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crazy kivin’s brush with death

Or: Pain is what tells us to protect our body.

One of the best ways to travel around Australia is to hitchhike. Granted, it is not for everyone, but it certainly was for me. A few mates and I set up an annual hitchhiking race, whereby we would all meet for breakfast and set up a staggered start.

The agreement was that when you reached the target town, you had to get your race card stamped by the barman at a pre-designated pub. It was, therefore, a time trial. Winner got all expenses reimbursed by the other racers and then gave half of it to a charity.

If the target town was far enough away, you would often run into each other along the way. Occasionally you would fly past another racer while they waited on the side of the road for a lift. We implemented a time-exchange program, whereby if you convinced your lift to stop for a competitor, the competitor was required to donate you 30 minutes in exchange for first dibs at the next point. Most trips were for a long weekend. The longest was from Sydney to a place called Kaniva, in country Victoria. 1165 km⁴. This was my best performance, and possibly the best performance by anyone hitchhiking, anywhere. Ever. It was certainly the best in the 6 year history of the Annual Hitchhiking Race for Charity⁵.

As usual, we met for breakfast at Badde Manors, a reasonably grungy café on St John’s Road in Glebe, inner western suburbs of Sydney. Later we shifted to Digi.Kaf, the first cyber café in town, which would end up hosting me while I wrote up my doctoral thesis. They (well, Susie really – I am not sure if Paul, the owner, ever knew about it) kept me well stocked with very good coffee and panini and soups and little treats. “All for the progress of science” Susie would say. Anyway, on the Kaniva trip, we left Badde Manors in staggered fashion between 9.40 and 11.20. There were six of us. I was last.

It was tricky, as always, to get out of Sydney. Technically, we were permitted to take a bus, but it cost 30 minutes per dollar, which is pretty expensive, so no-one really did.

Trains and taxis were banned. Usually, the best plan was to head down to one of the main distributors that headed out of town and to stick a sign up. A few of the boys made their first sign over breakfast and our endeavours became the talk of the café. My signs were always a bit more melodramatic than the others. For example, Dicko might write a sign like this:

Whereas I would write a sign like this:

On the back of the signs, I always wrote a pleasant farewell, because I think everyone who considers stopping for a hitchhiker but doesn’t stop for them – you know - takes their foot off the throttle a bit but goes on anyway – has a look in the rear-view mirror to confirm the wisdom of their choice. So, I wrote this on the back:

The flipside message got me at least one lift. That was in wheat country in western NSW. A farmer reversed about 400 metres to pick me up after reading:

As it turned out, the Kaniva trip didn’t need a sign. I packed up our plates and took them into the kitchen, had a final chat to the cook, whose kiddies I was babysitting the following Friday, and picked up my bag. I was just about to step out and stroll down to the eastern distributor when a fellow on the opposite side of the café remarked:

“Did I hear thet you are going to Kaniva?”

I responded in the affirmative and then got a barrage of questions:

“Why?”

LM: Hitchhiking race

Why?

LM: Fun, primarily, and we raise money for MissionBeat or Salvo’s or someone like that

Kun yer talk?

LM: Yes

Are yer posh?

LM: I don’t reckon. What do you reckon Cook? Am I posh?

Cook: About as posh as my Rottweiler

Kun yer drive?

LM: Yes

I’ll take yer thun

LM (a little Uncomfortable): Sorry?

I’ll take yer thun. Kaniva. I’m huddin to Lullumur. Nuxt town along. Be good to huv company. Uvin uf you are un Aussie.

So there it was. A lift. From start to finish. And that is how I met Crazy Kivin. Kevin was his real name but he was a Kiwi and I can’t help talking like a Kiwi whenever I spend time with Kiwi’s (you may have picked this up already). Crazy Kiv drove a reasonably old Mazda ute⁶. Two seats, flat tray. He was parked (illegally) right at the front door of Badde Manors. We got in and started chatting. He was a most intriguing fellow. He was heading to Lillimur to meet a Bull Mastif that he was thinking about buying. His ute was small and the engine worked hard, especially when we got out of Sydney into the glorious southern tablelands.

