Numb: A Dark Thriller (7 page)

22 YEARS AGO

The 7
th
World Congress On Pain, held in France and sponsored by the International Association for the Study of Pain, had brought together over four thousand clinicians, scientists and healthcare providers from all over the world to learn and exchange knowledge regarding the understanding, treatment and prevention of this traumatic condition through workshops and lectures over a five day period.

Now into its fourth day inside the luxurious conference room within the Paris Marriott Hotel, Dr Robert Carter stepped up to the podium and faced the five hundred strong audience, all of whom were eager to hear his speech, as six months earlier the relatively-unknown palliative care consultant had published an article in the IASP’s scientific journal
‘Pain’
, detailing a recent case of his that still continued to baffle the brightest minds within the medical community.

Dr Carter, his hair thinning and greying in equal measure as he approached his half century, shuffled his notes and cleared his throat before looking out at the seated men and women in the humid and dark auditorium. Quite a few were medical students eager to hear tales from seasoned professionals. Most, however, were respected doctors and professors. Some were world famous within the medical community for their skills and knowledge. And here he was, a humble consultant from the equally humble Thirnbridge University Hospital, asked to be one of the guest speakers at such a prestigious event.

“Hello, ladies and gentlemen,” he said into the small microphone fixed atop the stand. He almost jumped as his voice boomed back from the speakers in the four corners of the room. “It’s a lovely sunny day outside. I hope when I’ve finished you all don’t regret having been stuck indoors listening to me.”

That brought a few laughs and Carter relaxed a little. He hated presentations and avoided them as often as he could, but today he was honoured to have been given the opportunity to elaborate on the two thousand word article he’d written.

“So we have enough time for questions I’ll just re-cap the main points in my article.” He took a sip of water. His throat always dried up when giving presentations. His voice would probably start to go in the next few minutes. “The basis for
‘The Numb Mind’
occurred three years ago. On the fourteenth of March that year, a bright spring morning in England, a commuter train fell from a bridge just outside the city of Thirnbridge. There were over fifty fatalities and almost all of the survivors suffered some sort of injury. Of the survivors, one stood out. A young boy of ten, pulled from the wreckage of the first carriage – the most badly damaged – a full six hours after the incident. Amazingly he’d been saved from certain death due to some dislodged luggage that had cushioned his fall and also because of a small opening in the side of the crushed carriage in which he lay that allowed enough fresh air inside so that his lungs were not consumed by smoke. However, in those six hours between the accident and rescue, that poor boy was alone and awake, in a carriage filled with the dead and dying, which included his unfortunate mother and father.”

Carter took another sip of water and turned to the next page of notes.

“Now, as in my article, the child in question will be referred to as Boy D. Boy D is now in the care of his grandmother and only a handful of people and medical professionals are aware of his condition. For his own sake, we intend to keep it that way. After everything he’s been through, anonymity seems to be the easiest way towards a normal life for him. And what do I mean by a normal life? Well, I’ll explain...

“When Boy D was freed from the wreckage, the emergency services were horrified by the extent of his injuries, which included – amongst several broken bones and abrasions - a severe injury to his spine. The skin had been flayed from most of his back so that part of his spinal cord was actually visible through his shredded clothing. Throughout the rescue and subsequent admittance to hospital he remained conscious but in a state of complete shock, barely acknowledging anyone around him. He neither responded verbally or non-verbally as he was assessed and sedated before being rushed into theatre.

“During surgery it was discovered that his injuries were not as severe as were first suspected. His several fractured bones were clean breaks that could be fixed with simple casts and one or two pins. His many cuts were considered relatively minor with no damage to underlying muscle or tendons and were cleaned and stitched. Scans also showed no apparent head trauma; no bleeding on the brain and no embedded shrapnel. Despite the gruesome injury to his spine, there was found to be no nerve or disc damage and the spinal column itself hadn’t been severed. At worst the surgeons suspected spinal shock; where the nerves are compressed and movement below the trauma site is non-existent for a period of a few days before movement returns to normal. The boy was placed in an induced sleep for several days to save him from the pain of the major skin-grafting procedure he’d required to mend the trauma to his back but the surgeons were optimistic that he would make a full recovery.

“A week later the boy’s anaesthetics were gradually reduced until he finally regained consciousness. Once awake he did indeed regain movement of his legs and was recovering well physically, but mentally he remained... distant. He didn’t respond to anyone or anything. He just stared blankly at the walls, lost in a world of his own. The doctors and nursing staff suspected he was suffering from a form of post traumatic stress disorder and a child psychologist was brought in to help but couldn’t find a way to get through to him. He just wouldn’t respond to anyone. He wouldn’t even eat or drink.”

Carter turned to the next page of notes. He was halfway through his speech already. He hoped there would be a lot of questions afterwards otherwise he’d never fill the allotted hour.

“Boy D remained locked inside himself for over three months until eventually – and suddenly – he came back into the real world,” continued the doctor. “One of the nurses got the fright of her life during one late shift when she heard a series of heart-stopping screams coming from the boy’s room and hurried in to find the lad in hysterics, sitting up in bed, yelling and shouting for help. He cried almost constantly for the following three days and suffered terrible nightmares when asleep. After that, the shock now out of his system, he appeared to begin recovering both mentally and physically. And as his body continued to heal it seemed that so did his mind. He began to communicate with the doctors and nurses as well as the other children on his ward. He responded well to physiotherapy and was soon able to walk unaided. He was a very strong young boy who flew through his rehabilitation. His recovery was going better than anyone could have hoped for, apart from one thing. He revealed that he was in no pain at all; not even the slightest ache.”

