When the One You Love Hurts

"Mrs. Bryant, I don't know why your 45-year-old husband has the body of a 70-year-old man, but he does."

Dr. Ross's words echoed in my head as we talked in the small post-op consultation room following my husband, Paul's, neurosurgery. This room was a familiar place. Just three years earlier I met with an orthopedic surgeon in this room to discuss the outcome of Paul's hip replacement surgery. Now we were talking about his spinal surgery.

My husband is one of 20 million Americans living with some degree of osteoarthritis—a disease that erodes the cartilage that cushions our joints, eventually resulting in bone-on-bone rubbing. It's the leading cause of hip and knee replacements.

For Paul, osteoarthritis first made its presence known in his left hip. After shoveling wet, heavy, Chicago snow in 1992, he noticed pain from what felt like a pulled groin muscle. But the pain persisted for months, and finally he went to see our physician. The diagnosis of osteoarthritis didn't alarm us. Many people we knew had some degree of arthritis pain. Take some acetaminophen, maybe some ibuprofen, and you're good to go!

But Paul went through bottles of acetaminophen, buckets of ibuprofen, and round after round of prescriptions to treat pain. He tried chiropractic therapy, exercise and rest, heating pads and cold packs … the pain became worse. Most days he came home from work irritable from the relentless aching in his hip.

"Hi, hon. How was your day?" I held my breath, wondering what kind of mood Paul would be in.

"Same as always! The contractors are jerks, my co-workers aren't carrying their load, and my boss isn't doing anything about it. Sometimes I think I'll just leave and not go back!"

With that, he'd stomp off to the bedroom until dinner. He was certainly angry, but the contractors, co-workers, and boss weren't the problem. He was angry at the pain.

Over time, Paul's retreats to the bedroom grew lengthier. He became withdrawn, and eventually depressed. We had two children under six years old at the time, and Paul was becoming less involved with our family. I felt I was carrying way more responsibility for rearing our kids than he was. I rehearsed bitter speeches in my head: I'm not the only parent here, you know. I could use your input and involvement. How come you get to lie on the bed and watch TV while I do the parenting and the housework? When does it get to be about me? When I have a headache or cramps, I just work through them—why can't you do the same? Why don't you just take charge and be a man?

But I never gave voice to those thoughts—I was afraid it would make him angrier. Cartilage wasn't the only thing breaking down in the Bryant household. Frankly, I didn't get it … until the day I saw it for myself.

Painful pictures

Paul tried to avoid hip replacement as long as possible, but in 1999, after talking to several other young men who'd had the surgery, he decided to pursue it. We went together to see an orthopedic specialist, who showed us a picture of a healthy hip—a comfy, cushioned ball-and-socket fit. And then he showed us Paul's x-ray. No cushion—just one bone rubbing against another.

I shivered when I saw it. And I repented.

Being a young and strong man, Paul recuperated quickly and smoothly with a brand new titanium hip. Our marriage was more pleasant, with a brand new man playing the role of husband. But one morning in December 2002, Paul woke with the worst neck and shoulder pain he'd ever experienced. He attributed it to "sleeping funny" and made an appointment with a chiropractor. One look at an x-ray, and the chiropractor refused to touch him. The osteoarthritis had eroded the cartilage between Paul's vertebrae, causing them to shift alignment and crimp his spinal cord.

And that's how I ended up in the post-op room with Dr. Ross following Paul's spinal surgery. The cervical laminectomy opened several of Paul's vertebrae and relieved some of the pressure on his spine, but he's never fully been free from neck and shoulder pain since that day late in 2002.

Two years and a second hip replacement—on the other hip— later we joke about Paul being the Bionic Man. But chronic pain is no laughing matter for the sufferer or the family he or she lives with. In some ways, it's brought out the worst in Paul, me, and our marriage—Paul was one cranky man, I was one impatient woman, and neither of us talked about it. But it has also been the point from which we've had our greatest marital victories. It hasn't been easy for either of us; in fact, it's been downright, well—painful. But the marriage God has resurrected from the pain is evidence of his grace.

What makes this pain different?

Pain taps the human capacity for compassion. We hear the cry, see the bruise, witness the physical reactions of the one in pain, and we respond. But what about pain from a hidden cause? When there is no painful event, visible bruise, or sudden yell—just month after month of pain from a source that isn't externally visible? Doctors Paul J. Donoghue and Mary E. Siegel call the source of this kind of pain Invisible Chronic Illness (ICI). In their book, Sick and Tired of Feeling Sick and Tired, they describe a much different human reaction to this kind of pain:

The symptoms of invisible illnesses have no external evidence of suffering that elicit compassion. Instead, the patient often endures suspicion and withdrawal from others. And so, in addition to disturbing, even agonizing and disabling symptoms, the patient of invisible illness suffers, often deeply, from the negative reactions of others. Such reactions frequently lead the patient to confusion, loneliness, self-pity, and self-doubt.