Crazy and I rattled past the Dog on the Tuckerbox just outside of Gundagai, and turned off the main drag, onto the Sturt Highway and towards Wagga Wagga. That was about 5 hours in. The ute was low on fuel so we stopped in at Wagga⁷, which is when Crazy asked me to drive.

We were not back on the highway for more than a few minutes when the exclamation mark light came on. I have always loved the exclamation mark light. It is completely uninformative except to say “something is wrong somewhere, but I’m not going to tell you exactly where”. Crazy’s ute was manufactured when cars were just getting fitted with little computers that would tell you stuff about the car. More information than the usual temperature, oil and brake lights on the dash. The computers were sophisticated enough to tell you something was wrong, but you had to find out yourself what exactly it was (bit like psychotherapy I guess). I mentioned the recently illuminated light to Crazy –

LM: Hey Kiv – we better check thus out – your warning light is on

Crazy Kevin: Yeah I know hey bro’. It comes on a but – bin on sunce before Gundagai. Doesn’t seem to be a problem though ey?

LM: It might be Kiv. Why don’t you take a look in the manual, see what utt says?

CK: Naah. It’ll be alright bro

He seemed to not worry at all about it, but it did concern me. I had driven my girlfriend’s dad’s car for a few minutes after the exclamation mark light came on and ended up with a cracked head gasket (on the car, not on me). So, I was pretty insistent with Kiv. He cracked.

CK: Alright yer bug worry wart. You keep drivung and I wull fux utt up.

With that, Crazy got something from under his seat and then leaned over towards me. He stuck his head up under the dash. He was fiddling around there for a while (this made me a little Uncomfortable), and then with a final click, something happened and the light went off. He came out with a little globe in his hand.

CK: There utt is. No worries now. Won’t bother you a but.

This was indeed a novel strategy and one that didn’t sit too comfortably with me. I drove on and, funnily enough, forgot about it. That is until we passed the turn off into Narrandera, at which point we headed south toward Deniliquin and the Mallee country. This time a big P illuminated on the left of the dash, just above where the exclamation mark had been.

LM: Hey Kiv, what does P mean, on the dash?

CK: Stuffed uf I know bro’. Panic? Ho ho fruggin ho?

LM: Thunk we should stop Kiv? Take a look under the bonnet perhaps?

CK: Naah – I’ll fux utt up – I know cars

Again he leaned over and fiddled behind the dash, emerging with another little globe and a look of satisfaction. The most amazing thing was how easily I tended to forget about the two little lights. We went another hundred miles or so when a third light came on. This one looked like a water jug.

Again, Crazy just leaned over and emerged a few minutes later with the globe. He was positively chuffed with his little haul of globes and began tossing them back and forth in his hands. The thing was, I began to think that this was truly avoiding the problem – the ute was running well, it didn’t seem sick in any way, and Kiv seemed to know exactly what he was doing. The last light to come on had a picture of what looked vaguely like a foot on a brake pedal. I told Kiv and this time he lent right across me and pulled a fuse out of the little black box near my knee. All the dash lights went out.

CK: “Sorted hey Bro’. Now you won’t get any lights tellung you anything now.”

Sure enough, we rolled into the Commercial Hotel in Kaniva at 11.46. We were just in time for last drinks and the barman signed my card: “23:52 Friday.” It had taken me 12 hours and 52 minutes to travel 1165 kilometres. That is unbelievable hitchhiking time.

After closing, Crazy set up the swag⁸ on the back of the ute and I slept under the tray. The sun came up about a millisecond before the council street cleaner sprayed me with water. We were both up and Crazy got in the ute so he could see this Bull Mastiff first thing – his theory was that dogs are always grumpy before breakfast, so before breakfast was the only time to tell for sure if it was a “Heckyl or a Jive⁹ – makes all the difference”. I bid him farewell and he took off up the main street.