That was the main point and Carter took a dramatic pause to let it linger.

The room remained silent, all eyes still fixed on him. Everyone seemed intrigued and Carter’s confidence in his presentation skills grew as he continued with his story.

“The doctors and surgeons assessed Boy D again, performed scans and x-rays and found that the nerve endings in his spine were all in tact and that the boy had not lost any movement or sensation from any part of his body. He could feel touch. He could feel the healing skin knitting together. He could feel the stiffness in his injured limbs. He could control his bowel and bladder. There was just no recovery pain.

“Because of my expertise regarding pain control, I was asked to look at him along with a neurosurgeon and several orthopaedic specialists. After putting the boy through various tests and eliminating the notion that he was feigning, we could find no medical reason for his lack of recovery pain – especially none involving spinal damage which seemed to be the obvious cause. One of my colleagues suspected Congenital Insensitivity to Pain disorder, but that was quickly ruled out as the boy’s grandmother informed us that he had been a normal healthy child up until the accident who had had his fare share of bumped heads and scraped knees and had cried thousands of tears in his young life. Plus he had none of the trademark signs for CIP; no loss of bladder or bowel control; no old and unknown fractures; no damage to his tongue or oral cavity; no eye damage. More importantly, he told us he could remember feeling pain before the accident but not since.”

Another pause to let his words sink in. Another sip of water to lubricate his throat.

“We assumed that the problem did not rise from his nociceptors. How would it be possible for every pain receptor throughout his body to cease functioning all at the same time? If the problem was in only one part of his body – below the waist, for example - then yes, it would be possible and a hidden spinal compression could be blamed. But, like I have already said, every test performed showed no damage to the central nervous system.

“So, in the end, all we could agree on was that his mind must be behind this most perplexing puzzle. Imagine if you will, someone placing their hand into a fire. The instance any damage occurs to the skin the nociceptors in the hand would pass a signal up through the spinal column to his brain. The thalamus would then assesses this pain and work out what action to take. Not only would a pain signal be sent, the person would automatically pull their hand away from the flames. In Boy D’s case, none of this happens. His hand would burn. His skin would bubble and melt and unless he was aware of what was happening the hand would remain in the fire. Signals would still be sent to the brain warning of the danger and the brain would prepare to start the healing process once the danger was over but a pain signal would not be relayed and neither would a reflex action. His mind simply refuses to acknowledge the feeling of pain yet at the same time it is still very aware of damage being caused to his body. If he is burned, his skin will blister. If he receives a cut, the blood will coagulate. Should he catch an infection, his immune system would try to fight it. If he is cold, he shivers. If hot, he sweats. Yet he feels none of these sensations.”

A few of the audience members began to mumble to one another at that point. Carter didn’t blame them. The story
did
seem unbelievable. No doubt many of the professionals in this room would be already convinced that Carter and his colleagues had
surely
missed something in their physical examination and rigorous tests.

“We all know that the body administers its own anaesthetics but none powerful enough to make severe pain tolerable,” Carter went on. “The mind also has powers to control pain, we all know that too. It can be controlled to believe what is not. In the nineteen-seventies Professor Ernest Hilgard used hypnosis in several experiments regarding pain control. In one such case, the subject under hypnosis was asked to place their hand in ice cold water under the allusion that it was room temperature and managed to keep it there comfortably for several minutes whilst those not hypnotised lasted only seconds, thus proving that the mind controls everything, even the sensation of pain. But in this case the mind is being controlled and forced to ignore pain. In Boy D’s case, this action seems to be involuntary.”

Carter turned to his final page of notes.

“Now, the million dollar question – why does Boy D not feel pain? Well, the simple, disappointing answer is that we really don’t know. My own personal opinion is that his condition is linked to posttraumatic stress disorder and not any physical injury. We all know that shock can affect people in very different ways. Sometimes it can kill. Other times it can save lives. Think of the many soldiers in the many wars who have lost limbs in the heat of a battle who later stated that they’d felt no pain until long afterwards. I think an even better comparison to Boy D’s case can been seen in early cases of shell-shocked soldiers in the trenches of the First World War. Their symptoms - back then sadly seen by the majority of officers and medical personal as acts of cowardice - included hysteria, paralysis, anxiety, muscle contractions, nightmares and depression. More interestingly, many cases of blindness and deafness with no physical cause were also reported. Yes, shock can actually render people blind. Shock can also make people deaf. There was no damage to these men’s eyes or ears but they really couldn’t see or hear. One poor chap was profoundly deaf. Couldn’t hear the loudest noise. Yet if you whispered the word ‘bomb’ in his ear he would panic and look for the nearest piece of furniture to hide under. He
could
hear, but only the one word his brain allowed him to.

“An army major, Arthur Hurst, was one of the first people to recognise the role shock could play on the human mind and the many problems it can cause. He successfully treated many World War One survivors and, in time, a lot of them fully recovered from their various disorders. And I think time is our best hope in Boy D’s case.”

Carter smiled at the audience. It was conclusion time. Well, his conclusion. The truth might never be known.

“I believe that when that poor boy lay alone and injured in that carriage, surrounded by the dead, he went into shock and once in shock his mind went into survival mode. I believe his brain refused to acknowledge pain for the boy’s survival and that condition has persisted for an unknown reason to this day and maybe will continue for the rest of his life. Pain is a sense – an extension of touch. If shock can lead to the loss of other senses such as sight and hearing, why not pain? I’ll finish by stating what I truly believe; that Boy D has been left numb, not by an injury to his body, but by a shock to his mind.”