Ann-Marie MacDonald - Adult Onset

No one knows, no one sees. But the body will tell. Act out in illness or in violence.

She brushes her teeth, this woman of forty-eight who has everything. Mary Rose MacKinnon puts on kissy boxer shorts and a tank top.

It is when she turns out the light that she becomes aware of the pain. Like the sound of a fridge humming, it isn’t until all else is still that she “hears” it. It is just present enough to disrupt sleep and she needs her sleep, tomorrow is another day; another day another pair of boots …

In the bathroom, she switches on the light, opens the mirror and reaches for the Advil. There is nothing wrong. It is merely memory lodged in her arm. That’s your badness coming out … She knows what “badness” means. She knew at age five. Badness was hot, as her arm so often was. Badness had to do with what were called “impure thoughts”: sins you committed with your mind whether you wanted to or not. Sins you committed with your hand by touching yourself “down there.” The constant pain in her arm was not only a punishment, it was a beacon of her badness. Throbbing red light of badness, its pulsations occupied the same frequency as sexual excitement. Best keep that sort of pain to oneself.

She closes the cabinet with a prickle of fear lest the devil appear behind her. She relaxes suddenly and looks directly into the mirror — if Satan is there, let him show his face. But there is only her own face, sheet-wrinkled and bloodshot. Hi there, and happy Friday . She swallows two pills.

Pain blooms in her arm like a time-lapse hothouse flower. What is happening? It’s okay, you know what this is. “Remembered pain.” Phantom pain. Back-from-the-grave pain—

“It hurts.”

She has said it aloud and scared herself — she sounds too young, as though a child has spoken through her mouth …

Get a grip .

Am I having a panic attack? No, because there is still an “I,” a rind of self around the pain. Cancer. I see no indication of that . But that was six months ago. Throbbing now. The cysts have come back. I know of no research to support that . Electrical pain signal, pinging from a transmission pole in her arm up to her back teeth, shorting-out her vision. She ought to have filled the prescription for Tylenol 4s when she had the chance. You want fives? We’re talking bone pain, right? She swallows another Advil and chases it with two regular Tylenols. She holds the mirror in a staring contest; pain is something she can do. You get an old pathway that kicks up … A pathway overgrown with vines. It has slumbered for decades, but someone is hacking open the entrance. Where does it lead? There is no glimpse of a castle, just a tangle of thorns … Mary Rose steps away from the mirror, and into the path of an oncoming narrative.

Downstairs, she opens the freezer and presses a bag of frozen organic peas to her arm. She retains sufficient self-possession not to start with “bone cancer.” Still, her hands are cold as she googles “pediatric bone cysts.”

BOSTON CHILDREN’S HOSPITAL

Smiling doctors in white coats, soulful children gazing into the camera. This is the real world, not just the world in her head.

What is a unicameral bone cyst?

A unicameral bone cyst is a fluid-filled cavity in the bone, lined by compressed fibrous tissue. It usually occurs in the long bones of a growing child, especially the upper part of the humerus.

Check

They affect children primarily between the ages of 5 and 15.

Check

They are considered benign. More invasive cysts can grow to fill most of the bone’s metaphysis and cause what is known as a pathological fracture.

See Jane fall .

What are the symptoms of a unicameral bone cyst?

“It hurts. That’s your first clue.”

Unless there has been a fracture, bone cysts are without symptoms.

“How many times did your mother make a sling for you out of an old scarf?”

THE NATIONAL HEALTH SERVICE DIRECT WALES

A bone cyst is a benign (non cancerous), fluid-filled cavity in the bone which weakens the bone and makes it more likely to fracture (break). It occurs mostly in children and young adults.

It is not known what causes bone cysts.

They are twice as likely to affect boys than girls.

“ As girls,” not “ than .”

If the cyst causes the bone to fracture, it is likely that your child will experience additional symptoms, such as: pain and swelling, inability to move or put weight on the injured limb or body part.

“How could we know? You never cried.”

You should always contact your GP if you or your child experiences persistent bone pain.

“If you’d had a broken leg, we’d have taken you to a doctor.”

Further testing is usually only required if:

“ Required onlyif,” otherwise only is modifying required .

The cyst has developed on the end of a long bone that is still growing (an area of the bone that is known as the growth plate).

The cyst is so large that the affected bone is at risk of fracturing (breaking).

See Jane fall the second time .

Curettage and bone grafting

During this procedure a surgeon cuts into the bone to gain access to the cyst.

While the pills have distanced the pain, they have not doused it. Of course not, it is phantom pain! “When I reach for this glass of Scotch, what stops my hand from passing right through it?”

The fluid inside the cyst is drained and the lining of the cyst scraped out using a tool called a curette. The resulting cavity inside the bone is filled with chips of bone, either from other parts of your child’s body or from donated bone tissue.

“A piece of someone’s kneecap.”

… carried out under general anaesthetic, which means that your child will be asleep during the surgery and will not feel any pain.

Thanks to the Tylenol, someone is feeling pain, but it is not me. Not-Me is feeling it. “Mary Rose, do you read me? Come in, Mary Rose, this is Armpain, I am being held prisoner on the Planet Zytox …”

MEDSCAPE REFERENCE

Reoperation — subsequent operation required due to recurrence.

A view of the hospital smokestack, as seen from Dr. Sorokin’s window, captured in a calendar of beautiful watercolours painted entirely with the artist’s foot.

Should pathologic fractures of the long bones be treated via immediate flexible intramedullary nailing?

Jane is crucified the first time .

TEXTBOOK OF PEDIATRIC EMERGENCY MEDICINE

page 357:

… injured when the arm is forcefully abducted, for example falling and grabbing a tree branch …

See Jane swing like an airplane .

If the pain is chronic …

Even Andy-Patrick respected her sore arm …

Pressure may produce exquisite tenderness in this area so palpation would be gentle.

“You can stop massaging it now, Dad. It feels better.”

What causes a unicameral bone cyst?

Nothing, you’re born with them. Her feet are freezing and sweating inside her slippers. The pain is gone. Cancer does not behave like that, is not vanquished by over-the-counter analgesics — she is either neurotic or among a minority of normal people who experience neurological pain feedback loops. If she met herself now, she would not want to be her friend. It is time to go to bed.

Theories have been proposed but none have been definitively proven.