RICE, or PEACE and LOVE

Em Haas

My mom came home late. She came home with my aunt and my dad, and they all walked in together, my aunt hovering close by and my dad keeping my mom upright as she wobbled to the couch and fought to keep her eyes open. Most of the lights were oit now because the scar is still there: four jagged, lightened pieces of skin she hates.

I might have run to her, my little legs carrying me as fast as I could across the carpet to a mom I barely recognized. I might have walked because of how scary it was to see her that way. I don’t really remember anymore. But I clearly remember my mom, her head tipped back on our old, moss-green couch, her arm in a sling, her hair tied back in a lazy ponytail. I could see her eyes then, too, and she had kept them open just to look at me.

When you Google, ‘what to do for wrist pain,’ the first thing that comes up is an article from Penn Medicine. It says to rest the wrist, apply an ice pack, take ibuprofen and-or tylenol, and suggests talking to a doctor about wearing a brace. Usually, this is shortened with the acronym RICE, or rest, ice, compression, and elevation, but recently PEACE and LOVE have become suggested abbreviations. PEACE stands for protection, elevation, avoidance of anti-inflammatories, compression, and education on the doctor’s end. LOVE comes after PEACE, standing for loading – or building tolerance – optimism, vascularisation, and exercise. Doing these things, along with time and patience, should better the condition of a patient with a soft tissue injury, but after four years of PEACE, I have yet to feel LOVE.

“So, what brings you in today?”

“My wrist has been hurting a lot,” I oversimplify. I can’t do schoolwork the way that it’s assigned because it starts to hurt so bad that I can’t finish it. I can’t do part of my job without a flare up. I don’t know what to do anymore. This is the truthful answer, but I tend to cry at the doctor — the notes from one of my recent appointments describes me as interactive and appropriate, but tearful — and I didn’t want to cry in front of him. I wanted answers, and I wanted to feel better, and the answer I was too shy to give him was this: There is never a day without pain. Sometimes, when I bend my wrist, there’s such a sharp pain that comes so quickly I gasp out loud and have to hold onto it, like it might feel better if I do that. There are days when the pain is so bad and lasts so long I have to skip class to lie in bed and ice it, even though I know it won’t do anything. There is, to my knowledge, no way to make it stop.

“Okay.” He sits on his rolling chair, then pushes himself in front of me. “Where does it hurt?”

“My ulna,” I tell him. Four months before, in my high school biology class, we had had to memorize over sixty bones in the human body. When we had learned about the bones in the wrist, I’d committed the ones that had been hurting me the most to memory. “But also here, in the carpals.”

“So, everywhere,” the doctor summarizes. That makes me smile. “Yeah, basically.”

He makes sure I can twist and bend my wrists and asks if there’s any pain. I say no, so he moves on to taking my hands in his and pressing. That doesn’t hurt, either. He makes me squeeze both of his pointer and middle fingers as tight as I can. But he’s asking the wrong questions and looking in the wrong places. When he starts feeling the rest of my arm, I want to stop him and say, What are you doing? I told you my wrist is hurting. Look closer. Listen to me. But his face lights up and it’s too late to say any of that.

“Your muscles are really tense,” he explains, “and you really don’t have any grip strength. So I’m going to send you to physical therapy so you can work on building your strength up again, okay?”

He tells me to stop wearing a brace, because wearing one will only make me weaker, and he tells me that what I have is adolescent and will go away by the time I turn twenty-five.

The worst part about that visit, in hindsight, was that I believed him. But I had finally been given an answer, so I held it tight and didn’t let it go.

I look at the records from this doctor’s appointment two years later, at my desk in college. It’s a thick stack of papers, five copies of the same thing shoved into a white manilla envelope. I remember the answer I was given, but I see them with more experienced eyes now. Patient reports, ‘It’s going alright and feeling OK.’ ‘Patient rates the pain at a 9 out of 10.’ ‘Functional limitations: lifting, reaching, and activities of daily living.’

I cry every single time I look at those papers, because what seventeen year old can’t lift their backpack without their wrist hurting? What seventeen year old can’t hold a book in their hand for longer than a few minutes without having to set it down? What seventeen year old was never given the results they were promised?

My mom calls me the morning of my doctor’s appointment. I’m home alone, save for my dog, who trails at my heels up until I go still to answer her. “Hi.”

