Sideways: Observations on Pain and Privilege

No doubt you've seen a movie or TV show where a sudden cataclysmic t-bone car crash happens without warning. It's a really effective way to shock the audience, kind of a horror film technique applied to regular dramatic scripts, and it's become so common that it's now a trope. I think it's so effective because we've all experienced a situation where something hits us with a WHAM! ... totally out of the blue, physically or emotionally ... and our lives suddenly go sideways.

Sometimes that WHAM! hits us collectively. Covid-19 is just that sort of shock, a global car crash that has turned billions of lives sideways. Sometimes that WHAM! hits us individually.

A little more than two weeks ago I wrote this note about a personal healthcare issue I was having.

No Country For Old Men

My healthcare issue - varicose veins in my ass, commonly known as hemorrhoids - wasn't life-threatening. Neither was the complication I developed three weeks ago - an anal fissure. Now there are two words you never expected to read in an Epsilon Theory note! Certainly I never expected to write them. It's a brutal term, right? Sounds awful. I promise you, though, the reality is worse. The pain is ... otherworldly. The pain is ... transcendent. But again, not life-threatening. This isn't a sideways moment.

So Friday morning a week ago, I had a hemorrhoidectomy where the internal varicose veins were removed and the anal fissure was repaired. The surgery went well. I was sent home, prepared for the long (and painful) recovery ahead.

And then that evening my bladder stopped working.

And my life went sideways.

I have two observations from that sideways Friday night, one about pain and one about privilege. Pain first.

I thought I knew pain. I thought I knew the limits of pain. But in the ER that Friday night, in the course of several ... ummm ... poorly executed catheterizations, I discovered that I knew nothing about the limits of pain. I discovered *chef's kiss* pain that night, and I'll never be the same.

So obviously I'm better now, nine days later. I can pee and poop on my own, which unless you've ever had the experience of NOT being able to pee or poop on your own, I don't think you can fully appreciate. Certainly I couldn't have. Is there still pain? Of course, but it's an entirely different kind of pain, an understandable pain that has an established beginning, middle and end. What I experienced over the weeks before the surgery and especially in the ER visits was pain beyond understanding. And that's what left a scar.

They say that pain is a teacher. This is a lie, at least when it comes to pain beyond understanding. I suppose understandable pain could be used as a correction, as part of a causal learning process. Pain beyond understanding, though ... pain beyond understanding teaches you nothing.

They also say that pain and pleasure are opposites. This is also a lie, again when it comes to pain beyond understanding. Pain beyond understanding is its own thing, sui generis to use a ten-dollar phrase. It becomes your entire world when it hits. It is All. Pain beyond understanding is a jealous god. It is your jealous god, and you will give yourself over to It. I've heard people talk about religious conversions in this language, in the sense of being brought low and placing themselves in the hands of a higher power. For me it was a lower power. In the early morning hours that Saturday in the ER, I capitulated. I gave myself over to the jealous god of pain beyond understanding and whatever mercy the ER staff would bestow.

I am 56 years old. But I had never felt old. I had never thought of myself as old. I had never felt ... fragile ... until I experienced pain beyond understanding. And not just a physical fragility. No, the physical fragility is something that I can bring into understanding. It's something that I can work on; something that I know how to improve on. It's the emotional fragility that I feel far more keenly than the physical fragility, because even as the pain and the physical fragility subsides, the emotional fragility remains strong.

And I don't know how to fix it.

Experiencing pain beyond understanding has not inured me to pain, it has sensitized me to pain. I am constantly checking in with my body for any signs of pain. I am more aware of pain and reactive to pain - no matter how slight, no matter if it's physical or emotional - than I have ever been. I don't like this pain-sensitized person, this Neb Tnuh. Neb is self-absorbed. Neb still hears his jealous god whispering in his ear, tickling him with an ache here and a prick there. Neb is distracted, at a time in his life and his family's lives when concentration and focus have never been more important.

I think there are a lot of people in this world who, at one time or another, have experienced pain beyond understanding and so endure this emotional fragility that I'm describing. I think that on a collective level, we are ALL suffering from an emotional fragility brought on by the pain beyond understanding caused by Covid-19 and its physical and economic repercussions.

And we don't know how to fix it.

I'm equally stuck on a fix for my second observation from the night when my life went sideways. This observation isn't about pain. It's about privilege. I know that's a terribly overused word, and I tend to cringe whenever I hear it. But in this case it's exactly the right word. It's the only word.

I believe that if I were black or poor, much less black and poor, there was a non-trivial chance that I would have died last weekend. I know that sounds melodramatic. But it's really not.

The privilege of class that I'm talking about is not that I'm able to afford a decent health insurance plan, that I don't have to worry about whether or not I can go to the ER when my bladder stops working. That's a very real thing and a very real privilege, but it's not what I'm writing about here.

The privilege of race that I'm talking about is not that I got better facilities or more effective therapies from the nurses and the attending doc in the ER that night. Nope, they were entirely equal opportunity in their maddening mix of mostly nonchalance and occasional attention, in their absolute refusal to consider this a complication from that morning's surgery (which would have pushed all sorts of liability red buttons), and in their determination to get me out of the hospital as soon as humanly possible, even if that meant returning to the ER for a new admission every four to six hours until I could see a urologist. On Monday. I'm not making this up.

No, the privilege of being a well-to-do white guy in a Connecticut hospital ER at 1 AM on a Saturday morning is that I was able to advocate for my own survival to the (mostly) white nurses and the (exclusively) white doctors, and they would actually listen to me. I was able to speak with the attending docs as their peer (or as much of a peer as an ER doc sees anyone). I was able to speak with the nurses and all the clerical representatives of the insane bureaucracy that is a modern medical facility as a person of authority. I was able to advocate successfully for an additional three hours in the ER and another set of tests, which I know doesn't sound like much, but which I promise you was everything.

The privilege of being a well-to-do white guy in a Connecticut hospital ER at 1 AM on a Saturday morning is that everyone recognized that there would be consequences if my sideways moment got any worse. It would be annoying and possibly dangerous to their position if I had an "adverse outcome", plus I spoke in a language and from a position of authority that was comfortable to them, that everyone was accustomed to responding to. None of that would move mountains. None of that would get me admitted to the hospital. But it was sufficient on the margin for me to get the time and the additional tests that I advocated for. And that made ALL the difference.

One of the first lessons I learned as an investor is that markets happen on the margins.

So does life.

That's what a sideways moment IS ... a point in time where your very life becomes a probabilistic exercise, where you are well and truly at the mercy of one of two merciless social institutions: hospitals or the police. Each is an insane bureaucracy designed to deny exceptions to the rule, designed to grind everyone equally beneath its wheels, designed to eliminate marginal considerations.

One day, your life or the life of someone you love will go sideways, and the outcome of that sideways moment will depend on a stranger in one of these two massive institutions - healthcare or public safety - treating you differently on the margin. In my sideways moment last Friday night, I got that marginal difference in treatment, and you'll never convince me that my race and class weren't the edge in winning that marginal difference. That's privilege.

We should all have that privilege - the privilege of advocacy, the privilege of mercy, the privilege of empathy - and it's my life's work to see that we do.