I have this thing about watching people as they drive off. I have to watch them until they are out of sight. I think it is a legacy of standing on the street as a kid waving my grandparents off as they headed back home after a couple of weeks with our family. Nanna would have her arm out waving the whole time and we would all wave as long as we could see them and then turn around and notice Mum’s tears, not really knowing what to do about them. Crazy was no more than a couple of hundred yards away when his left indicator came on but I could hear the ute accelerating into the corner. In fact, it didn’t turn the corner at all. Instead it just accelerated straight across the road, jumped the kerb and blew up. It turned into a speeding fire ball, still accelerating, careering across a big carpark until it met with a brick fence at which time it stopped dead still, on fire, back wheels spinning madly in thin air.

Crazy Kivin dropped out onto the ground and crawled away. By the time I got to him he looked bad. There was a whole lot of blood. He already had a lump the size of a golf ball on the left side of his forehead and a gash across his cheek. He explained that the steering and brakes went and the car just started accelerating. Nothing he could do.

CK: I hope that guy from the Kaniva Times got a shot of the old girl blowing up. That’d be my 12 minutes. But you know the worst thing?

LM: What Kiv? What’s the worst thing?

CK: I’ll not know if that Bull Mastif is a Heckyl or a bloody Jive.

so, what does Crazy Kivin’s brush with death have to do with pain?

The one sentence take home message: Pain is a critical protective device – ignore it at your own peril.

If Nigel attempted to ‘anaesthetise’ the problem with his SuperSkoda, then Crazy Kivin might have been taking some more drastic measures. The whole point of warning lights on the dash of a car is to tell you, the driver, that something requires action. Sure, you can do things to turn the light off – to anaesthetise the dash perhaps. To surgically remove the apparent culprit, or end up doing neurolysis10 on the whole electric supply, but if your clinical reasoning is not sound, then there might be a major cost. The cost for Kevin was not simply that part of his ute that was in danger. Rather, the cost for Kevin was (almost) everything. Death. Kaput. All over. Both Crazy Kivin and Nigel were attempting to remove pain, rather than remove the cause(s) of pain. In Nigel’s case, it was a specific pathology (problem) with the engine’s attachment to the car. In Kivin’s case, there were many contributing factors and he just kept removing his ute’s ability to tell the driver about it.

It is clear that both Nigel and Kivin were spectacularly stupid people. If they ever read this I imagine they will think the whole thing is a tribute to their cleverness. That is another amazing thing - Kivin convinced me that what he was doing was not stupid. Simply by knowing a whole lot about cars, or at least seeming to, I figured there was no reason to doubt him.

I think there are plenty of things about these stories that make them useful metaphors for patients in pain. They remind us that pain is a warning system, which usually gives us early warning of something in the body going, or about to go, awry. To devise strategies that effectively remove that system is, ultimately, going to be problematic. In this sense, I have told this story to patients with the following types of issues:

1 Athletes who push their bodies so hard that the normal pain protective system doesn’t work very well. If patients don’t change their behaviour in response to pain, then pain hasn’t achieved its goal.

2 Patients who don’t care what is wrong with them as long as they can find someone to ‘block it again’, or a drug that will turn it off, so that they can go back to their full lifestyle straight away without having to actively do anything to help themselves (in a rehabilitation sense).

3 Patients who are keen to use TENS or drugs as their main pain management strategy. This scenario is similar to (2) but also slightly different. For the TENS thing, I find patients are really receptive to Nigel’s SuperSport 110 story because of the whole turn the radio up so that the fuzzy noise is louder than the noise coming from the problem – it is an obvious link to the proposed mechanisms of TENS – to use non- noxious11 input to inhibit the noxious input.

4 Those patients who tend to avoid things because they know that they will hurt. I use Crazy Kivin’s strategy of simply removing the light globes that lit up the various lights as a metaphor of the way some patients tend to avoid the pain, but don’t address the underlying problem.