PRIVATE PAIN AND PUBLIC DISPLAY: A SWISS ARMY OFFICER
A 43-year-old reserve major, described by his wife as tough and taciturn, was skiing with his squad in the Upper Engadine region of Switzerland when a snow bridge collapsed below him. He remembers free-falling into a crevasse with ice walls in front and behind, and scraping down one wall. With a tremendous crash and thump, he found himself wedged firmly in the ice crack. One arm was jammed above his head and he could not move his legs. He remembers hearing his gun and ski poles rattling down below, deeper into the crevasse. He was winded but was surprised to fee} no pain whatsoever. He looked up and saw his men peering over the brink, and called out that he was all right but could not move.
A man was lowered down to him on a line and put a sling around him. The men above hauled on the ropes, and he remembers his relief on feeling himself swaying free. They carried him down to an open area and radioed for a helicopter, which arrived after 25 minutes. His men were unusually quiet and subdued, in contrast to their normal boisterous behaviour. He recalls feeling ashamed as he had lectured on how to avoid such accidents. He wondered what this would do to his chances of promotion, and talked of this to the sergeant, who tried to cheer him up. During all this time, he recalls no trace of pain, either when he hit the ice slot or during his rescue.
He was strapped onto a stretcher and the helicopter took off. At just this time, some 45 minutes after his fall, a searing pain started in his left shoulder and spread to his neck and chest. He cried out. A crew member gave him a subcutaneous injection of 15 milligrams of the narcotic morphine from the standard equipment in the emergency kit. By the time they arrived in hospital, he was dozy and the pain had lessened.
In hospital, it was found that he had a dislocated left shoulder, a broken left collar bone, and serious bruises over his pelvis and upper legs. He was briefly anaesthetized and the shoulder bones were put in their proper place. He was put to bed and slept. Next morning, his shoulder ached all the time and he felt severe stabs of pain if he moved. He was sore all over, and was given painkillers. He felt exhausted and dozed for long periods. When the doctors came on their routine ward round, his pain escalated as they uncovered him and he cried out when they gently touched his shoulder. For the rest of the day, he curled up, moving as little as possible. He wanted no food. When visitors came, he put on his standard act: 'Nothing to it'; 'Just a bit of a fall'; and 'I'll be out of here in a day or two'. Within himself, he wished they would go away and leave him alone.
This history has two clear epochs. In the first emergency period of 45 minutes, where survival, escape and rescue had clear priority, there was injury but no pain. He was mentally clear and supervising his own rescue. Furthermore, he was assessing the situation clearly but blaming himself and fearing for the future. In the second period, when pain began, recovery from the injury had priority. Pain was present and increased with movement or touch. Beyond the presence of pain, his usual character had changed: normally a very active man, he was overwhelmed by lethargy and fatigue, usually a good eater, he had no appetite, habitually gregarious, he disliked company, although verbally he put on a very good act in imitating his old self. Within himself, he displayed the complete syndrome of the best tactics for recovery in people or animals: don't move, and don't let anyone else move you, just sleep. Outside himself, he displayed the opposite, for the benefit of other people and for his own image: 'I'm alright'; 'Soon be out'; 'Don't worry'; 'It only hurts when I laugh'.
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