Pain is a constant part of Terrell's life, and sometimes that pain can be excruciating.
During a recent visit to his home, Terrell told me that on the previous day, his pain was a "10" on a scale of 0-10. On such days, he said, "I try to distract myself from it." If he can't, he curls into a fetal position, which seems to help and lets him drift off to sleep.
Doctors and nurses have told me that people generally underestimate the pain associated with sickle cell disease. One nurse said that some sickle cell patients manage to hold down jobs and raise families while suffering from pain that would send healthy people to bed.
But no one can function normally with level 10 pain. Patient education literature from the Mayo Clinic describes "0" as "no pain," "5" as "moderate pain" and "10" as "worst possible pain" on an intensity scale. Mayo experts suggest that patients describe their pain to health care providers. Is it stinging, penetrating, dull, throbbing or achy? Such descriptions can help doctors prescribe medications or suggest other pain management techniques such as deep breathing, visualization or prayer.
Terrell, who has suffered the pain of sickle cell disease for most of his life, has gotten help from doctors and nurses in dealing with it. But he's also learned to push through it much of the time and just keep living.
Laura Ungar has been the Courier-Journal's medical writer since 2004. Major projects have examined Kentucky's poor health, black lung disease, cervical cancer in India and the health insurance crisis among America's middle class. You can follow her series on 
Sam Upshaw, 46, of Louisville, has been a photographer with The Courier-Journal for 22 years. In addition to covering the community on a daily basis, he has visually documented Muhammad Ali, Kentucky's poor health, the University of Louisville's win at the Orange Bowl in Miami and Hurricane Ivan in Florida. Spending time with Terrell, he is inspired by the young man's strength and wisdom, which helps put life's little inconveniences in perspective.
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