. The medication the doctor gave me--Neurontin--has helped with some of the worst discomfort. That doesn't change the fact that it's downright weird to feel that the lump on my back has gotten more pronounced as the bullet works its way out.

All together now: "Ewwwwwww."