“Hi,” she says. “I want you to listen to me.”

Her tone is gentle, but I want you to listen to me is never said happily. I swallow and nod. “Okay.”

I hear her shift in her desk chair. “I want you to be... you today, but I also want you to be a little bit more...”

“Assertive,” I finish for her. “Bold.”

“Exactly. This has been bothering you for years. You need to tell them about it.” She pauses. “You need to tell them how much you’re hurting, Em. Because you’re hurting a lot.”

For a second, I hardly know how to respond. She, of all people, knows what it’s like to hurt so much and for so long. She’s had the same kind of wrist pain longer than I’ve been alive and has taught me every trick she’s ever learned, because in the two years since my last appointment, the pain has gotten worse and spread to both of my wrists. I see myself doing the same things she does to try and take care of her aching joints –icing where it hurts, always keeping Tylenol on me, rubbing my wrists and arms and hands when my muscles feel tense. She texts me every other day asking me how I’m doing with three question marks, eager to hear that maybe I’m feeling better, and I think I break her heart every time I tell her how much my wrists hurt, just like hers.

“I know,” I finally say, and then the line goes quiet for a few seconds. I stare at the brown-beige carpet of our living room and sniff back the rest of my tears. She lets me in a few seconds of silence.

“I wish I could be there with you,” she says.

“I know. But I’ll call you afterwards to tell you how it goes.”

“Okay,” she says, “let me know what they say. And if you need anything, I’ll be with my phone. I’ll answer.” It’s a promise.

“I will,” I say, “Love you.”

“I love you, too.”

I hang up. I leave.

I’m not the one who ends up calling – my mom calls again when I’m at the doctor. I’ve chosen an orthopedic this time with the hopes that specialized work will get me specialized answers. A nurse has just looked through my chart, at the answers I was last given, and the doctor will be coming soon. I scroll through Twitter in the meantime, and halfway through reading something or other, she calls. I answer on the second ring.

I update her on everything that’s happened – which mainly includes the suggestion of a cortisone shot – and she comforts me through it, until the doctor comes in. My mom stays on the line as she talks, half-focusing on work and me while I explain my situation through tears. The orthopedic does a couple of tests that mostly check for carpal tunnel, then looks at my chart again before turning in her chair, to me. I’m so excited over the possibility of any kind of answer I could cry.

“Here’s what I want you to do,” the orthopedic says.

I’m holding my mom in one hand, and my heart is in my throat. Whatever she says, I’ll do.

“I want you to take Tylenol, a thousand milligrams, three times a day. I want you to ice your wrist, to use Voltaren, and to see our hand therapist later today.” She lists out four different times, and I choose the second one. She asks if I can do these things, and I say yes. She leaves to go print out my papers, and it’s me and my mom again. My mom starts. “So.”

“Everything I’ve been doing already.” I’m dizzy with disappointment. Almost twenty years old and I’m still being told the same things I was when I was seventeen and sixteen and and fifteen. I’m being asked if I can do them when it’s what I’ve been doing all along. Before I know it, I’m crying again. I’m on the verge of sobbing all by myself, and my mom apologizes, saying again how much she wishes she could just take the pain away from me, how much she wishes she were there. Selfishly, in hindsight, I’m glad she wasn’t, because I was ashamed enough crying alone.

The hand therapist is older – maybe in her 60s or 70s – with short, gray-white hair, and she almost reminds me of one of my Greek professors with the way she carries herself. She’s efficient and confident, and does more tests on both of my wrists in fifteen minutes than any doctor has done i four years. I tell her so, and she tells me that it took her a long time to remember all of these little tests because they all check for issues in the carpals. “I still forget some sometimes,” she says as she presses into the middle of my wrists, somewhere close or in between my capitate and hamate. She determines that whatever I have is causing instability in my joints, and that’s what’s causing the pain. She puts a sheet of plastic in a hot-water bath, and when it’s softened, she molds it to the shape of my arm, saying to wear it 24/7. She says that the stabilization encouraged by the brace will help with the pain. She says to come see her in a few weeks. I want to trust her, because she’s been more extensive than anyone else, and try to push away my doubts.

But now, four weeks have passed and there’s been no difference, but I wear it anyway – I’m wearing it anyway – and I don’t know what’s supposed to come next.