It was the hidden and long-term nature of Paul's pain that made it so difficult for me to be compassionate. He looked okay to me—no bruises, no bumps, no visible evidence of calamity. Get over it already! I would think. How long is this going to go on?

So as I grew impatient, Paul sank deeper into the loneliness and self-pity described by Donoghue and Siegel. Loneliness and self-pity are difficult to live with, and I grew more resentful and critical. It becomes a cycle.

Paul and I both needed to learn new ways of thinking about his pain.

No one wants pain. I know that seems obvious, but I'd actually taken the attitude that Paul was enjoying being in pain. When friends would call and ask us to go out with them, Paul would often say he didn't want to commit because he didn't know what the pain would be like that day. I thought, You like being the center of attention, don't you? You like having everything be all about you. In all reality, he hated the pain and the ways it limited him. He hated our plans revolving around his pain. He hated that his pain made us cancel our plans and disappointed me. He hated his pain far more than I did.

Being in pain is not a license to be a pain. When I have a head-ache, I have to guard against irritability. How much more when pain is chronic—when it goes on day after day, month after month, year after year? Paul and I are learning that chronic pain is a reason—but not an excuse—for irritability. It is never okay for the one in pain to take it out on the people around him or her. Now that we both understand this, I'm more willing to hold Paul accountable without dismissing the reality of his pain, and Paul is more receptive. I ask, "Paul, you seem really short-tempered—are you okay? Are you in pain today?" That's his cue to step back and examine his behavior.

There are other ways to be involved. One of the things that's saddened Paul most about his pain is how it's affected his ability to be involved with our children. Paul and our son share a love for sports. But his pain prevents him from playing sports with Michael. The all-American images of a father teaching his son to play catch, scoop up grounders, or tackle a running back are beyond Paul's grasp. But he's learned that pain doesn't necessarily limit him, it just forces him to be more creative. So Paul reads up on which rookie is tearing up the National League this year, which defensive end the Steelers are considering in the draft, and who's leading the NBA in three-point shots so he and Michael can still connect on that level.

Sitting on the bleachers to watch our daughter, Valerie, in her band and chorus concerts causes him terrible neck pain. So he brings a lawn chair and sets it up so he can be more comfortable and not miss his daughter's events.

If we thought communication was important before … In our pre-marital counseling, we discussed the importance of communication. Seemed like a no-brainer, and we assumed we were pretty good at it. But we discovered that communication in a marriage is difficult enough without the added stress of chronic pain. I never wanted to confront Paul about his behavior because he responded with anger and defensiveness. When I did try to confront him, my words were more accusatory and resentful than productive. One night a minor incident turned into the most heated argument we've ever had. We both exploded at each other. That's the problem with pent-up resentment—when it blows, it's volcanic.

The next day we agreed we needed help. We decided to set aside 90 minutes one night a week as our own "marriage counseling." Together we worked through The Christ-centered Marriage by Neil T. Anderson and Charles Mylander and discussed our relationship. Thankfully, it turned our marriage around.

We contracted with each other that I wouldn't let frustrations build. Instead I'd let Paul know how his moods affected me, focusing on his behavior and my feelings. I'd say, "Paul, when you talk to me like you just did, I feel disrespected and hurt. What's going on?" In return, he agreed to listen, discuss, perhaps even disagree—but not to respond with anger. We're not perfect at it, and it's still difficult, but it's much better than it was.

Taking on each other's burdens

I've learned to pray for Paul with more compassion and with understanding that "our struggle is not against flesh and blood … " (Ephesians 6:12). Paul is not the enemy. We've also learned to serve others and remove the focus from ourselves. We lead a Bible study together and make a point of connecting with people as a couple. It amazed us that our pastor asked us to teach the pre-marriage class at our church, after all we've been through. Perhaps that's why.

I had one of those aha! moments in church when our pastor said, "We quote Scripture and pray, 'Lord, make me an overcomer. Make me more than a conqueror!' But then we're shocked when the Lord allows something to be in our lives that we need to overcome and conquer! How can we be overcomers and conquerors when there's nothing to overcome and conquer?" Good question. Perhaps it's a good answer to Dr. Ross's long-ago musings in the post-op room, as well.

Kate V. Bryant, a freelance author, and her husband, Paul, have been married 20 years and live near Chicago.

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